Ryotaro Asano1, Takeshi Ogo2, Keiko Ohta-Ogo3, Shigefumi Fukui4, Akihiro Tsuji4, Jin Ueda4, Nao Konagai4, Tetsuya Fukuda5, Yoshiaki Morita5, Teruo Noguchi6, Kengo Kusano6, Toshihisa Anzai6, Hatsue Ishibashi-Ueda3, Satoshi Yasuda6. 1. Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 2. Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Medicine for Pulmonary Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: tak@ncvc.go.jp. 3. Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan. 4. Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 5. Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan. 6. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Abstract
BACKGROUND: Balloon pulmonary angioplasty (BPA) has shown beneficial effects for chronic thromboembolic pulmonary hypertension (CTEPH). However, previous studies have shown less cardiac output improvement and symptoms remaining after BPA, implying poor right ventricular (RV) function recovery. Therefore, we investigated the residual RV dysfunction after BPA to reveal risk factors, clinical effects, and possible underlying histopathological mechanisms. METHODS AND RESULTS: We investigated 61 consecutive CTEPH patients who underwent cardiovascular magnetic resonance before and 3 and 12 months after BPA series. Residual dysfunction (RD) of RV was defined as RV end-diastolic volume index >100 ml/m2 or RV ejection fraction (EF) <45% at 12-month follow-up. Patients were divided into RD (44%) and normalized dysfunction (ND) (56%) groups. Compared with the ND group, the RD group had significantly worse World Health Organization (WHO) functional class at follow-up. No significant hemodynamic differences were observed between the groups. On multivariable logistic regression analysis, male sex (odds ratio [OR] 12.5, p = 0.004) and prolonged QRS duration (OR 1.08, p = 0.029) were independently associated with residual RV dysfunction. Additionally, RV histopathology in 11 CTEPH autopsy cases showed that QRS duration was correlated with RV fibrosis area. CONCLUSIONS: Relatively high percentage (44%) of residual RV dysfunction with worse WHO functional class was observed in CTEPH patients even after BPA. Prolonged QRS duration may predict poor recovery in RV function after BPA.
BACKGROUND:Balloon pulmonary angioplasty (BPA) has shown beneficial effects for chronic thromboembolic pulmonary hypertension (CTEPH). However, previous studies have shown less cardiac output improvement and symptoms remaining after BPA, implying poor right ventricular (RV) function recovery. Therefore, we investigated the residual RV dysfunction after BPA to reveal risk factors, clinical effects, and possible underlying histopathological mechanisms. METHODS AND RESULTS: We investigated 61 consecutive CTEPHpatients who underwent cardiovascular magnetic resonance before and 3 and 12 months after BPA series. Residual dysfunction (RD) of RV was defined as RV end-diastolic volume index >100 ml/m2 or RV ejection fraction (EF) <45% at 12-month follow-up. Patients were divided into RD (44%) and normalized dysfunction (ND) (56%) groups. Compared with the ND group, the RD group had significantly worse World Health Organization (WHO) functional class at follow-up. No significant hemodynamic differences were observed between the groups. On multivariable logistic regression analysis, male sex (odds ratio [OR] 12.5, p = 0.004) and prolonged QRS duration (OR 1.08, p = 0.029) were independently associated with residual RV dysfunction. Additionally, RV histopathology in 11 CTEPH autopsy cases showed that QRS duration was correlated with RV fibrosis area. CONCLUSIONS: Relatively high percentage (44%) of residual RV dysfunction with worse WHO functional class was observed in CTEPHpatients even after BPA. Prolonged QRS duration may predict poor recovery in RV function after BPA.
Authors: Sylwia Sławek-Szmyt; Aleksander Araszkiewicz; Stanisław Jankiewicz; Anna Smukowska-Gorynia; Marek Grygier; Magdalena Janus; Maciej Lesiak; Tatiana Mularek-Kubzdela Journal: J Clin Med Date: 2022-01-26 Impact factor: 4.241
Authors: Michał Piłka; Szymon Darocha; Marta Banaszkiewicz; Maria Wieteska-Miłek; Małgorzata Mańczak; Rafał Mańczak; Piotr Kędzierski; Michał Florczyk; Anna Dobosiewicz; Adam Torbicki; Marcin Kurzyna Journal: Ann Noninvasive Electrocardiol Date: 2020-04-26 Impact factor: 1.468