Russian Heart Failure Journal 2007year Clinical implication of pulmonary vascular remodeling in idiopathic fibrosing alveolitis


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2007/

Clinical implication of pulmonary vascular remodeling in idiopathic fibrosing alveolitis

Mukhin N. A., Popova E. N., Kogan E. A., Lebedeva M. V., Osipenko V. I., Fomin V. V.

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Urgency. Factors determining the sustained increase of pulmonary blood pressure in idiopathic interstitial pneumonias have not been clearly identified. Aim. Specifying the clinical implication of individual mechanisms for pulmonary remodeling resulting in lung hypertension in different variants of idiopathic fibrosing alveolitis (IFA). Materials and methods. 152 patients with IFA (mean age, 46.7±19.8 years) documented by result of lung biopsy were evaluated. Spiral computer tomography and transthoracic echoCG with measurement of mean pulmonary arterial pressure (MPAP) were performed in all patients. Plasma angiotensin-converting enzyme (ACE) activity was measured in 83 patients using the enzyme-linked immunosorbent assay (ELISA). Plasma level of NO metabolites (nitrate) was measured in 40 patients using high-performance liquid chromatography. Blood levels of serotonin and histamine were measured in 37 patients. Results. MPAP was the highest (56.7±2.5 mm Hg) in idiopathic pulmonary fibrosis (IPF); in other forms of IFA (35.9±7.3 mm Hg) MPAP was also higher than in the control group of healthy individuals (14.1±0.57 mm Hg) (р<0.001 for IPF; р<0.01 for other forms of IFA). Plasma level of NO3- and ACE activity were the lowest in patients with IPF. Plasma levels of serotonin and histamine were significantly higher in all variants of IFA that in the control group. Conclusion. Among all IFA variants, pulmonary hypertension is most characteristic of IPF. At the same time activation of mediators contributing to the development of IPF (serotonin, histamine) was detectable also in other forms of IFA; in these patients MPAP was also significantly higher than in healthy individuals.

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