Abstract
We examined the cardiovascular function as well as the structure of the muscular pulmonary arteries in patients who had died while enrolled in the National Institutes of Health nocturnal oxygen therapy trial (NOTT). The cardiovascular function of the patients classified into groups based on the severity of the pulmonary hypertension was examined, and we compared the morphologic data in these groups to those obtained from age-matched controls who died with no evidence of cardiovascular disease. The groups with severe pulmonary hypertension had markedly increased pulmonary vascular resistance but similar cardiac index to the group with only mild hypertension. In the structural analyses, we found definite alterations in arterial structure from the control population: the patients who had pulmonary hypertension had markedly increased percentages of intima and media. These differences were most pronounced in the medium and larger muscular arteries. The degree of pulmonary hypertension did not appear to alter vascular structure consistently, although there was a trend towards an increase in muscle media in the smaller vessels. When the patients were classified into a group who responded to oxygen administration by a decrease in Ppa, and an age- and Ppa-matched group who did not respond, there were no differences in vascular structure between these groups, although both groups had greater percentages of intima and media compared to the control group. We conclude that, in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD), there are structural alterations of the muscular pulmonary arteries, but these do not correlate with either the severity of the pulmonary hypertension or the ability of the pulmonary vasculature to respond to oxygen administration.
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References
Agusti AGN, Barbera JA, Roca J, Wagner PD, Guitart R, Rodriguez-Roisin R (1990) Hypoxic pulmonary vasoconstriction and gas exchange during exercise in chronic obstructive pulmonary disease. Chest 97:268–275
Bove KE, Rowlands DT, Scott RC (1966) Observations on the assessment of cardiac hypertrophy utilizing a chamber partition technique. Circulation 33:558–568
Boysen PG, Block AJ, Wynne JW, Hunt LA, Flick MR (1976) Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chest 1:117–124
Burrows B, Kettel LJ, Niden AH, Rabinowitz M, Diener CF Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 286:912–918, 1972
Caslin AW, Heath D, Madden B, Yacoub M, Gosmey JR, Smith P (1990) The histopathology of 36 cases of plexogenic pulmonary arteriopathy. Histopathology 16:9–19
Cooper R, Ghali J, Simmons BF, Castaner A Elevated pulmonary artery pressure: an independent predictor of mortality. Chest 99:112–120, 1991
Crouch CE, Parks WC, Rosenbaum JL, Chang D, Whitehouse L, Wu L, Stenmark KR, Orton EC, Mecham RP (1989) Regulation of collagen production by medial smooth muscle cells in hypoxic pulmonary hypertension. Am Rev Respir Dis 140:1045–1051
Davies P, Maddalo F, Reid L (1985) Effects of chronic hypoxia on structure and reactivity of rat lung microvessels. J Appl Physiol 58:795–801
Fernie JM, Lamb D (1988) Assessment of the effects of age and smoking on the media of muscular pulmonary arteries. J Pathol 155:241–246
Fletcher EC, Levin DC (1984) Cardiopulmonary hemodynamics during sleep in subjects with chronic obstructive pulmonary disease. The effect of short and long-term oxygen. Chest 85:6–14
Fulton RM, Hutchinson EC, Jones AM (1952) Ventricular weight in cardiac hypetrophy. Br Heart J 14:413–420
Hale EA, Ewing SL, Gosnell BA, Niewoehner DE (1984) Lung disease in long-term cigarette smokers with and without chronic air-flow obstruction. Am Rev Respir Dis 130:716–721
Magee F, Wright JL, Wiggs BR, Pare PD, Hogg JC (1988) Pulmonary vascular structure and function in chronic obstructive pulmonary disease. Thorax 43:183–189
Mecham RP, Whitehouse LA, Wrenn DS, Parks WC, Griffin GL, Senior RM, Crouch EC, Stenmark KR, Voelkel NF (1987) Smooth muscle-mediated connective tissue remodeling in pulmonary hypertension. Science 237:423–426
Murray TR, Chen L, Marchall BE, Macarak EJ (1990) Hypoxic contraction of cultured pulmonary vascular smooth muscle cells. Am J Respir Mol Biol 3:457–465
Nocturnal Oxygen Therapy Trial Group (1980) Continuous or nocturnal oxygen therapy in hypoxemia chronic obstructive lung disease. Ann Intern Med 93:391–398
Ohar JA, Pyle JA, Waller KS, Hyers TM, Webster RO, Lagunoff D (1990) A rabbit model of pulmonary hypertension induced by the synthetic platelet-activating factor acetylglyceryl ether phosphorylcholine. Am Rev Respir Dis 141:104–110
Peacock AJ, Pickett C, Morris K, Reeves JT (1989) The relationship between rapid growth and pulmonary hemodynamics in the fast-growing broiler chicken. Am Rev Respir Dis 139:1524–1530
Riley DJ, Poiani GJ, Tozzi CA (1990) Mechanisms of increased vascular collagen content in hypoxic pulmonary hypertension Prog Respir Res 26:39–46
Selinger SR, Kennedy TP, Buescher P, Terry P, Parham W, Gofreed D, Medinger A, Spagnolo SV, Michael JR (1987) Effects of removing oxygen from patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 136:85–91
Stuart-Harris C, Bishop JM, Clark TJH, Dornhorst AC, Cotes JE, Flenley DC, Howard P, Oldham PD (1981) Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet March, Vol. I, 28:681–685
Thurlbeck WM, Dunnill MS, Hartund W (1972) A comparison of three methods of measuring emphysema. Hum Pathol 1:215–226
Timms RM, Khaja FU, Williams GW (1985) Hemodynamic response to oxygen therapy in chronic obstructive pulmonary disease. Ann Intern Med 102:29–36
Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Pelletier A (1985) Long-term oxygen therapy can reverse the progression of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 131:493–498
Wilkinson L (1988) SYSTAT: The System for Statistics. Evanston, IL: SYSTAT, Inc.
Wilkinson M, Langhorne CA, Heath D, Barer GR, Howard P (1988) A pathophysiological study of 10 cases of hypoxic cor pulmonale. Q J Med 249:65–85
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Wright, J.L., Petty, T. & Thurlbeck, W.M. Analysis of the structure of the muscular pulmonary arteries in patients with pulmonary hypertension and COPD: National Institutes of Health Nocturnal Oxygen Therapy Trial. Lung 170, 109–124 (1992). https://doi.org/10.1007/BF00175982
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DOI: https://doi.org/10.1007/BF00175982