Perhimpunan Dokter Paru Indonesia - Pulmonary vessels remodeling in COPD
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Pulmonary vessels remodeling in COPD

Giuseppe Valerio1, Pierluigi Bracciale2 and Donato Lacedonia3
1Pulmonary Disease, Clinica Salus, Brindisi, Ital,2Pulmonary Disease, Ospedale Civile, Fasano, BrinidisiItaly, 3Pulmonary Disease, University of Foggia, Foggia, Italy

Our aim was to measure pulmonary vessels loss and pulmonary artery pressure in the different GOLD stages .Patients affected by COPD with PH (n=39,FEV1 3915%,PaO2 6012mmHg,PaCO2 4610mmHg , PAP 338mmHg) and without PH (n=39, FEV1 4321% ,PaO2 6212mmHg, PaCO2 399mmHg,PAP175mmHg) were divided in three groups belonging to stage I-II , III and IV GOLD stage . Each subset was compared to healthy people (n=13) . Airways obstruction was measured by pletismography , Pulmonary Artery Pressure(PAP) by catheterization of pulmonary artery , vessels involvement by perfusion scintigraphy.Lung vessels loss is significant even in former stages of COPD (274) , showing a progressive trend (204, 284, 305 in stages I-II, III and IV respectively; 31%in healthy people) in not hypertensive patients with a significant relationship with airways obstruction (% of unperfused areas = 35- .241 FEV %;4; p<.05) .It was significant and stable in not hypertensive patients (30+4,27+4, 27+3 in stages I-II, III and IV respectively) . The apico-basal gradient of perfusion was significantly inverted (1.87 .4 ,1.86.6 and .625 .2 in PH, without PH and h. p.). Compliance of vessels under effort showed higher PAP/Q in patients with PH (PAP/Q= 1.8+1.2mmHg/L/m vs 1.6+.9 in not hypertensive and healthy people) but the difference was not significant .Vessels loss was not significantly related to PH , but it impaired effort because of higher pressures due to lesser recruitment and a leftward shift of the trace.Vascular rarefaction is an early feature of COPD , more sensitive than spirometric measurements. Pulmonary hypertension looks not dependent solely upon vessels loss but upon different pathways such as organic remodelling and vasospastic response to hypoxia .

PP-PDPI. 24/03/17.

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