1. Relationship between pulmonary vascular obstruction (PVO) and pulmonary vascular resistance in chronic thromboembolic pulmonary hypertension (CTEPH) and acute pulmonary embolism (PE). a) Patient AL: 24-year-old female with CTEPH. Percentage of PVO estimated...
Relationship between pulmonary vascular obstruction (PVO) and pulmonary vascular resistance in chronic thromboembolic pulmonary hypertension (CTEPH) and acute pulmonary embolism (PE). a) Patient AL: 24-year-old female with CTEPH. Percentage of PVO estimated on perfusion lung scan at 75%. Total occlusion of left lung and occlusion of right middle and lower lobes. Haemodynamics: mean pulmonary arterial pressure (PAP) 32 mmHg; cardiac index 1.7 L·min-1·m-2; total pulmonary vascular resistance (TPR) 18.8 mmHg·L-1·min·m2. Despite 75% PVO, the TPR was only b) Patient BJ: 54-year-old female with CTEPH. Percentage of PVO estimated on perfusion lung scan at 35%; multiple bilateral segmental and subsegmental perfusion defects. Haemodynamics: mean PAP 45 mmHg; cardiac index 1.4 L·min-1·m-2; TPR 32.1 mmHg·L-1·min·m2. c) Relationship between percentage of PVO assessed by perfusion lung scan and TPR in patients with acute PE (n=31). A strong hyperbolic correlation was found. d) For a given degree of PVO, most patients with CTEPH (n=45) have higher TPR values than patients with acute PE (n=31), suggesting that, in addition to mechanical obstruction by organised clots, they have small-vessel disease. Patient AL is located on the hyperbolic correlation (no microvasculopathy), whereas patient BJ has a disproportionate and very high level of TPR compared to mild PVO (severe microvasculopathy). Reproduced and modified from [86] with permission.
Gérald Simonneau et al. Eur Respir Rev 2017;26:160112
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