Optical coherence tomography assessment of pulmonary vascular remodeling in advanced heart failure. The OCTOPUS-CHF study

• Published in: Revista española de cardiología (English ed.) 2023-05, Vol.76 (5), p.312-321
• Main Authors: Martínez-Solano, Jorge, Ortiz-Bautista, Carlos, Gutiérrez-Ibañes, Enrique, García-Cosío, María Dolores, Sarnago-Cebada, Fernando, Díaz-Molina, Beatriz, Pascual, Isaac, Gómez-Bueno, Manuel, Calviño-Santos, Ramón, Gómez-Hospital, Joan Antoni, García-Lara, Juan, de la Fuente-Galán, Luis, Mirabet-Pérez, Sonia, Martínez-Sellés, Manuel
• Format: Article
• Language: English
• Subjects: Advanced heart failure; Cardiac Catheterization - methods; Cateterismo cardiaco derecho; Female; Heart Failure - complications; Heart Failure - diagnostic imaging; Hipertensión pulmonar; Humans; Hypertension, Pulmonary - diagnostic imaging; Imagen intravascular; Insuficiencia cardiaca avanzada; Intravascular imaging; Male; Middle Aged; Optical coherence tomography; Prospective Studies; Pulmonary Artery - diagnostic imaging; Pulmonary hypertension; Pulmonary vascular remodeling; Remodelado vascular pulmonar; Right heart catheterization; Tomografía de coherencia óptica; Tomography, Optical Coherence - methods; Vascular Remodeling; Vascular Resistance
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2022.09.005

Pulmonary vascular remodeling is common among patients with advanced heart failure. Right heart catheterization is the gold standard to assess pulmonary hypertension, but is limited by indirect measurement assumptions, a steady-flow view, load-dependency, and interpretation variability. We aimed to assess pulmonary vascular remodeling with intravascular optical coherence tomography (OCT) and to study its correlation with hemodynamic data. This observational, prospective, multicenter study recruited 100 patients with advanced heart failure referred for heart transplant evaluation. All patients underwent right heart catheterization together with OCT evaluation of a subsegmentary pulmonary artery. OCT could be performed and properly analyzed in 90 patients. Median age was 57.50 [interquartile range, 48.75-63.25] years and 71 (78.88%) were men. The most frequent underlying heart condition was nonischemic dilated cardiomyopathy (33 patients [36.66%]). Vascular wall thickness significantly correlated with mean pulmonary artery pressure, pulmonary vascular resistance, and transpulmonary gradient (R coefficient=0.42, 0.27 and 0.32 respectively). Noninvasive estimation of pulmonary artery systolic pressure, acceleration time, and right ventricle-pulmonary artery coupling also correlated with wall thickness (R coefficient of 0.42, 0.27 and 0.49, respectively). Patients with a wall thickness over 0.25mm had significantly higher mean pulmonary pressures (37.00 vs 25.00mmHg; P=.004) and pulmonary vascular resistance (3.44 vs 2.08 WU; P=.017). Direct morphological assessment of pulmonary vascular remodeling with OCT is feasible and is significantly associated with classic hemodynamic parameters. This weak association suggests that structural remodeling does not fully explain pulmonary hypertension. El remodelado vascular pulmonar es prevalente en la insuficiencia cardiaca avanzada. El cateterismo derecho es la prueba de elección, pero está limitado por la asunción de medidas indirectas, un enfoque de flujo no pulsátil, su dependencia de la carga o la variabilidad en la interpretación. Nuestro objetivo es evaluar la vasculopatía pulmonar mediante tomografía de coherencia óptica (OCT) intravascular y correlacionarla con los parámetros hemodinámicos. Estudio observacional, prospectivo y multicéntrico que incluyó a 100 pacientes en estudio previo al trasplante cardiaco. Todos se sometieron a un cateterismo derecho con OCT de la arteria pulmonar. La OCT se pudo analizar en 9