Journal article

Publication year: 2014

Journal: Journal of Cardiovascular Magnetic Resonance

Volume number: 16

ISSN: 1097-6647

eISSN: 1532-429X

Open access status: Gold

DOI Link: https://doi.org/10.1186/s12968-014-0096-7

Publisher: Elsevier

Abstract: 

Background: The aim of the study was to characterize RV adaptation to varying loading conditions in patients with chronic thromboembolic hypertension (CTEPH) before and after pulmonary endarterectomy (PEA). Nearly 4% of patients with pulmonary embolism develop CTEPH. PEA offers a cure with excellent outcome. By use of cardiovascular magnetic resonance (CMR) combined with hemodynamic measurements pulmonary arterial elastance (Ea-pulm_i), end-systolic right ventricular elastance (Ees-RV_i) and ventriculo-arterial coupling (Ea-pulm_i/Ees-RV_i) can be studied before and after PEA.

Methods: Sixty-five patients (mean age 41 +/- 12 years, 28 female) underwent CMR pre- and post-PEA. Ejection fraction (EF), end-diastolic (EDVi), end-systolic (ESVi), and stroke (SVi) volumes were indexed for body surface area. Ea-pulm_i was calculated as pulmonary artery mean pressure (mPAP)/SVi, and Ees-RV_i as mPAP/ESVi.

Results: mPAP decreased from 47 +/- 12 to 25 +/- 9 mmHg, p = 0.0001. Ea-pulm_i was increased before PEA and normalized afterwards (2.8 +/- 2.1 vs. 0.85 +/- 0.4 mmHg/ml/m(2), p = 0.0001). Ees-RV_i was depressed before and after PEA (0.72 +/- 0.27 vs. 0.66 +/- 0.3 mmHg/ml/m(2), p = 0.13). EF improved from 25 +/- 12% to 46 +/- 10%, p = 0.0001, because ventriculo-arterial coupling was restored (4.2 +/- 3 vs. 1.4 +/- 0.6, p = 0.0001). EDVi and ESVi mproved significantly (EDVi 92 +/- 32 to 72 +/- 23 ml, p = 0.0001; ESVi 69 +/- 31 to 41 +/- 18 ml, p = 0.0001).

Conclusion: RV function is largely determined by afterload and returns to normal once afterload is normalized. This is paralleled by a significant improvement of CMR indices of right ventricular remodelling.

Harvard Citation style: Rolf, A., Rixe, J., Kim, W., Boergel, J., Moellmann, H., Nef, H., et al. (2014) Right ventricular adaptation to pulmonary pressure load in patients with chronic thromboembolic pulmonary hypertension before and after successful pulmonary endarterectomy - a cardiovascular magnetic resonance study, Journal of Cardiovascular Magnetic Resonance, 16, Article 96. https://doi.org/10.1186/s12968-014-0096-7

APA Citation style: Rolf, A., Rixe, J., Kim, W., Boergel, J., Moellmann, H., Nef, H., Liebetrau, C., Kramm, T., Guth, S., Krombach, G., Mayer, E., & Hamm, C. (2014). Right ventricular adaptation to pulmonary pressure load in patients with chronic thromboembolic pulmonary hypertension before and after successful pulmonary endarterectomy - a cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance. 16, Article 96. https://doi.org/10.1186/s12968-014-0096-7