Background: Wave reflection is enhanced in patients with pulmonary arterial hypertension (PAH), which may be derived from a mismatch of pulmonary artery (PA) impedance between proximal and distal sites of arteries. Whether enhanced wave reflection correlates with histological remodeling remains unknown, partly because lung biopsy is not clinically recommended for PAH patients due to substantial risks of mortality and morbidity.
Methods: Pulmonary hypertension was induced by SU5416 injection and 3-week hypoxic exposure (SuHx-PH) in rats, and hemodynamic and histological examinations were performed at 4weeks (SuHx-PH) and 8weeks (SuHx-PH) after SU5416 injection (n=7 each). Two groups of age-matched normal rats were also analyzed (n=7 each). Using an elastic tube with a 3-element Windkessel model, PA impedance was parameterized as pulmonary artery compliance (C), peripheral resistance (R), characteristic impedance (Z), and transmission time (T) in conducting arteries. Wave reflection was quantified as reflection gain at 0 Hz (Γ) in the frequency domain, and as the ratio of peak backward pressure to peak forward pressure (K) in the time domain.
Results: The SuHx-PH groups demonstrated increased R and Z, and decreased C and T compared with normal groups. Γ and K were significantly higher in the SuHx-PH group than in the SuHx-PH group, and correlated strongly with a histological index of vascular wall thickening (R=0.839, P<0.001 for Γ and R=0.775, P<0.001 for K).
Conclusions: Enhanced wave reflection caused by abnormal PA impedance correlates with histological remodeling, and may have a diagnostic value in clinical staging of PAH.
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