Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy

Abstract

The aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 ± 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 ± 61.5 vs. 216.6 ± 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients.

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

“…In accordance with previous studies, we observed a significant reverse geometric remodeling of the right atrium 3 months after PEA, which also could lead to improved RV diastolic filling. Olson N. et al demonstrated that after PEA, also LV systolic myocardial deformation has been demonstrated to improve following effects from improved LV diastolic function; however, the study was limited by a short‐term follow‐up after PEA (9.1 ± 3.9 after) .…”

“…We found a persistent lack of ability to increase RV-EF and RV-GLS during peak exercise before as well as after PEA. Physical capacity over time was improved and correlated directly with improvement in RV performance.In accordance with previous studies, we observed a significant reverse geometric remodeling of the right atrium 3 months after PEA,1,20 which also could lead to improved RV diastolic filling. Olson N. et al demonstrated that after PEA, also LV systolic myocardial F I G U R E 3 Impact of cardiac afterload on right ventricle systolic function was evaluated by two-dimensional echocardiography.…”

Remodelado auricular derecho y niveles plasmáticos de Galectina-3 se relacionan con la capacidad funcional de pacientes con hipertensión arterial pulmonar

“…La función y remodelado ventricular derecho tiene un significativo valor pronóstico en pacientes con HAP 2-3 y técnicas de deformación de imagen permiten una sensible evaluación del remodelado y la función VD 4 . Por otro lado, el remodelado y función auricular derecha (AD) evaluada por ecocardiografía usando speckle tracking 5 y por resonancia nuclear magnética 6 se asocian con eventos clínicos en pacientes con HAP.…”