RPS 1115 - Pulmonary arteries, veins, aorta, carotid and lymphatics

Purpose:

Balloon pulmonary angioplasty (BPA) is a treatment of obstructed pulmonary arteries (PAs) for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Since the effect of BPA in untreated (unobstructed) PAs is unknown, we investigated the treatment response in treated and untreated PAs by analysing CT pulmonary angiography (CTPA).

Methods and materials:

We studied 22 consecutive CTEPH patients (20 female; age 67±14) who underwent CTPA and right-heart catheterisation (RHC) pre- and post-BPA. In consensus, 3 experts selected treated artery segments based on the BPA locations and approximately 5 untreated artery segments at a similar level. Post-BPA CTPA scans were registered to pre-BPA scans and local intravascular density changes were measured. The median density change in treated (MDC_T) and untreated segments (MDC_U) was calculated based on manual selections. The difference between MDC_U and MDC_T was tested by a paired t-test. The difference in density changes (ΔMDC) between treated and untreated PAs was calculated (MDC_T-MDC_U). Changes in RHC parameters included systolic, diastolic, and mean pulmonary artery pressure (ΔsPAP, ΔdPAP, and ΔmPAP) and in pulmonary vascular resistance (ΔPVR). The relation between haemodynamic changes and ΔMDC was studied with Spearman’s correlation.

Results:

MDC_T (51±85 HU) and MDC_U (-23±103 HU) were significantly different and in the opposite direction (p=0.001). ΔMDC was significantly correlated with ΔdPAP (R=-0.55, p=0.008) and ΔPVR (R=-0.47, p=0.026), and marginally correlated with ΔmPAP (R=-0.4, p=0.068).

Conclusion:

Perfusion in treated PAs increased, whereas perfusion in untreated PAs decreased. Not only improved perfusion in treated arteries but also the normalisation in untreated arteries may play a significant role in improving haemodynamics by BPA.

Limitations:

The normal vascular perfusion of healthy people is lacking.

Ethics committee approval

Approved by the local ethics committee and written informed consent from patients was obtained.

Funding:

No funding was received for this work.

Purpose:

To analyse the effect of different compression therapies on venous malformations (VM).

Methods and materials:

Patients with VM in the upper and lower extremities (N=20) were eligible for the study. Patients were treated with compression stockings class I and II for 4 weeks in a randomised order. Patients and physicians were blinded to the compression class. The absolute volume of the VM was measured by segmentation in MRI images. The volume of the extremity was obtained by perimetry measurements (PER). Quality of life was assessed by the SF-12 score. MRI and PER were performed at baseline and after the wearing period of 4 weeks of each compression class.

Results:

In comparison with baseline measurements, both compression classes showed a significant reduction of the volume of the VM in MRI scans (p<0.001), whereas the decrease of the lesions’ volume was inforced by compression class II (p=0.039). In contrast, PER did not reveal significant differences in comparison to the baseline for both compression classes (p=0.26, p=0.055). No subgroup in the quality of life assessment showed a significant difference between compression classes.

Conclusion:

MRI is an applicable tool for the systematic assessment of the total volume of VM. Both compression stockings class I and II reduce the total volume of VM, with superiority in class II. As there is no difference in the quality of life between both compression classes, class II compression stockings may be recommended for conservative treatment of patients with local swelling and pain caused by VM.

Limitations:

The limited number of patients with intraindividual comparison of different interventions.

Ethics committee approval

IRB (Institutional Review Board) approval was obtained from Friedrich-Alexander-University Erlangen-Nuremberg, Germany (124_17 B).

Funding:

Study was funded by medi GmbH & Co. KG, Bayreuth, Germany.

Purpose:

For not yet fully understood reasons, the stroke incidence rate is higher in men than in women. Carotid atherosclerosis is a major cause of ischaemic strokes. Several plaque components are important determinants for plaque progression and rupture. Sex differences in these so-called vulnerable plaque characteristics, including intraplaque haemorrhage (IPH), lipid-rich necrotic core (LRNC), thin or ruptured fibrous cap (TRFC), and ulcerations, may help further explain sex differences in strokes. This study aims to analyse sex differences in plaque composition and morphology in symptomatic patients.

Methods and materials:

We selected 238 patients from the Plaque At RISK-study (PARISK), which included patients with recent ischaemic symptoms and <70% ipsilateral carotid artery stenosis. Plaque characteristics were assessed with MRI (n=224) and MDCTA (n=188). We used multivariable logistic regression analyses to assess the effects of sex on the presence and volume of plaque characteristics. Differences in volumes were analysed using multivariable linear regression models in those patients in whom the plaque component of interest was present.

Results:

Men had significantly higher plaque burden (β=23.05, 95%CI:15.81-30.29). Men also had a higher prevalence of IPH (OR=3.29, 95%CI:1.54-7.50) and LRNC (OR=2.40, 95%CI:1.25-4.62) after an adjustment for age and plaque burden. These associations remained significant after additionally adjusting for cardiovascular risk factors and medication (OR=2.79, 95%CI:1.25-6.60; OR=2.48, 95%CI:1.23-5.07). In patients with IPH and/or LRNC in their symptomatic carotid plaque, the volume of IPH and LRNC was not significantly associated with sex after an adjustment for age and plaque burden. Sex was not associated with the presence of TRFC, ulcerations, and calcifications.

Conclusion:

Vulnerable plaque components like IPH and LRNC are more common in men than women in symptomatic patients with mild-to-moderate carotid stenosis.

Limitations:

n/a

Ethics committee approval

Institutional review board approval was obtained. All patients gave written informed consent.

Funding:

No funding was received for this work.

Purpose:

Pulmonary hypertension has been shown to be an independent predictor of poor outcome in patients undergoing transcatheter aortic valve replacement (TAVR). In this retrospective longitudinal study we sought to evaluate whether pulmonary artery enlargement measured on pre-procedural computed tomography angiography (CTA) is associated with 1-year mortality in patients after TAVR.

Methods and materials:

We retrospectively included 402 patients undergoing TAVR from July 2012-March 2016. Clinical parameters and pre-procedural CTA scans were retrospectively reviewed. Patients were followed for all-cause mortality. The main pulmonary artery (MPA) area and diameter were measured on pre-procedural CTAs near the bifurcation on double-oblique reformations. Kaplan-Meier and Cox proportional hazards regression analyses were performed.

Results:

The median follow-up time of 402 patients was 433 (interquartile 339-797) days. A total of 56/402 (14%) died within 1 year after TAVR. MPA area (p<0.001) and the Society of Thoracic Surgery risk scores (STS-score) (p=0.001) were significantly larger in 1-year non-survivors (N=56) versus survivors (N=346). Multivariate Cox analysis adjusted for age, gender, STS score, cardiac risk, frailty, and NYHA classification showed that both MPA area (HR1.30 [95%-CI 1.16–1.46] per cm², p<0.001) and STS-scores (HR1.10 [1.02–1.20] per STS point, p=0.0016) were independently associated with 1-year mortality. The area under the curve for 1-year mortality was similar for MPA area (AUC=0.67 [95%-CI 0.59–0.75]) compared to STS-score (AUC=0.64 [95%-CI 0.57–0.72]). Kaplan-Meier analysis showed that the mortality of patients with a pre-procedural MPA area of ≥7.4 cm² was significantly higher compared to patients with a smaller MPA area of <7.4c m² (mortality 23% vs 9%; log-rank p<0.001).

Conclusion:

The enlargement of MPA on pre-procedural CTAs is independently associated with post-procedural 1-year mortality in patients who undergo TAVR.

Limitations:

A retrospective single-centre design. Further studies are needed to demonstrate the reproducibility of our results in other CT scanners and cohorts.

Ethics committee approval

/a

Funding:

No funding was received for this work.