Right ventricular reverse remodelling after balloon pulmonary angioplasty

Abstract

Balloon pulmonary angioplasty (BPA) has been reported to improve haemodynamics and functional capacity, with an acceptable risk, in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not candidates for pulmonary endarterectomy. However, right ventricular (RV) function, an important predictor in CTEPH, remains to be elucidated. We aimed to examine the impact of BPA on RV remodelling and dysfunction relative to haemodynamic improvements in patients with inoperable CTEPH.20 consecutive patients with inoperable CTEPH who underwent BPA with cardiovascular magnetic resonance before and after BPA were retrospectively studied.BPA led to significant amelioration of the mean pulmonary arterial pressure, cardiac index and pulmonary vascular resistance (PVR), without death or major complications. Furthermore, BPA significantly ameliorated right-sided heart failure symptoms and signs, and exercise capacity. Cardiovascular magnetic resonance revealed a marked improvement in RV end-diastolic and end-systolic volume index, with concomitant improvements in RV ejection fraction, mass and interventricular septal bowing after BPA. Changes in RV volumes strongly correlated with changes in cardiac index and PVR.BPA induced RV reverse remodelling and improved systolic dysfunction safely by ameliorating haemodynamics in patients with inoperable CTEPH. Evaluating RV function with cardiovascular magnetic resonance may be effective for noninvasively monitoring BPA efficacy. @ERSpublications BPA safely ameliorates haemodynamics, leading to right ventricular reverse remodelling in inoperable CTEPH

Multiple Beneficial Effects of Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension

“…BPA was first used for inoperable CTEPH in the 1990 s, 22 and is now widely performed in Japan. 4-6, 23 Indeed, BPA dramatically improves not only pulmonary hemodynamics but also functional status, exercise capacity and right ventricular functions, 5, 22-24 which was also confirmed in the present study.…”

Balloon Pulmonary Angioplasty Improves Biventricular Functions and Pulmonary Flow in Chronic Thromboembolic Pulmonary Hypertension

“…27 In the present study, we were able to demonstrate that BPA improves not only RV function but also LV function in CTEPH patients. The discrepancy in the effects of BPA on LV remodeling between the two studies could be explained by the facts that in the Fukui et al study, the hemodynamic improvement by BPA was not complete (mean PA pressure, from 39.4±7.6 to 27.3±8.5 mmHg, P<0.001) and the time from the final BPA session to CMR was short (4.0±0.8 months), 27 whereas in the present study, hemodynamic improvement was complete ( Table 2) and the duration between the final BPA session and CMR was relatively long (9.0±8.7 months). Pressure overload and remodeling in the RV could cause LV dysfunction through ventricular interaction, ventricular interdependence, leftward septal shift and RV hypertrophy.…”

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

“…Published studies of BPA are discussed below and summarised in table 1 [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]43]. The first full report was published in 2001 by FEINSTEIN et al [15] in the USA, describing 18 patients with inaccessible or "nonsurgical" CTEPH.…”