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Andersen KH, Andersen CB, Gustafsson F, et al. Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension. Pulm Circ. 2017;7(2):514-521doi: 10.1177/2045893217709762.
Andersen, K. H., Andersen, C. B., Gustafsson, F., & Carlsen, J. (2017). Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension. Pulmonary circulation, 7(2), 514-521. https://doi.org/10.1177/2045893217709762
Andersen, Kasper Hasseriis, et al. "Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension." Pulmonary circulation vol. 7,2 (2017): 514-521. doi: https://doi.org/10.1177/2045893217709762
Andersen KH, Andersen CB, Gustafsson F, Carlsen J. Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension. Pulm Circ. 2017 Apr-Jun;7(2):514-521. doi: 10.1177/2045893217709762. Epub 2017 May 24. PMID: 28440731; PMCID: PMC5467948.
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Pulm Circ. 2017 Apr-Jun;7(2):514-521. doi: 10.1177/2045893217709762. Epub 2017 May 24.

Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension.

Pulmonary circulation

Kasper Hasseriis Andersen, Claus Bøgelund Andersen, Finn Gustafsson, Jørn Carlsen

Affiliations

  1. 1 Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  2. 2 Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

PMID: 28440731 PMCID: PMC5467948 DOI: 10.1177/2045893217709762

Abstract

Pulmonary vascular arterial remodeling is an integral and well-understood component of pulmonary hypertension (PH). In contrast, morphological alterations of pulmonary veins in PH are scarcely described. Explanted lungs (n = 101) from transplant recipients with advanced chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary arterial hypertension (IPAH) were analyzed for venous vascular involvement according to a pre-specified, semi-quantitative grading scheme, which categorizes the intensity of venous remodeling in three groups of incremental severity: venous hypertensive (VH) grade 0 = characterized by an absence of venous vascular remodeling; VH grade 1 = defined by a dominance of either arterialization or intimal fibrosis; and VH grade 2 = a substantial composite of arterialization and intimal fibrosis. Patients were grouped according to clinical and hemodynamic characteristics in three groups: COPD non-PH, COPD-PH, and IPAH, respectively. Histological specimens were examined by a cardiovascular pathologist blinded to clinical and hemodynamic data. Pathological alterations of pulmonary veins were present in all hemodynamic groups, with the following incidences of VH grade 0/1/2: 34/66/0% in COPD non-PH; 19/71/10% in COPD-PH; and 11/61/28% in IPAH. In COPD, explorative correlation analysis of venous remodeling suggested a modest positive correlation with systolic and mean pulmonary artery pressure ( P = 0.032, respectively) and an inverse modest correlation with diffusion capacity for carbon monoxide ( P = 0.027). In addition, venous remodeling correlated positively with the degree of arterial remodeling ( P = 0.014). In COPD-PH and IPAH, advanced forms of pulmonary venous remodeling are present, emphasizing that the disease is not exclusively restricted to arterial lesions. In addition, venous remodeling may be related to the hemodynamic severity, but more rigorous analysis is required to clearly define potential relationships.

Keywords: chronic obstructive pulmonary disease; idiopathic pulmonary arterial hypertension; pulmonary hypertension; pulmonary vasculature; vascular changes

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