Bosentan treatment is associated with improvement of right ventricular function and remodeling in chronic thromboembolic pulmonary hypertension.

Medical pretreatment before pulmonary endarterectomy (PEA) can optimize right ventricular (RV) function and may improve postoperative outcome in high-risk patients. Using cardiac magnetic resonance imaging (cMRI), we determined whether the dual endothelin-1 antagonist bosentan improves RV function and remodeling in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who waited for PEA. We hypothesized that medical therapy prior to PEA will be associated with improvements in RV remodeling and function. In this pilot study, 15 operable CTEPH patients were randomly assigned to either bosentan (n = 8) or no bosentan (n = 7, control) for 16 weeks, next to "best standard of care." Both before and after treatment, RV stroke volume index (RVSVI), RV ejection fraction (RVEF), RV mass, RV isovolumic relaxation time (rIVRT), leftward ventricular septal bowing (LVSB), and left ventricular ejection fraction (LVEF) were determined using cMRI. After 16 weeks, the change (Δ) from baseline (median [range]) in the studied cMRI parameters differed significantly between the bosentan group and the controls: Δ RVSVI: 6 [-4-11] vs 1 [-6-3] mL/m(-2) ; Δ RVEF: 8 [-10-15] vs -4 [-7-5]%; Δ RV mass: -3 [-6--2] vs 2 [-1-3] g/m(-2) ; Δ rIVRT: -30 [-130-20] vs 10 [-30-30] msec; Δ LVSB: 0.03 [-0.03-0.13] vs -0.03[-0.08-0.04] cm(-1) ; and Δ LVEF: 8 [-5-17] vs -2 [-14-2]% (all P < 0.05). The change from baseline in mean pulmonary artery pressure (-11 [-17-11] vs 5 [-6-21] mm Hg, P < 0.05) and 6-minute walk distance (20 [3-88] vs -4 [-40-40] m, P < 0.05) also differed significantly. In CTEPH, compared with control, treatment with bosentan for 16 weeks was associated with a significant improvement in cMRI parameters of RV function and remodelling.

Surie S ，Reesink HJ ，Marcus JT ，van der Plas MN ，Kloek JJ ，Vonk-Noordegraaf A ，Bresser P ... -  《-》

Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension.

Fukumitsu M ，Westerhof BE ，Ruigrok D ，Braams NJ ，Groeneveldt JA ，Bayoumy AA ，Marcus JT ，Meijboom LJ ，de Man FS ，Westerhof N ，Bogaard HJ ，Vonk Noordegraaf A ... -  《-》

Evaluation of improvement in exercise capacity after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: correlation with echocardiographic parameters.

The study evaluates the alterations in exercise capacity of chronic thromboembolic pulmonary hypertension (CTEPH) patients after pulmonary endarterectomy (PEA) and investigates the echocardiographic parameters associated with the degree of functional recovery. Thirty consecutive patients with the diagnosis of CTEPH (17 males; mean age, 45.9 ± 15.1 years) who had been referred for PEA operation were included in the study. Each patient underwent transthoracic echocardiography and 6-minute walk test (6-MWT) before and 6 months after PEA. After PEA, 6-MWT distances significantly increased (242.8 ± 112.8 m vs. 423.6 ± 89.1 m, p < 0.001), whereas systolic pulmonary artery pressures and right ventricular dimensions significantly decreased (86 ± 25.1 mm Hg vs. 41.9 ± 15.6 mm Hg, p < 0.001 and 42.1 ± 10.1 mm vs. 35.3 ± 5.6 mm, p < 0.001, respectively). Magnitude of change in 6-MWT distance (Δ-6-MWT) was found to be correlated with concomitant change in tricuspid annular plane systolic excursion and left ventricular myocardial performance index (r: 0.518, p: 0.004 and r: -0.385, p: 0.043, respectively). Linear regression analysis revealed preoperative 6-MWT distance as an independent negative predictor of delta-6-MWT (beta: -0.89, t: -3.97, p: 0.001). CTEPH patients with more severely depressed exercise capacity at baseline displayed relatively greater degree of functional recovery after PEA in our study. Improvement in functional capacity was found to be correlated with improvement in parameters reflecting right ventricular functions rather than improvement in pulmonary artery pressure after PEA operation.

Kepez A ，Sunbul M ，Kivrak T ，Eroglu E ，Ozben B ，Yildizeli B ，Mutlu B ... -  《-》

Exercise facilitates early recognition of cardiac and vascular remodeling in chronic thromboembolic pulmonary hypertension in swine.

Stam K ，van Duin RWB ，Uitterdijk A ，Cai Z ，Duncker DJ ，Merkus D ... -  《-》

Changes in right ventricular structure and function assessed using cardiac magnetic resonance imaging in bosentan-treated patients with pulmonary arterial hypertension.

Chin KM ，Kingman M ，de Lemos JA ，Warner JJ ，Reimold S ，Peshock R ，Torres F ... -  《-》