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Therapeutic monitoring response of pulmonary arterial hypertension using a combined computed tomography- computational fluid analysis strategy

  • Author Footnotes
    1 The authors equally contribute to the manuscript.
    Gianluca Rigatelli
    Correspondence
    Corresponding author at: Section of Cardiovascular Diagnosis and Endoluminal Interventions, Viale Tre Martiri 140, 45100 Rovigo, Italy.
    Footnotes
    1 The authors equally contribute to the manuscript.
    Affiliations
    Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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  • Author Footnotes
    1 The authors equally contribute to the manuscript.
    Marco Zuin
    Footnotes
    1 The authors equally contribute to the manuscript.
    Affiliations
    Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
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  • Author Footnotes
    1 The authors equally contribute to the manuscript.
      Pulmonary arterial hypertension (PAH) is a progressive disease of the small pulmonary arteries characterized by vascular proliferation and remodelling, increased pulmonary vascular resistances (PVR) and endothelial dysfunction [
      • Lai Y.C.
      • Potoka K.C.
      • Champion H.C.
      • Mora A.L.
      • Gladwin M.
      Pulmonary arterial hypertension: the clinical syndrome.
      ]. Over the last years, an increasing attention has been posed on the use of computational fluid dynamic analysis (CFD) in the field of cardiovascular medicine [
      • Zuin M.
      • Rigatelli G.
      • Faggian G.
      • Roncon L.
      Mathematics and cardiovascular interventions: Role of the finite element modeling in clinical decision making.
      ], and a growing attention has emerged also in the analysis of PAH. Different studies, using both CFD analysis and 4D-flow magnetic resonance (MRI), have demonstrated that the wall shear stress (WSS), a well-known force in cardiovascular disease, is involved both in the progression and maintenance of PAH [
      • Barker A.J.
      • Roldán-Alzate A.
      • Entezari P.
      • Shah S.J.
      • Chesler N.C.
      • Wieben O.
      • et al.
      Four-dimensional flow assessment of pulmonary artery flow and wall shear stress in adult pulmonary arterial hypertension: results from two institutions.
      ,
      • Tang B.T.
      • Pickard S.S.
      • Chan F.P.
      • Tsao P.S.
      • Taylor C.A.
      • Feinstein J.A.
      Wall shear stress is decreased in the pulmonary arteries of patients with pulmonary arterial hypertension: an image-based, computational fluid dynamics study.
      ]. Indeed, CFD results have demonstrated that WSS in the pulmonary arteries of PAH patients was lower than in healthy subjects [
      • Truong U.
      • Fonseca B.
      • Dunning J.
      • Burgett S.
      • Lanning C.
      • Ivy D.D.
      • et al.
      Wall shear stress measured by phase contrast cardiovascular magnetic resonance in children and adolescents with pulmonary arterial hypertension.
      ]. Current diagnostic techniques used to assess and monitoring both PAH severity and therapy efficacy, as transthoracic echocardiography (TTE) and right heart catheterization (RHC) are graved by several drawbacks including operator's dependence and expertise.

      Keywords

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