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Right ventricular strain predicts exercise tolerance after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

Session CTEPH: Catheter-directed and surgical therapy

Speaker Toshimitsu Tsugu

Event : ESC Congress 2017

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Hypertension
  • Session type : Moderated Posters

Authors : T Tsugu (Tokyo,JP), M Murata (Tokyo,JP), T Kawamura (Tokyo,JP), M Kataoka (Tokyo,JP), Y Minakata (Tokyo,JP), H Tsuruta (Tokyo,JP), Y Itabashi (Tokyo,JP), Y Maekawa (Tokyo,JP), H Mitamura (Tokyo,JP), K Fukuda (Tokyo,JP)

Authors:
T. Tsugu1 , M. Murata2 , T. Kawamura3 , M. Kataoka3 , Y. Minakata3 , H. Tsuruta3 , Y. Itabashi3 , Y. Maekawa3 , H. Mitamura1 , K. Fukuda3 , 1Tachikawa Hospital, Department of Cardilogy - Tokyo - Japan , 2Keio University School of Medicine, Department of Laboratory Medicine - Tokyo - Japan , 3Keio University School of Medicine, Department of Cardilogy - Tokyo - Japan ,

Topic(s):
Chronic pulmonary hypertension

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 836

Background: The prognosis of chronic thromboembolic pulmonary hypertension (CTEPH) is poor. Balloon pulmonary angioplasty (BPA) has a potential to overcome this problem. However, even though hemodynamics may significantly be improved with BPA, exercise tolerance is not always ameliorated correspondingly.

Purpose: The objective of this study was to investigate if any laboratory parameters can predict exercise tolerance by examining the correlation between RV function and exercise tolerance after BPA, using right heart catheterization (RHC) and echocardiography.

Methods: We studied consecutive 68 patients with CTEPH. Assessments of RV hemodynamics and function were performed before, after, and 6 months after BPA. RV hemodynamic parameters including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output, were measured by RHC. RV function was assessed by conventional echocardiographic parameters such as RV diameter, tricuspid annular plain systolic excursion, RV S', RV index of myocardial performance, and RV fractional area change. Furthermore, the two-dimensional speckle-tracking echocardiography as well as the three-dimensional transthoracic echocardiography (3D-TTE) were used to investigate RV strain and RV volumetric parameters including RV ejection fraction and RV end diastolic volume and systolic volume. Exercise capacity was assessed by 6-minute walk distance (6MWD) before and 6 months after BPA.

Results: Hemodynamic parameters such as mPAP, PVR, and cardiac index were significantly improved immediately after BPA, and the effects of BPA were maintained at follow up after 6 months. Among all cases, PVR was normalized after 6 months in 53 cases (78%). RV free wall longitudinal strain at 6 months after BPA (RVFS_6M) was inversely correlated with 6MWD (r=0.33, p=0.02) in these 53 cases, implicating that RV dysfunction after BPA was associated with exercise tolerance regardless of RV afterload. Therefore, we investigated the RV parameters before BPA that correlated with RVFS_6M. Three-dimensional RV ejection fraction (r=0.35, p=0.01) and RV free wall longitudinal strain before BPA (RVFS_pre) (r=0.43, p=0.01) were significantly correlated with RVFS_6M. Receiver operating characteristic analysis revealed that the smaller RVFS_pre (<-15.9%) was the strongest predictor for normalization of RVFS_6M (area under the curve 0.71, p=0.02) among RV parameters.

Conclusions: Although RV afterload affects the RV function, RV myocardial injury may remain and be associated with persistent RV dysfunction and impaired exercise tolerance even after successful BPA therapy. Thus the assessment of RV function would be useful for the management of CTEPH.

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