Long-term changes of resting and exercise right ventricular systolic performance in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy - A two-dimensional and three-dimensional echocardiographic study.

To characterize right ventricular (RV) geometry and function in chronic thromboembolic pulmonary hypertension (CTEPH) patients at rest and during exercise before pulmonary thromboendarterectomy (PEA), and at 3 and 12 months after PEA using two-dimensional and three-dimensional echocardiography with reference to clinical performance and exercise capacity. Forty subjects (20 CTEPH patients and 20 controls) were enrolled between December 2014 and January 2017. Three-dimensional echocardiography demonstrated a significant reduction and normalization of end-diastolic and end-systolic RV volumes in CTEPH patients 12 months after PEA. RV systolic function improved after PEA; however, tricuspid annular plane systolic excursion (TAPSE) (baseline 18 ± 6 mm vs 15 ± 3 mm at 12 months after PEA, P < .05) and tricuspid lateral annular systolic velocity (RV-S') (baseline -8.3 ± 2.1 cm/s vs -7.2 ± 1.3 cm/s at 12 months after PEA, P < .05) declined significantly after PEA. Tricuspid regurgitation gradient was 64 ± 21 mm Hg at baseline, 40 ± 14 mm Hg at 3 months, and 30 ± 13 at 12 months, P < .00001. RV free-wall longitudinal strain at peak exercise was significantly increased from baseline (-10.6 ± 5.5%) to 12 months of follow-up (-15.8 ± 5.2%), P < .005. Physical exercise capacity, measured as peak oxygen uptake, was significantly increased and correlated directly with improvement of resting and exercise-induced RV-EF. Improvement of RV geometry and systolic function, along with the reduction of systolic pulmonary pressure, can be expected following PEA in CTEPH patients during long-term follow-up. Improvement of RV myocardial contractility after PEA was only revealed at peak exercise over time. Importantly, physical exercise capacity was significantly increased and was found to be directly correlated with improvement of resting and exercise-induced RV-EF.

Waziri F ，Mellemkjaer S ，Clemmensen TS ，Hjortdal VE ，Ilkjaer LB ，Nielsen SL ，Poulsen SH ... -  《-》

Improvement of right ventricular dysfunction after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: utility of echocardiography to demonstrate restoration of the right ventricle during 2-year follow-up.

Pulmonary endarterectomy (PEA) is an effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH) by dissecting the residual thrombus from the native vessel wall. The goal of PEA is to improve pulmonary hemodynamics and right ventricular dysfunction, and thus increase exercise capacity, alleviate symptoms and decrease mortality. The aim of this study, accordingly, was to assess the ability of echocardiography to provide a mechanism to monitor the time course of RV functional improvement after PEA. Twenty-six consecutive adult patients who underwent PEA for CTEPH were included in the study. All the patients underwent transthoracic echocardiography and right heart catheterization before surgery. Follow-up echocardiography was performed within 3, 12, and 24 months of surgery. The parameters of right ventricle were compared with baseline data. In all cases, the RV was enlarged and systolic function was impaired before surgery. RV systolic pressure fell from 92±16 mm Hg before surgery to 41±9 mm Hg by the 3 month post-PEA follow-up (P<0.001). RV end-diastolic area and end-systolic area likewise decreased from 35.8±4.4 cm(2) to 26.6±4.8 cm(2) (P<0.001) and from 27.1±3.8 cm(2) to 17.9±3.8 cm(2) (P<0.001), respectively. The RV myocardial performance index also decreased from a ratio of 0.8±0.1 to 0.5±0.1 (P<0.001). The tricuspid annular plane systolic excursion increased from 8.8±0.6mm to 10.1±0.9 mm (P<0.001). Tricuspid regurgitation (TR) improved from a mean grade of 3.1±0.5 to 2.2±0.7 (P<0.001). At the 12 and 24 month follow-up examinations, RV systolic pressure and function remained improved, respectively. The RV systolic pressure remained above 50 mmHg in only two cases. In patients with CTEPH who undergo PEA, echocardiography is a useful tool for the evaluation of RV function. Echocardiographic measurements of RV size, systolic pressure, systolic function, and TR show significant improvement, and this effect is sustained for up to 24 months after surgery.

Li YD ，Zhai ZG ，Wu YF ，Yang YH ，Gu S ，Liu Y ，Su PX ，Wang C ... -  《-》

Long-term changes of right ventricular myocardial deformation and remodeling studied by cardiac magnetic resonance imaging in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy.

Right ventricular (RV) afterload in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is associated with reduced myocardial contractility and ventriculoarterial coupling. The impact of increased afterload on RV myocardial deformation was assessed by comparing the characteristics of CTEPH patients to healthy controls at baseline, and by comparing characteristics of CTEPH patients before and 12 months after pulmonary endarterectomy (PEA). Cardiac deformation and function of CTEPH patients (n = 20) and healthy controls (n = 20) were assessed by cardiac magnetic resonance (CMR). CTEPH patients were also examined with right heart catheterization before and 12 months after PEA. PEA resulted in significant improvement of invasive hemodynamics and normalization of RV hypertrophy and right atrial, RV and left ventricular dimensions and volumes. RV ejection fraction improved from 30 ± 13% at baseline to 44 ± 10% at 12 months (p < 0.0001) but remained decreased compared with control subjects (54 ± 4%, p < 0.05). RV global circumferential strain (GCS) normalized 12 months after PEA, but RV global longitudinal strain (GLS) remained significantly lower in CTEPH patients than controls (baseline -12.9 ± 3.3% vs. -16.5 ± 3.6% at 12 months p < 0.01, vs. controls -19.3 ± 3.2%, p < 0.05). RV mass changes were significantly correlated with RV-ejection fraction, RV-GLS, and RV-GCS. RV-pulmonary arterial coupling with the volume method improved at 12 months (0.49 ± 0.30 vs. 0.84 ± 0.31, p < 0.0005), but remained significantly reduced compared with healthy controls (1.19 ± 0.20, p < 0.0005). RV global longitudinal and circumferential myocardial three-dimensional strain by CMR improved significantly in CTEPH patients 12 months after PEA. Improvements in myocardial deformation were associated with regression of RV hypertrophy and decrease in pulmonary artery pressure.

Waziri F ，Ringgaard S ，Mellemkjær S ，Bøgh N ，Kim WY ，Clemmensen TS ，Hjortdal VE ，Nielsen SL ，Poulsen SH ... -  《-》

The value of speckle-tracking echocardiography in identifying right heart dysfunction in patients with chronic thromboembolic pulmonary hypertension.

Li AL ，Zhai ZG ，Zhai YN ，Xie WM ，Wan J ，Tao XC ... -  《-》

Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension.

Kamimura Y ，Okumura N ，Adachi S ，Shimokata S ，Tajima F ，Nakano Y ，Hirashiki A ，Murohara T ，Kondo T ... -  《-》