Pulmonary Hypertension and Right Ventricular Dysfunction in Chronic Lung Diseases: New Pathobiologic Concepts
Jose Gomez-Arroyo, Herman J. Bogaard, Laszlo Farkas, Antonio Abbate, Norbert F. Voelkel.
Here we provide background information for the pathobiological concept of a “sick lung circulation”, and how
it may affect cardiac function. We propose that in most chronic and progressive lung diseases, but in particular
COPD/emphysema and interstitial lung diseases (ILD), there are significant pathological changes of the small pulmonary
vessels. Complementing the WHO classification of pulmonary vascular diseases we provide a classification which is
based on pathogenetic mechanisms such as inflammation, hypoxia and angioproliferation. We also propose that chronic
lung disease – related ‘cor pulmonale’ is insufficiently explained by an elevation of the pulmonary arterial pressure.
Keywords: COPD, emphysema, lung vascular remodeling, HIF-1 &agr;, VEGF, endothelial-mesenchyma transition [EnMT], “sick
Rights & PermissionsPrintExport