Optimization of PH diagnostic process with IVUS during right heart catheterization

Abstract

Objective:To assess the vasodilator effect of inhaled NO during RHC and morphological changes of pulmonary arteries by IVUS in patients with PAH. Design and Method: We have prospectively enrolled 10 consecutive patients with PH (9 fem and 1 men), at the age of 49 +_13 years.

Our pts including IPAH (n=5), CTEPH (n=1), associated with CVD (n=1), FPAH (n=3), who underwent RHC including the IVUS. All pts underwent RHC including IVUS evaluation (Eagle Eye Gold ; Volcano Therapeutics,) and general characteristics of different tissues by IVUS. We used IVUS parameters such as: intima-media thickness and pulsatility index (PI). All patients were divided into respondents and non-respondents (after the acute probe).

Results: Pulmonary angiography showed dilatation of the main artery (3,2 cm). We attempted to use radiofrequent analysis (Virtual histology by IVUS). In one IPAH pt mean PA pressure (mPAP) from 53 mm Hg increased to 56 mm Hg after iNO; pulmonary vascular resistance (PVR) values were 1790 dyne ×c/cm⁵ and 1429 dyne ×c/cm⁵ respectively before and after NO. IVUS data: intima - media thickness before and after NO was 2,4 and 2,0 mm. PI increased from 14,3 % to 16.6% after NO IVUS with virtual histology (VH) demonstrates proximal right PA with irregular intimal surface and intimal disruption. The soft tissue echoes (arrow) are consistent with an atherosclerotic lesion.

Conclusions: IVUS gives unique data about PA morphology. At present the noninvasive identification of pulmonary atherosclerosis in vivo is an unrealizable task. From diagnostic point of view IVUS may be considered an important method to improve the visualization capability for the treatment optimization of patients with PAH.