Skip to main content
SpringerLink
Log in

Pulmonary Vascular Capacitance is Associated with Vasoreactivity and Long-Term Response to Calcium Channel Blockers in Idiopathic Pulmonary Arterial Hypertension

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to identify the relationship between pulmonary vascular capacitance (PVC) and vasoreactivity in patients with idiopathic pulmonary arterial hypertension (IPAH), and the value of PVC in predicting long-term response to CCB treatment.

Methods

Pulmonary vasodilator testing with inhaling iloprost was performed in 308 newly diagnosed IPAH patients. Acute vasodilator-responsive patients accepted CCBs treatment. Patients who benefit from long-term CCB were defined as those being in World Health Organization (WHO) functional class II or I after at least 1 year on CCB monotherapy.

Results

PVC had significant correlations with WHO function class, 6-min walk distance, mean pulmonary arterial pressure, and pulmonary vascular resistance (r = −0.363, p < 0.001; r = 0.333, p < 0.001; r = −0.514, p < 0.001; r = −0.739, p < 0.001). Thirty-five acute vasodilator-responsive IPAH patients (11.4 %) displayed less severe disease and a higher baseline PVC (1.5 ± 0.6 vs. 1.1 ± 0.7 ml/mmHg, p = 0.003). During acute vasodilator testing, PVC increased significantly by mean of 79 ± 48 % and reached to a higher absolute value of 2.6 ± 1.5 ml/mmHg compared with non-responsive patients (1.4 ± 1.5 ml/mmHg, p < 0.001). Furthermore, PVC increased more during acute vasodilator testing in the 24 patients who benefit from long-term CCB treatment (1.4 ± 1.3 vs. 0.5 ± 0.4 ml/mmHg, p = 0.004). The OR of increased PVC during vasodilator testing for predicting patients with long-term response to CCB was 1.24 (95 % CI 1.02–1.50, p = 0.031) as assessed by multivariable logistic regression analysis.

Conclusions

PVC was higher in acute vasodilator-responsive IPAH patients and may be a predictor of long-term response to CCBs therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sitbon O, Humbert M, Jagot JL et al (1998) Inhaled nitric oxide as a screening agent for safely identifying responders to oral calcium-channel blockers in primary pulmonary hypertension. Eur Respir J 12(2):265–270

    Article  CAS  PubMed  Google Scholar 

  2. Rich S, Kaufmann E, Levy PS (1992) The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N Engl J Med 327(2):76–81

    Article  CAS  PubMed  Google Scholar 

  3. Sitbon O, Humbert M, Jaïs X et al (2005) Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension. Circulation 111(23):3105–3111

    Article  CAS  PubMed  Google Scholar 

  4. Jing ZC, Jiang X, Han ZY et al (2009) Iloprost for pulmonary vasodilator testing in idiopathic pulmonary arterial hypertension. Eur Respir J 33(6):1354–1360

    Article  CAS  PubMed  Google Scholar 

  5. Lankhaar JW, Westerhof N, Faes TJ et al (2006) Quantification of right ventricular afterload in patients with and without pulmonary hypertension. Am J Physiol Heart Circ Physiol 291(4):H1731–H1737

    Article  CAS  PubMed  Google Scholar 

  6. Lankhaar JW, Westerhof N, Faes TJ et al (2008) Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension. Eur Heart J 29(13):1688–1695

    Article  PubMed  Google Scholar 

  7. Galiè N, Hoeper MM, Humbert M et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 30(20):2493–2537

    Article  PubMed  Google Scholar 

  8. Tuder RM, Abman SH, Braun T et al (2009) Development and pathology of pulmonary hypertension. J Am Coll Cardiol 54(1 Suppl.):S3–S9

    Article  CAS  PubMed  Google Scholar 

  9. McLaughlin VV, Davis M, Cornwell W (2011) Pulmonary arterial hypertension. Curr Probl Cardiol 36(12):461–517

    Article  PubMed  Google Scholar 

  10. Chemla D, Castelain V, Hervé P et al (2002) Haemodynamic evaluation of pulmonary hypertension. Eur Respir J 20(5):1314–1331

    Article  CAS  PubMed  Google Scholar 

  11. Castelain V, Hervé P, Lecarpentier Y et al (2001) Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension. J Am Coll Cardiol 37(4):1085–1092

    Article  CAS  PubMed  Google Scholar 

  12. Lau EM, Iyer N, Ilsar R et al (2012) Abnormal pulmonary artery stiffness in pulmonary arterial hypertension: in vivo study with intravascular ultrasound. PLoS One 7(3):e33331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Tedford RJ, Hassoun PM, Mathai SC et al (2012) Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation 125(2):289–297

    Article  PubMed  Google Scholar 

  14. Hunter KS, Lee PF, Lanning CJ et al (2008) Pulmonary vascular input impedance is a combined measure of pulmonary vascular resistance and stiffness and predicts clinical outcomes better than pulmonary vascular resistance alone in pediatric patients with pulmonary hypertension. Am Heart J 155(1):166–174

    Article  PubMed  Google Scholar 

  15. Weir EK, Rubin LJ, Ayres SM et al (1989) The acute administration of vasodilators in primary pulmonary hypertension. Experience from the National Institutes of Health Registry on Primary Pulmonary Hypertension. Am Rev Respir Dis 140(6):1623–1630

    Article  CAS  PubMed  Google Scholar 

  16. Costa EL, Jardim C, Bogossian HB et al (2005) Acute vasodilator test in pulmonary arterial hypertension: evaluation of two response criteria. Vasc Pharmacol 43:143–147

    Article  CAS  Google Scholar 

  17. Newman JH, Brittain EL, Robbins IM et al (2015) Effect of acute arteriolar vasodilation on capacitance and resistance in pulmonary arterial hypertension. Chest 147(4):1080–1085

    Article  PubMed  Google Scholar 

  18. Tonelli AR, Alnuaimat H, Mubarak K (2010) Pulmonary vasodilator testing and use of calcium channel blockers in pulmonary arterial hypertension. Respir Med 104(4):481–496

    Article  PubMed  Google Scholar 

  19. Mahapatra S, Nishimura RA, Sorajja P et al (2006) Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension. J Am Coll Cardiol 47(4):799–803

    Article  PubMed  Google Scholar 

  20. Gan CT, Lankhaar JW, Westerhof N et al (2007) Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. Chest 132(4):1906–1912

    Article  PubMed  Google Scholar 

  21. Grignola JC, Domingo E, Aguilar R et al (2013) Acute absolute vasodilatation is associated with a lower vascular wall stiffness in pulmonary arterial hypertension. Int J Cardiol 164(2):227–231

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by National Key Technology R&D Program, China (Project No.: 2011BAI11B15).

Author information

Authors and Affiliations

  1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road, Xicheng District, Beijing, 100037, China

    Xiao-Ling Cheng, Jian-Guo He, Zhi-Hong Liu, Qing Gu, Xin-Hai Ni, Zhi-Hui Zhao, Qin Luo & Chang-Ming Xiong

Authors
  1. Xiao-Ling Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian-Guo He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi-Hong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qing Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xin-Hai Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhi-Hui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qin Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chang-Ming Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang-Ming Xiong.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, XL., He, JG., Liu, ZH. et al. Pulmonary Vascular Capacitance is Associated with Vasoreactivity and Long-Term Response to Calcium Channel Blockers in Idiopathic Pulmonary Arterial Hypertension. Lung 194, 613–618 (2016). https://doi.org/10.1007/s00408-016-9905-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9905-0

Keywords

Search

Navigation