Use of intravascular ultrasound to measure local compliance of the pediatric pulmonary artery: in vitro studies

Abstract

Background: The accurate measurement of local pulmonary artery compliance in pediatric pulmonary hypertension is an important step toward further understanding the biomechanical and hemodynamic aspects of the disease. The emergence of intravascular ultrasound (IVUS) imaging techniques promises the ability to make such measurements clinically. However, the use of IVUS for compliance measurements has not been validated. Furthermore, confusion exists regarding the most appropriate method to measure compliance.

Methods: This study validated IVUS measurements against a laser micrometer standard for 4 elastic tubes of varying compliance. Two methods of quantifying local compliance were explored: The pressure-strain modulus (E(p)), (E(p)(g/cm(2)) = DeltaP x R(d)/DeltaR (Where DeltaP is pulse pressure, R(d) is diastolic radius, and DeltaR is systolic minus diastolic radii) and the dynamic compliance (C(dyn)), (C(dyn)(%/100 mm Hg) = [DeltaD/(DeltaP x D(d))] x 10(4) Where DeltaD is systolic minus diastolic diameters and D(d) is diastolic diameter.

Results: IVUS diameter measurements agreed well with laser micrometer data although slight overestimation (mean = 3.67% +/- 2.78%) was present. Mean values of E(p) ranged from 353.3 g/cm(2) to 2676.0 g/cm(2); mean C(dyn) values ranged from 5.7% diametric change/100 mm Hg to 39.5% diametric change/100 mm Hg for all tube models. Although mean values of E(p) and C(dyn) could be distinguished among the various tubes, the extremely large measurement uncertainty for E(p) precluded statistical differentiation. The uncertainty in E(p) increased inversely with the diametric change, indicating a potential limitation of E(p) associated with stiffening arteries.

Conclusions: We conclude that C(dyn) is a more robust mean of quantifying pediatric pulmonary artery compliance, especially as arteries stiffen with chronic pulmonary hypertension.