Clinical value of echocardiography in evaluating hemodynamics and right ventricular function in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty

Chen, Jiaxin; Ding, Shan; Zhang, Chenkai; Li, Rifei; Guo, Wenliang; Hong, Chen; Tang, Qing

doi:10.21037/jtd-21-1536

Cited by 2 publications

(1 citation statement)

References 29 publications

(45 reference statements)

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“…Finally, we assumed that the RAP estimated by echocardiography from the inferior vena cava diameters and inspiratory collapse was accurate, based on which the consistency of US-PASP and RHC-PASP was analyzed. There may be reputedly imprecise ( 33 , 37 ), but Chen et al ( 38 ) reported that RAMP did not change significantly before and after BPA. However, further study is needed on researching new methods of RAP ultrasound assessment in order to screen suspicious populations reliably.…”

Section: Discussionmentioning

confidence: 99%

A better method to evaluate the reliability of echocardiography for assessment of pulmonary hypertension: comparison of tricuspid regurgitant spectrum quality grading and tricuspid valve regurgitation degree

Deng,

Guo,

Yang

et al. 2024

J Thorac Dis

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Background Transthoracic echocardiography (TTE) is recommended as the most important noninvasive screening tool for the diagnosis of pulmonary hypertension (PH), sonographers usually measure the volume of regurgitant flow rather than evaluating the spectral quality, so physicians will determine whether the ultrasound measurements of pulmonary arterial systolic pressure (US-PASP) are reliable based on the volume of tricuspid regurgitation (TR). Therefore, for the first time, we grade the quality of TR spectrum (TRS) based on its integrity and clarity, aiming to assess clinical application value of different tricuspid regurgitant spectrum quality grades (TR-SQG), and investigate whether the accuracy of US-PASP is more trustworthy than TR. Methods We retrospectively analyzed 108 patients with chronic thromboembolic PH (CTEPH) to compare the correlation and agreement between US-PASP and right heart catheterization measurements of PASP (RHC-PASP). TR area (TRA) and TRS were measured in each patient, and TR-SQG was performed. Results The correlation coefficients between US-PASP and RHC-PASP were r=0.622 (P<0.001), r=0.754 (P<0.001), r=0.595 (P<0.001) in mild, moderate, severe TR, and r=0.301 (P=0.135), r=0.747 (P<0.001), r=0.739 (P<0.001), r=0.828 (P<0.001) in TR-SQG I–IV, respectively. Bland-Altman analysis revealed the mean biases of 5.05, 3.06, 7.62 mmHg in mild, moderate, severe TR, and −16.47, −8.07, 1.82, 6.09 mmHg in TR-SQG I–IV, respectively. In mild TR with the TR-SQG III and IV, the correlation coefficients between US-PASP and RHC-PASP were r=0.779 (P<0.001), intraclass correlation coefficient (ICC) =0.774, paired t -test P=0.160, respectively; and the consistency was significantly higher than that of mild TR without considering TR-SQG. In moderate TR with the TR-SQG III and IV, the r=0.749, ICC =0.746, paired t -test P=0.298 between US-PASP and RHC-PASP. Conclusions The US-PASP with TR-SQG III or IV is trustworthy, and its accuracy and consistency are better than those predicted by the traditional severity of TR. The establishment of the ultrasound evaluation system of TR-SQG helps clinicians to judge whether the US-PASP is accurate, credible, and reliable.

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Section: Discussionmentioning

confidence: 99%

A better method to evaluate the reliability of echocardiography for assessment of pulmonary hypertension: comparison of tricuspid regurgitant spectrum quality grading and tricuspid valve regurgitation degree

Deng,

Guo,

Yang

et al. 2024

J Thorac Dis

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Study on the improvement of right ventricular structure and function after balloon pulmonary Angioplasty in chronic thrombotic pulmonary hypertension patients with different degrees of pulmonary arterial hypertension by echocardiography

Ding,

Cai,

Lin

et al. 2023

Preprint

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Objective: Analyze the improvement of right heart structure and function in CTEPH patients with different degrees of pulmonary hypertension after BPA treatment, in order to provide a basis for determining the effectiveness of BPA treatment, and to screen patients with different treatment effects and adjust the subsequent treatment strategies. Method: The patients with CTEPH were selected for preoperative echocardiography, and the right ventricular systolic function parameters, pulmonary artery pressure parameters, left ventricular related parameters were measured; RHC were measured before and after BPA. Perform another echocardiographic within 24 hours after BPA. According to the results of RHC-mPAP before BPA, CTEPH patients were divided into three groups: mild pH, moderate pH and severe PH. Compare the changes in pulmonary artery pressure, right heart structure, and function among three groups of patients after BPA, and analyze their treatment effects. Results: A total of 94 CTEPH patients were included in the study, including 30 mild PH patients, 37 moderate PH patients, and 27 severe PH patients. After BPA, TPVR was significantly reduced in all patients (P=0.029, P=0.002, P=0.004). RHC-sPAP, RHC-mPAP and PVR were decreased in patients with moderate PH (P=0.004, P=0.005, P=0.002) and severe PH (P<0.001, P=0.001, P=0.003); The PAD, RAEDA, RAESA, RVEDA, RVESA, IVCmax, IVCmin and CRIVC in patients with moderate PH were significantly improved. TRA and ∆PTR were also reduced (P<0.001, P=0.001); RAEDA, RAESA, RVEDA, RVESA, FAC, IVCmax, IVCmin were also significantly improved in patients with severe PH. However, patients with mild PH showed no significant changes in the RV volume and hemodynamic parameters. In all patients, RV systolic function parameters (TAPSE, S’, RIMP, RVFAC) did not improve significantly after BPA within 24 hours. Conclusion: BPA has an ideal and rapid therapeutic effect on CTEPH patients with moderate/severe PH, and the therapeutic effect of moderate PH is better than that of severe PH, but not in mild PH; Rapid assessment of patient response after BPA could help screen patients with poor treatment outcomes to consider adjustment for subsequent treatment decisions. After BPA, the structural inverse remodeling of the right heart appeared earlier than the functional inverse remodeling.

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Clinical value of echocardiography in evaluating hemodynamics and right ventricular function in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty

Cited by 2 publications

References 29 publications

A better method to evaluate the reliability of echocardiography for assessment of pulmonary hypertension: comparison of tricuspid regurgitant spectrum quality grading and tricuspid valve regurgitation degree

A better method to evaluate the reliability of echocardiography for assessment of pulmonary hypertension: comparison of tricuspid regurgitant spectrum quality grading and tricuspid valve regurgitation degree

Study on the improvement of right ventricular structure and function after balloon pulmonary Angioplasty in chronic thrombotic pulmonary hypertension patients with different degrees of pulmonary arterial hypertension by echocardiography

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