A new review article summarizing the clinical application of pulmonary vascular resistance in pulmonary arterial hypertension (PAH) patients was published in the Journal of Cardiothoracic Surgery.

“As one of the diagnostic indicators of hemodynamics, pulmonary vascular resistance plays an irreplaceable role in the pathophysiology, diagnosis and treatment of pulmonary arterial hypertension,” wrote Jianying Deng, from the Department of Cardiovascular Surgery at Chongqing Kanghua Zhonglian Cardiovascular Hospital in China.

“At the same time, PVR and PAH risk stratification indicators have a certain correlation, and also have important value in the prognosis and early diagnosis of some PAH,” he added.

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This review article covers how pulmonary vascular resistance is linked to the pathophysiology of PAH, its diagnostic value, and its role in the hemodynamic classification of pulmonary hypertension. It also touches on its role in the preoperative assessment of PAH related to congenital heart disease and on PAH risk stratification, prognosis assessment, and early diagnosis. 

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PAH is a rare and progressive disease characterized by the narrowing and thickening of the pulmonary arteries causing pulmonary vascular resistance and right ventricular hypertension, which can eventually lead to heart failure and death if left untreated.

However, pulmonary vascular resistance is not the best index to evaluate right ventricular afterload, Deng said, as it is a static index that does not include the pulsatile load.

“Considering the heterogeneity of PAH, we should not only have an overall concept of right ventricle-pulmonary artery but also explore the value of pulmonary vascular impedance,” Deng wrote. “I believe that with the development of medical technology, we will have a better understanding of PAH.”

Finally, the review explores factors influencing pulmonary vascular resistance such as age, blood viscosity, preterm birth, and air pollution.

“A more comprehensive understanding of the influencing factors of [pulmonary vascular resistance] helps to accurately interpret it,” Deng said.


Deng J. Clinical application of pulmonary vascular resistance in patients with pulmonary arterial hypertension. J Cardiothorac Surg. 2021;20;16(1):311. doi:10.1186/s13019-021-01696-4