Significance of Echocardiographic Assessment for Right Ventricular Function After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Induced Pulmonary Hypertension

Tsugu, Toshimitsu; Murata, Mitsushige; Kawakami, Takashi; Yasuda, Risako; Tokuda, Hanako; Minakata, Yugo; Tamura, Yuichi; Kataoka, Masaharu; Hayashida, Kentaro; Tsuruta, Hikaru; Maekawa, Yuichiro; Inoue, Soushin; Fukuda, Keiichi

doi:10.1016/j.amjcard.2014.10.034

Cited by 70 publications

(41 citation statements)

References 19 publications

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“…Data comparing outcomes of PEA in operable patients with those of BPA in inoperable patients suggest that the efficacy and safety of the two procedures are similar in their target cohorts [35]. In addition to the improvements in haemodynamics and functional capacity, there is accumulating evidence that BPA leads to improvements in right ventricular function, including volumes, ejection fraction, peak systolic strain, myocardial remodelling and alleviation of dyssynchrony [31,32,[36][37][38].…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

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Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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“…Gray scale imaging of the RV 4CV was obtained with a frame rate of 40–80 Hz, and recordings were processed with acoustic-tracking software (EchoPAC; GE Healthcare), allowing off-line semi-automated speckle-based strain analysis, as described previously [24]. Briefly, lines were first manually traced along the RV endocardium before an additional epicardial line was automatically generated by the software to create a region of interest.…”

Section: Methodsmentioning

confidence: 99%

“…Three-dimensional echocardiographic images were obtained from the apical window with the patient in the same position as for 2D echocardiography, as described previously [24]. Briefly, echocardiographic images were stored digitally for offline analysis using TomTec 4D RV Function software (4D analysis; TomTec, Munich, Germany).…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

et al. 2016

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BackgroundRight ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, it remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH. The aim of this study was to identify the most useful parameter that correlates with hemodynamics and predicts clinical outcomes in PAH.ResultsMost of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan-Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH.Materials and MethodsEighty-six consecutive patients were enrolled in this study. RV hemodynamic parameters were measured by right heart catheterization (RHC). RV function was assessed using two-dimensional speckle-tracking echocardiography and three-dimensional transthoracic echocardiography (3DTTE) to evaluate RV free wall global strain (RVFS) and RVEF.ConclusionsRVEF measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in PAH patients.

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“…The measurement of RV global longitudinal systolic strain using 2D speckle tracking analysis has been described previously [14,15]. Briefly, from the apical 4-chamber view, a region of interest (ROI) was manually traced along the endocardial border of the RV free wall and septal wall, and the width was set to match wall thickness.…”

Section: Two-dimensional Speckle Tracking Strain Analysismentioning

confidence: 99%