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J Clin Med. 2018 Dec 9;7(12). pii: E532. doi: 10.3390/jcm7120532.

Small Airway Disease in Pulmonary Hypertension-Additional Diagnostic Value of Multiple Breath Washout and Impulse Oscillometry.

Author information

1
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. frederik.trinkmann@umm.de.
2
Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68135 Mannheim, Germany. joshua.gawlitza@umm.de.
3
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. monique.kuenstler@t-online.de.
4
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. julia.schaefer2@umm.de.
5
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. michele.schroeter@gmx.de.
6
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. julia.michels@umm.de.
7
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. ksenija.stach@umm.de.
8
DZHK (German Center for Cardiovascular Research), partner site Mannheim, University Medical Center Mannheim, 68135 Mannheim, Germany. ksenija.stach@umm.de.
9
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. christina.doesch@gmail.com.
10
DZHK (German Center for Cardiovascular Research), partner site Mannheim, University Medical Center Mannheim, 68135 Mannheim, Germany. christina.doesch@gmail.com.
11
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. jsaur@uni-mannheim.de.
12
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. martin.borggrefe@umm.de.
13
DZHK (German Center for Cardiovascular Research), partner site Mannheim, University Medical Center Mannheim, 68135 Mannheim, Germany. martin.borggrefe@umm.de.
14
1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, 68135 Mannheim, Germany. ibrahim.akin@umm.de.
15
DZHK (German Center for Cardiovascular Research), partner site Mannheim, University Medical Center Mannheim, 68135 Mannheim, Germany. ibrahim.akin@umm.de.

Abstract

Airways obstruction is frequent in patients with pulmonary hypertension (PH). Small airway disease (SAD) was identified as a major contributor to resistance and symptoms. However, it is easily missed using current diagnostic approaches. We aimed to evaluate more elaborate diagnostic tests such as impulse oscillometry (IOS) and SF₆-multiple-breath-washout (MBW) for the assessment of SAD in PH. Twenty-five PH patients undergoing body-plethysmography, IOS and MBW testing were prospectively included and equally matched to pulmonary healthy and non-healthy controls. Lung clearance index (LCI) and acinar ventilation heterogeneity (Sacin) differed significantly between PH, healthy and non-healthy controls. Likewise, differences were found for all IOS parameters between PH and healthy, but not non-healthy controls. Transfer factor corrected for ventilated alveolar volume (TLCO/VA), frequency dependency of resistance (D5-20), resonance frequency (Fres) and Sacin allowed complete differentiation between PH and healthy controls (AUC (area under the curve) = 1.0). Likewise, PH patients were separated from non-healthy controls (AUC 0.762) by D5-20, LCI and conductive ventilation heterogeneity (Scond). Maximal expiratory flow (MEF) values were not associated with additional diagnostic values. MBW and IOS are feasible in PH patients both providing additional information. This can be used to discriminate PH from healthy and non-healthy controls. Therefore, further research targeting SAD in PH and evaluation of therapeutic implications is justified.

KEYWORDS:

impulse oscillometry; lung clearance index; multiple breath washout; pulmonary hypertension; small airway disease

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