The role of pulmonary arterial stiffness in the progression of chronic obstructive pulmonary disease: a literature review
DOI:
https://doi.org/10.14739/2310-1210.2026.2.350884Keywords:
chronic obstructive pulmonary disease, pulmonary artery stiffness, pulmonary hypertension, right ventricular failure, cardiac events, prognosisAbstract
Aim: to systematize data on the clinical, diagnostic, and prognostic significance of pulmonary arterial stiffness (PAS) in chronic obstructive pulmonary disease (COPD) and to elucidate its pathogenetic role in pulmonary arterial hypertension (PAH) and right ventricular dysfunction.
Materials and methods. An analysis of scientific research results published from 2015 to 2026 was conducted. Sources for the analysis were selected based on an information search in the PubMed, Google Scholar, Scopus, and Web of Science scientometric databases using the following keywords: “chronic obstructive pulmonary disease”, “pulmonary artery stiffness”, “pulmonary hypertension”, “right ventricular failure”, and “cardiovascular events” (plus Ukrainian equivalents).
Results. It has been found that PAS emerged early in COPD, preceding emphysema or significant airflow obstruction. The progression of PAS correlates with emphysema severity, lung hyperinflation, and bronchial obstruction, predicting disease severity, exacerbation frequency, and cardiovascular mortality. Loss of pulmonary artery compliance drove early right ventricular dysfunction, even with moderate PAH.
Conclusions. PAS in COPD serves as a valuable diagnostic marker of early remodeling within the pulmonary circulation. Assessing PAS parameters offers substantial diagnostic and prognostic value for tailoring patient management.
References
Cornelius T. Clinical guideline highlights for the hospitalist: GOLD COPD update 2024. J Hosp Med. 2024;19(9):818-20. doi: https://doi.org/10.1002/jhm.13416
Abdo M, Watz H, Alter P, Waschki B, Zayasu K, Magnussen H, et al. Characterization and mortality risk of impaired left ventricular filling in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2025;211(4):477-85. doi: https://doi.org/10.1164/rccm.202404-0750OC
Biradar K, Sandesh L, Sushmitha TD, Bindu CB. Echocardiographic evaluation of pulmonary artery hypertension and left ventricular dysfunction in chronic obstructive pulmonary disease patients and its co-relation with severity of disease. J Heart Valve Dis. 2025;30(10):88-95. doi: https://doi.org/10.61336/icr/25-10-16
Wu Z, Zhang H, Jiang Y, Li Z, Wang Y, Tian Y, et al. Association of Abnormal Lung Function and Its Subtypes With Arterial Stiffness: A Longitudinal Cohort Study. J Am Heart Assoc. 2024;13(1):e029929. doi: https://doi.org/10.1161/JAHA.123.029929
Lacolley P, Regnault V, Laurent S. Mechanisms of arterial stiffening: from mechanotransduction to epigenetics. Arterioscler Thromb Vasc Biol. 2020;40(5):1055-62. doi: https://doi.org/10.1161/ATVBAHA.119.313129
Roeder M, Sievi NA, Kohlbrenner D, Clarenbach CF, Kohler M. Arterial stiffness increases over time in relation to lung diffusion capacity: a longitudinal observation study in COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:177-87. doi: https://doi.org/10.2147/COPD.S234882
Herzog MJ, Müller P, Lechner K, Stiebler M, Arndt P, Kunz M, et al. Arterial stiffness and vascular aging: mechanisms, prevention, and therapy. Signal Transduct Target Ther. 2025;10(1):282. doi: https://doi.org/10.1038/s41392-025-02346-0
Olsson KM, Corte TJ, Kamp JC, Montani D, Nathan SD, Neubert L, et al. Pulmonary hypertension associated with lung disease: new insights into pathomechanisms, diagnosis, and management. Lancet Respir Med. 2023;11(9):820-35. doi: https://doi.org/10.1016/S2213-2600(23)00259-X
Bhattarai P, Lu W, Gaikwad AV, Dey S, Chia C, Larby J, et al. Arterial remodelling in smokers and in patients with small airway disease and COPD: implications for lung physiology and early origins of pulmonary hypertension. ERJ Open Res. 2022;8(4):00254-2022. doi: https://doi.org/10.1183/23120541.00254-2022
Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2016;138(1):16-27. doi: https://doi.org/10.1016/j.jaci.2016.05.011
Ambrosino P, Nolano M, Candia C, Grassi G, Maniscalco M. Addressing Oxidative Stress and Endothelial Dysfunction in Chronic Respiratory Diseases: The Role of Exercise and Multidisciplinary Rehabilitation. Antioxidants (Basel). 2024;13(12):1543. doi: https://doi.org/10.3390/antiox13121543
Banerjee S, Khubchandani J, Onukogu C, Okpom C, Johnson M. Elevated C-reactive protein and mortality risk among COPD patients. Egypt J Bronchol. 2024;18(1):38. doi: https://doi.org/10.1186/s43168-024-00291-0
Eapen MS, Lu W, Hackett TL, Singhera GK, Mahmood MQ, Hardikar A, et al. Increased myofibroblasts in the small airways, and relationship to remodelling and functional changes in smokers and COPD patients: potential role of epithelial-mesenchymal transition. ERJ Open Res. 2021;7(2):00876-2020. doi: https://doi.org/10.1183/23120541.00876-2020
Fratta Pasini AM, Stranieri C, Ferrari M, Garbin U, Cazzoletti L, Mozzini C, et al. Oxidative stress and Nrf2 expression in peripheral blood mononuclear cells derived from COPD patients: an observational longitudinal study. Respir Res. 2020;21(1):37. doi: https://doi.org/10.1186/s12931-020-1292-7
Huertas A, Guignabert C, Barberà JA, Bärtsch P, Bhattacharya J, Bhattacharya S, et al. Pulmonary vascular endothelium: the orchestra conductor in respiratory diseases: Highlights from basic research to therapy. Eur Respir J. 2018;51(4):1700745. doi: https://doi.org/10.1183/13993003.00745-2017
Huang Y, Ma W, Guo C, Su X. Mechanism of action and potential therapeutic targets of TGF-β-related signaling pathway and its downstream miRNA expression in pulmonary arterial hypertension. Front Pharmacol. 2025;16:1596767. doi: https://doi.org/10.3389/fphar.2025.1596767
Joglekar MM, Bekker NJ, Koloko Ngassie ML, Vonk JM, Borghuis T, Reinders-Luinge M, et al. The lung extracellular matrix protein landscape in severe early-onset and moderate chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol. 2024;327(3):L304-18. doi: https://doi.org/10.1152/ajplung.00332.2023
Arvidsson M, Ahmed A, Bouzina H, Rådegran G. Matrix metalloproteinase 7 in diagnosis and differentiation of pulmonary arterial hypertension. Pulm Circ. 2019;9(4):2045894019895414. doi: https://doi.org/10.1177/2045894019895414
Schäfer M, Ivy DD, Nguyen K, Boncella K, Frank BS, Morgan GJ, et al. Metalloproteinases and their inhibitors are associated with pulmonary arterial stiffness and ventricular function in pediatric pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2021;321(1):H242-52. doi: https://doi.org/10.1152/ajpheart.00750.2020
Lin C, Zheng X, Lin S, Zhang Y, Wu J, Li Y. Mechanotransduction Regulates the Interplays Between Alveolar Epithelial and Vascular Endothelial Cells in Lung. Front Physiol. 2022;13:818394. doi: https://doi.org/10.3389/fphys.2022.818394
Manning EP, Ramachandra AB, Schupp JC, Cavinato C, Raredon MSB, Bärnthaler T, et al. Mechanisms of Hypoxia-Induced Pulmonary Arterial Stiffening in Mice Revealed by a Functional Genetics Assay of Structural, Functional, and Transcriptomic Data. Front Physiol. 2021;12:726253. doi: https://doi.org/10.3389/fphys.2021.726253
Sun W, Chan SY. Pulmonary Arterial Stiffness: An Early and Pervasive Driver of Pulmonary Arterial Hypertension. Front Med (Lausanne). 2018;5:204. doi: https://doi.org/10.3389/fmed.2018.00204
Plunkett MJ, Paton JFR, Fisher JP. Autonomic control of the pulmonary circulation: Implications for pulmonary hypertension. Exp Physiol. 2025;110(1):42-57. doi: https://doi.org/10.1113/EP092249
da Silva Gonçalves Bós D, Van Der Bruggen C, Kurakula K, Sun XQ, Casali KR, Casali AG, et al. Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension. Circulation. 2018;137(9):910-24. doi: https://doi.org/10.1161/CIRCULATIONAHA.117.027451
Yang T, Chen C, Chen Z. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med. 2021;21(1):34. doi: https://doi.org/10.1186/s12890-020-01374-6
Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? Eur Respir Rev. 2018;27(149):180057. doi: https://doi.org/10.1183/16000617.0057-2018
Agoston-Coldea L, Lupu S, Mocan T. Pulmonary Artery Stiffness by Cardiac Magnetic Resonance Imaging Predicts Major Adverse Cardiovascular Events in patients with Chronic Obstructive Pulmonary Disease. Sci Rep. 2018;8(1):14447. doi: https://doi.org/10.1038/s41598-018-32784-6
Liu CY, Parikh M, Bluemke DA, Balte P, Carr J, Dashnaw S, et al. Pulmonary artery stiffness in chronic obstructive pulmonary disease (COPD) and emphysema: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study. J Magn Reson Imaging. 2018;47(1):262-71. doi: https://doi.org/10.1002/jmri.25753
Washko GR, Nardelli P, Ash SY, Vegas Sanchez-Ferrero G, Rahaghi FN, Come CE, et al. Arterial Vascular Pruning, Right Ventricular Size, and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. A Longitudinal Observational Study. Am J Respir Crit Care Med. 2019;200(4):454-61. doi: https://doi.org/10.1164/rccm.201811-2063OC
Lee JK, Kho BG, Yoon JY, Yoon CS, Na YO, Park HY, et al. The clinical characteristics associated with the ratio between the main pulmonary artery and ascending aorta diameter in patients with acute exacerbation of chronic obstructive pulmonary disease. J Thorac Dis. 2024;16(8):4924-34. doi: https://doi.org/10.21037/jtd-24-62
Cheng Y, Li L, Tu X, Pei R. The Main Pulmonary Artery to the Ascending Aorta Diameter Ratio (PA/A) as a Predictor of Worse Outcomes in Hospitalized Patients with AECOPD. Int J Chron Obstruct Pulmon Dis. 2022;17:1157-65. doi: https://doi.org/10.2147/COPD.S357696
Chen H, Shu T, Wang L, Yang L, Hu C, Du S, et al. Pulmonary artery enlargement predicts poor survival in patients with COPD: A meta-analysis. Pulm Circ. 2022;12(3):e12099. doi: https://doi.org/10.1002/pul2.12099
Tello K, Yogeswaran A, Majeed RW, Kiely DG, Lawrie A, Brittain E, et al. Association of Phosphodiesterase-5 Inhibitor Treatment With Improved Survival in Pulmonary Hypertension Associated With COPD in the Pulmonary Vascular Research Institute GoDeep Meta-Registry. Chest. 2025;167(1):224-40. doi: https://doi.org/10.1016/j.chest.2024.08.016
Zhong L, Leng S, Alabed S, Chai P, Teo L, Ruan W, et al. Pulmonary Artery Strain Predicts Prognosis in Pulmonary Arterial Hypertension. JACC Cardiovasc Imaging. 2023;16(8):1022-34. doi: https://doi.org/10.1016/j.jcmg.2023.02.007
Koç A, Ataş AE. Relationship between pulmonary artery-to-aorta ratio and hospital length of stay in chronic obstructive pulmonary disease exacerbations: a retrospective cohort analysis and clinical implications. J Health Sci Med. 2026;9(1):45-51. doi: https://doi.org/10.32322/jhsm.1794663
Kraidashenko OO. [Imbalance of the protease-antiprotease system against the background of chronic obstructive pulmonary disease in combination with ischemic heart disease]. Pathologia. 2023;20(2):182-8. Ukrainian. doi: https://doi.org/10.14739/2310-1237.2023.2.278133
Fisk M, Gale N, Mohan D, McEniery CM, Forman J, Bolton CE, et al. 1.6 The bode index prognostic score is an independent determinant of arterial stiffness in chronic obstructive pulmonary disease (copd). Artery Res. 2015;12(C):40. doi: https://doi.org/10.1016/j.artres.2015.10.007
Wernz MM, Voskrebenzev A, Müller RA, Zubke M, Klimeš F, Glandorf J, et al. Feasibility, Repeatability, and Correlation to Lung Function of Phase-Resolved Functional Lung (PREFUL) MRI-derived Pulmonary Artery Pulse Wave Velocity Measurements. J Magn Reson Imaging. 2024;60(5):2216-28. doi: https://doi.org/10.1002/jmri.29337
Weir-McCall JR, Liu-Shiu-Cheong PS, Struthers AD, Lipworth BJ, Houston JG. Pulmonary arterial stiffening in COPD and its implications for right ventricular remodelling. Eur Radiol. 2018;28(8):3464-72. doi: https://doi.org/10.1007/s00330-018-5346-x
Stone IS, Barnes NC, James WY, Midwinter D, Boubertakh R, Follows R, et al. Lung Deflation and Cardiovascular Structure and Function in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial. Am J Respir Crit Care Med. 2016;193(7):717-26. doi: https://doi.org/10.1164/rccm.201508-1647OC
Berton DC, Marques RD, Palmer B, O’Donnell DE, Neder JA. Effects of lung deflation induced by tiotropium/olodaterol on the cardiocirculatory responses to exertion in COPD. Respir Med. 2019;157:59-68. doi: https://doi.org/10.1016/j.rmed.2019.09.006
Yoon YS, Jin M, Sin DD. Accelerated lung aging and chronic obstructive pulmonary disease. Expert Rev Respir Med. 2019;13(4):369-80. doi: https://doi.org/10.1080/17476348.2019.1580576
Karnati S, Seimetz M, Kleefeldt F, Sonawane A, Madhusudhan T, Bachhuka A, et al. Chronic Obstructive Pulmonary Disease and the Cardiovascular System: Vascular Repair and Regeneration as a Therapeutic Target. Front Cardiovasc Med. 2021;8:649512. doi: https://doi.org/10.3389/fcvm.2021.649512
Fuhr DP, Brotto AR, Rowe BH, Bhutani M, Rosychuk RJ, Stickland MK. Examining changes in vascular function, arterial stiffness and systemic inflammation during hospitalization and recovery from an acute exacerbation of chronic obstructive pulmonary disease. Sci Rep. 2023;13(1):12245. doi: https://doi.org/10.1038/s41598-023-39001-z
Gall H, Felix JF, Schneck FK, Milger K, Sommer N, Voswinckel R, et al. The Giessen Pulmonary Hypertension Registry: Survival in pulmonary hypertension subgroups. J Heart Lung Transplant. 2017;36(9):957-67. doi: https://doi.org/10.1016/j.healun.2017.02.016
Nathan SD, Barbera JA, Gaine SP, Harari S, Martinez FJ, Olschewski H, et al. Pulmonary hypertension in chronic lung disease and hypoxia. Eur Respir J. 2019;53(1):1801914. doi: https://doi.org/10.1183/13993003.01914-2018
Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger R, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-731. doi: https://doi.org/10.1093/eurheartj/ehac237
Kovacs G, Avian A, Bachmaier G, Troester N, Tornyos A, Douschan P, et al. Severe Pulmonary Hypertension in COPD: Impact on Survival and Diagnostic Approach. Chest. 2022;162(1):202-12. doi: https://doi.org/10.1016/j.chest.2022.01.031
Brener MI, Burkhoff D, Sunagawa K. Effective Arterial Elastance in the Pulmonary Arterial Circulation: Derivation, Assumptions, and Clinical Applications. Circ Heart Fail. 2020;13(3):e006591. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.119.006591
Maron BA, Kovacs G, Vaidya A, Bhatt DL, Nishimura RA, Mak S, et al. Cardiopulmonary Hemodynamics in Pulmonary Hypertension and Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;76(22):2671-81. doi: https://doi.org/10.1016/j.jacc.2020.10.007
Lechuga CG, Raza F, Colebank MJ, Korcarz CE, Broman AT, Eickhoff JC, et al. Role of Characteristic Pulmonary Impedance With Exercise for Detection of Abnormal Pulmonary Vascular Response and Uncoupling in Pulmonary Hypertension Resulting From Heart Failure With Preserved Ejection Fraction. Chest. 2025;168(2):488-501. doi: https://doi.org/10.1016/j.chest.2025.02.019
Aradhyula V, Vyas R, Dube P, Haller ST, Gupta R, Maddipati KR, et al. Novel insights into the pathobiology of pulmonary hypertension in heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol. 2024;326(6):H1498-514. doi: https://doi.org/10.1152/ajpheart.00068.2024
Piccari L, Del Pozo R, Blanco I, García-Lucio J, Torralba Y, Tura-Ceide O, et al. Association Between Systemic and Pulmonary Vascular Dysfunction in COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:2037-47. doi: https://doi.org/10.2147/COPD.S257679
Prins KW, Rose L, Archer SL, Pritzker M, Weir EK, Kazmirczak F, et al. Disproportionate Right Ventricular Dysfunction and Poor Survival in Group 3 Pulmonary Hypertension. Am J Respir Crit Care Med. 2018;197(11):1496-9. doi: https://doi.org/10.1164/rccm.201712-2405LE
Mirani B, Dauz JD, Yazaki K, Latifi N, Santerre JP, Bendeck MP, et al. Right Ventricular Stiffening and Function Are Associated With Main Pulmonary Artery Remodeling in a Rat Model of Pulmonary Hypertension. Arterioscler Thromb Vasc Biol. 2025;45(6):945-64. doi: https://doi.org/10.1161/ATVBAHA.124.321354
Glass A, McCall P, Arthur A, Mangion K, Shelley B. Pulmonary artery wave reflection and right ventricular function after lung resection. Br J Anaesth. 2023;130(1):e128-e136. doi: https://doi.org/10.1016/j.bja.2022.07.052
Singh I, Oliveira RKF, Naeije R, Rahaghi FN, Oldham WM, Systrom DM, et al. Pulmonary Vascular Distensibility and Early Pulmonary Vascular Remodeling in Pulmonary Hypertension. Chest. 2019;156(4):724-32. doi: https://doi.org/10.1016/j.chest.2019.04.111
Alturaif N, Attanasio U, Mercurio V. Pulmonary arterial hypertension: sex-specific differences and outcomes. Ther Adv Respir Dis. 2025;19:17534666251350493. doi: https://doi.org/10.1177/17534666251350493
Wang S, Gao B, Shi M, Qumu S, Dong F, Wang P, et al. Exercise-Induced Oxygen Desaturation Increases Arterial Stiffness in Patients with COPD During the 6WMT. Int J Chron Obstruct Pulmon Dis. 2024;19:1479-89. doi: https://doi.org/10.2147/COPD.S465843
Richard R, Jensen D, Touron J, Frederic C, Mulliez A, Pereira B, et al. Haemodynamic compensations for exercise tissue oxygenation in early stages of COPD: an integrated cardiorespiratory assessment study. BMJ Open Respir Res. 2024;11(1):e002241. doi: https://doi.org/10.1136/bmjresp-2023-002241
Sassmann T, Douschan P, Foris V, Tröster N, Zeder K, Brcic L, et al. Abnormal pulmonary hemodynamics during exercise is associated with exercise capacity in COPD. Respir Res. 2022;23(1):331. doi: https://doi.org/10.1186/s12931-022-02238-9
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