The Serum Levels And Significance Of Vascular Endothelial Growth Factor In Patients With Chronic Cor Pulmonale

Background and Objectives: Hypoxic pulmonary hypertension (HPH) is the prerequisite for the pathogenesis of chronic cor pulmonale (CCP), but its mechanisms are not very clear. Hypoxic pulmonary vasoconstriction and pulmonary vascular remodelling play important roles in the pathogenesis of HPH. Vascular endothelial growth factor (VEGF) is a recently found vasodilating peptide. Recent studies suggest that VEGF plays an important role in the regulation of pulmonary hypertension. But the serum levels of VEGF in patiens with CCP remains unreported and the relationship between VEGF is not very defined. To elucidate the serum levels of VEGF in patients with CCP and its Pathophysiologic role and significance in pulmonary vascular remodelling, We measured the serum VEGF in 28 patients with CCPand investigated the relationship between them and their respective correlations with PaO2 and the ratio of right ventricular pre-ejection period (RVPEP) to the pulmonary flow acceleration time (AT), which reflected the degree of pulmonary hypertension (RVPEP/AT>1.0 indicating pulmonary hypertension).Subjects and Methods: CCP group comprising 28 patients (17 males and 11 females aged 45 to 86 years; mean盨D age, 66.07 + 9.18 years) was classified into two groups ( acute acceleration and remission stage ) according to their clinical presentation. 28 gender-and-age-matched healthy subjects served as a normal control group. The serum levels of VEGF were detected by enzyme linked immuno sorbent assay (ELISA). The RVPEP/AT values were measured with Dopple echocardiography and the PaO2 levels by arterial blood gas assay.Results: (1) The serum VEGF levels in the acceleration and remission stages of CCP group [VEGF: (183.59 ?4.40) pg/ml, (118.30+17.91) pg/ml] were both higher than those in the normal control group [VEGF: (56.15?0.54)pg/ml, ( PO.001, PO.001) ]; and the serum VEGF levels in the acceleration stage was higher than those in the remission stage (P<0.001). The PaO2 levels in the acceleration stage[(43.68 + 7.13) mmHg] were lower than those in the remisson stage[(66.29 + 4.26) mmHg, P<0.001]. The values ofRVPEP/AT in the acceleration stage (1.96+0.22) were higher than those in the remission stage (1.30 + 0.15, P<0.001), and the mean values of RVPEP/AT in the two stages were more than one. (2) In CCP group, the serum VEGF levels negatively correlated with PaO2 (r=-0.69, P<0.001; r=-0.59, PO.01) and positively correlated with RVPEP/AT (r=0.91, PO.001; r=0.60, P<0.01) in the acceleration and remission stages.Conclusions: (1) The serum VEGF levels in patients with CCP in the acceleration and remission stages were higher than those in the normal control group, especially in the acceleration stage. (2) In CCP group the serum VEGF levels negatively correlated with PaO2 and positively correlated with RVPEP/AT in two stages.This study indicates that: The serum levels of VEGF in patients with CCP were higher than those in the normal control group. The increasing of serum levels VEGF is in accordance with the increasing of PaO2, which indicates that VEGF participates in the regulation of pulmonary arterial pressure and plays an important role in the pathophysiology of CCP.