Modern Age Pathology of Pulmonary Arterial Hypertension

Overview

Journal Am J Respir Crit Care Med

Specialty Critical Care

Date 2012 Jun 9

PMID 22679007

Citations 303

Authors

Elvira Stacher

Brian B Graham

James M Hunt

Aneta Gandjeva

Steve D Groshong

Vallerie V McLaughlin

Marsha Jessup

William E Grizzle

Michaela A Aldred

Carlyne D Cool

Rubin M Tuder

Affiliations

Soon will be listed here.

Abstract

Rationale: The impact of modern treatments of pulmonary arterial hypertension (PAH) on pulmonary vascular pathology remains unknown.

Objectives: To assess the spectrum of pulmonary vascular remodeling in the modern era of PAH medication.

Methods: Assessment of pulmonary vascular remodeling and inflammation in 62 PAH and 28 control explanted lungs systematically sampled.

Measurements And Main Results: Intima and intima plus media fractional thicknesses of pulmonary arteries were increased in the PAH group versus the control lungs and correlated with pulmonary hemodynamic measurements. Despite a high variability of morphological measurements within a given PAH lung and among all PAH lungs, distinct pathological subphenotypes were detected in cohorts of PAH lungs. These included a subset of lungs lacking intima or, most prominently, media remodeling, which had similar numbers of profiles of plexiform lesions as those in lungs with more pronounced remodeling. Marked perivascular inflammation was present in a high number of PAH lungs and correlated with intima plus media remodeling. The number of profiles of plexiform lesions was significantly lower in lungs of male patients and those never treated with prostacyclin or its analogs.

Conclusions: Our results indicate that multiple features of pulmonary vascular remodeling are present in patients treated with modern PAH therapies. Perivascular inflammation may have an important role in the processes of vascular remodeling, all of which may ultimately lead to increased pulmonary artery pressure. Moreover, our study provides a framework to interpret and design translational studies in PAH.

Citing Articles

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