Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy

Ghio, Stefano; Morsolini, Marco; Corsico, Angelo Guido; Klersy, Catherine; Mattiucci, Gabriella; Raineri, Claudia; Vistarini, Nicola; Visconti, Luigi Oltrona; D’Armini, Andrea Maria

doi:10.1183/09031936.00195313

Cited by 27 publications

(27 citation statements)

References 24 publications

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“…Surie et al examined RV response to exercise with CMR in 13 CTEPH patients and 12 months after PEA; however, the patients exercised only at 40% of maximal workload . Other studies are retrospective, with the absence of simultaneous echocardiography or CMR imaging during exercise . Thus, our study adds new information by including consecutive CTEPH patients undergoing PEA, by using more advanced and newer echocardiographic modalities at rest and by studying the relationship between RV systolic function and physical capacity using maximal workload.…”

Section: Discussionmentioning

confidence: 98%

“…[5][6][7][8][9][10] A few studies have examined the association between RV systolic function in relation to physical capacity in CTEPH patients undergoing PEA. 3,[11][12][13][14][15] The existing exercise hemodynamic and echocardiographic studies evaluating the effect of PEA in CTEPH patients are characterized by different methodological designs regarding level of workload, post-PEA examination timing, level of pulmonary arterial pressure and absence of simultaneous echocardiographic and exercise testing. 3,[11][12][13][14][15] The association between symptoms, disease severity measured by RV systolic function, and prognosis has routinely been evaluated during resting conditions using 2D Doppler echocardiography.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2019

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Aims To characterize right ventricular (RV) geometry and function in chronic thromboembolic pulmonary hypertension (CTEPH) patients at rest and during exercise before pulmonary thromboendarterectomy (PEA), and at 3 and 12 months after PEA using two‐dimensional and three‐dimensional echocardiography with reference to clinical performance and exercise capacity. Methods and results Forty subjects (20 CTEPH patients and 20 controls) were enrolled between December 2014 and January 2017. Three‐dimensional echocardiography demonstrated a significant reduction and normalization of end‐diastolic and end‐systolic RV volumes in CTEPH patients 12 months after PEA. RV systolic function improved after PEA; however, tricuspid annular plane systolic excursion (TAPSE) (baseline 18 ± 6 mm vs 15 ± 3 mm at 12 months after PEA, P < .05) and tricuspid lateral annular systolic velocity (RV‐S′) (baseline −8.3 ± 2.1 cm/s vs −7.2 ± 1.3 cm/s at 12 months after PEA, P < .05) declined significantly after PEA. Tricuspid regurgitation gradient was 64 ± 21 mm Hg at baseline, 40 ± 14 mm Hg at 3 months, and 30 ± 13 at 12 months, P < .00001. RV free‐wall longitudinal strain at peak exercise was significantly increased from baseline (−10.6 ± 5.5%) to 12 months of follow‐up (−15.8 ± 5.2%), P < .005. Physical exercise capacity, measured as peak oxygen uptake, was significantly increased and correlated directly with improvement of resting and exercise‐induced RV‐EF. Conclusion Improvement of RV geometry and systolic function, along with the reduction of systolic pulmonary pressure, can be expected following PEA in CTEPH patients during long‐term follow‐up. Improvement of RV myocardial contractility after PEA was only revealed at peak exercise over time. Importantly, physical exercise capacity was significantly increased and was found to be directly correlated with improvement of resting and exercise‐induced RV‐EF.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Successful PEA is able to reduce pulmonary arterial haemodynamic with recovery of both cardiac and respiratory function and clinical benefit on exercise capacity and improving quality of life 180 , 181 …”

Section: Overview Of Medical and Surgical Therapymentioning

confidence: 99%

ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism

D’Agostino

Zonzin

Enea

et al. 2017

European Heart Journal Supplements

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Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.

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“…However, despite successful PEA, some patients can still have limited exercise capacity [4], which remains even lower if the pulmonary hemodynamics do not normalize [5]. Reduced pulmonary arterial compliance, age, sex, and the extent of recovery of both cardiac and respiratory function are important determinants of exercise capacity in patients with CTEPH after PEA [6]. The improvement in exercise tolerance, physical activity, and ability to cope with activities of daily living should be a target of the comprehensive management of these patients [7].…”

Section: Introductionmentioning

confidence: 99%

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

Rovere

Pinna

et al. 2018

Respiration

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Background: After undergoing a procedure of pulmonary endarterectomy (PEA), patients with chronic thromboembolic pulmonary hypertension (CTEPH) may still experience reduced exercise capacity. Data on effects of exercise training in these patients are scant. Objectives: To evaluate the effectiveness of exercise training after PEA for CTEPH and if the presence of “residual pulmonary hypertension” may affect the outcome. Methods: Retrospective data analysis of CTEPH patients undergoing inpatient exercise training after PEA. According to predefined criteria, patients were divided into those with (group 1) and without (group 2) a “good” post-surgery hemodynamic response. Assessments of the 6-min walking distance test (6-min walking distance test [6 MWT]: primary outcome) were performed before and after surgery (before training), after training and at 3-month follow-up. Hemodynamic and lung function data were also analyzed. Results: Data of 84 and 26 patients of groups 1 and 2, respectively, were analyzed. After surgery patients showed a reduction in 6 MWT, which significantly reversed after training and further improved at 3 months (p = 0.0001), without any significant difference between groups. The percentage of patients reaching the minimal clinically important difference in 6 MWT was similar between groups. The significant (p = 0.0001) post-surgery improvement in hemodynamics was maintained at 3 months without any significant difference between groups. New York Heart Association functional class improved in parallel to the hemodynamic improvement. Conclusions: Exercise training in patients with CTEPH after PEA, an inpatient exercise training program, improves exercise capacity for up to 3 months, independently of the post-surgery hemodynamic response.

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Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy

Cited by 27 publications

References 24 publications

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

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

ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

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