Effects of Right Ventricular Remodeling in Chronic Thromboembolic Pulmonary Hypertension on the Outcomes of Balloon Pulmonary Angioplasty: a 2D-speckle Tracking Echocardiography Study

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2024 Apr 15

PMID 38622598

Authors

Yaning Ma

Dichen Guo

Jianfeng Wang

Juanni Gong

Huimin Hu

Xinyuan Zhang

Yeqing Wang

Yuanhua Yang

Xiuzhang Lv

Yidan Li

Affiliations

Soon will be listed here.

Abstract

Background: Balloon pulmonary angioplasty (BPA) improves the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricle (RV) is an important predictor of prognosis in CTEPH patients. 2D-speckle tracking echocardiography (2D-STE) can evaluate RV function. This study aimed to evaluate the effectiveness of BPA in CTEPH patients and to assess the value of 2D-STE in predicting outcomes of BPA.

Methods: A total of 76 patients with CTEPH underwent 354 BPA sessions from January 2017 to October 2022. Responders were defined as those with mean pulmonary artery pressure (mPAP) ≤ 30 mmHg or those showing ≥ 30% decrease in pulmonary vascular resistance (PVR) after the last BPA session, compared to baseline. Logistic regression analysis was performed to identify predictors of BPA efficacy.

Results: BPA resulted in a significant decrease in mPAP (from 50.8 ± 10.4 mmHg to 35.5 ± 11.9 mmHg, p < 0.001), PVR (from 888.7 ± 363.5 dyn·s·cm to 545.5 ± 383.8 dyn·s·cm, p < 0.001), and eccentricity index (from 1.3 to 1.1, p < 0.001), and a significant increase in RV free wall longitudinal strain (RVFWLS: from 15.7% to 21.0%, p < 0.001). Significant improvement was also observed in the 6-min walking distance (from 385.5 m to 454.5 m, p < 0.001). After adjusting for confounders, multivariate analysis showed that RVFWLS was the only independent predictor of BPA efficacy. The optimal RVFWLS cutoff value for predicting BPA responders was 12%.

Conclusions: BPA was found to reduce pulmonary artery pressure, reverse RV remodeling, and improve exercise capacity. RVFWLS obtained by 2D-STE was an independent predictor of BPA outcomes. Our study may provide a meaningful reference for interventional therapy of CTEPH.

References

Guth S, Mayer E, Prufer D, Wiedenroth C . Pulmonary endarterectomy: technique and pitfalls. Ann Cardiothorac Surg. 2022; 11(2):180-188. PMC: 9012198. DOI: 10.21037/acs-2021-pte-185. View

Gonzalez-Hermosillo L, Cueto-Robledo G, Roldan-Valadez E, Graniel-Palafox L, Garcia-Cesar M, Torres-Rojas M . Right Heart Catheterization (RHC): A Comprehensive Review of Provocation Tests and Hepatic Hemodynamics in Patients With Pulmonary Hypertension (PH). Curr Probl Cardiol. 2022; 47(12):101351. DOI: 10.1016/j.cpcardiol.2022.101351. View

Jais X, Brenot P, Bouvaist H, Jevnikar M, Canuet M, Chabanne C . Balloon pulmonary angioplasty versus riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension (RACE): a multicentre, phase 3, open-label, randomised controlled trial and ancillary follow-up study. Lancet Respir Med. 2022; 10(10):961-971. DOI: 10.1016/S2213-2600(22)00214-4. View

Fukui S, Ogo T, Morita Y, Tsuji A, Tateishi E, Ozaki K . Right ventricular reverse remodelling after balloon pulmonary angioplasty. Eur Respir J. 2014; 43(5):1394-402. DOI: 10.1183/09031936.00012914. View

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View

Mendiola E, Da Silva Goncalves Bos D, Leichter D, Vang A, Zhang P, Leary O . Right Ventricular Architectural Remodeling and Functional Adaptation in Pulmonary Hypertension. Circ Heart Fail. 2023; 16(2):e009768. PMC: 9974595. DOI: 10.1161/CIRCHEARTFAILURE.122.009768. View

Darocha S, Roik M, Kopec G, Araszkiewicz A, Furdal M, Lewandowski M . Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry. EuroIntervention. 2021; 17(13):1104-1111. PMC: 9725062. DOI: 10.4244/EIJ-D-21-00230. View

Broch K, Murbraech K, Ragnarsson A, Gude E, Andersen R, Fiane A . Echocardiographic evidence of right ventricular functional improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant. 2015; 35(1):80-86. DOI: 10.1016/j.healun.2015.08.007. View

Valerio L, Mavromanoli A, Barco S, Abele C, Becker D, Bruch L . Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study. Eur Heart J. 2022; 43(36):3387-3398. PMC: 9492241. DOI: 10.1093/eurheartj/ehac206. View

10.

Martin-Suarez S, Loforte A, Cavalli G, Gliozzi G, Botta L, Mariani C . Therapeutic alternatives in chronic thromboembolic pulmonary hypertension: from pulmonary endarterectomy to balloon pulmonary angioplasty to medical therapy. State of the art from a multidisciplinary team. Ann Cardiothorac Surg. 2022; 11(2):120-127. PMC: 9012190. DOI: 10.21037/acs-2021-pte-23. View

11.

Carluccio E, Biagioli P, Lauciello R, Zuchi C, Mengoni A, Bardelli G . Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure. J Am Soc Echocardiogr. 2019; 32(7):836-844.e1. DOI: 10.1016/j.echo.2019.02.011. View

12.

Wiedenroth C, Deissner H, Adameit M, Kriechbaum S, Ghofrani H, Breithecker A . Complications of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: Impact on the outcome. J Heart Lung Transplant. 2022; 41(8):1086-1094. DOI: 10.1016/j.healun.2022.05.002. View

13.

Olsson K, Wiedenroth C, Kamp J, Breithecker A, Fuge J, Krombach G . Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: the initial German experience. Eur Respir J. 2017; 49(6). DOI: 10.1183/13993003.02409-2016. View

14.

Zhang X, Guo D, Wang J, Gong J, Wu X, Jiang Z . Speckle tracking for predicting outcomes of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Echocardiography. 2020; 37(6):841-849. DOI: 10.1111/echo.14709. View

15.

Ghofrani H, Kim N . Medical and interventional therapies for inoperable CTEPH: a necessary combination?. Lancet Respir Med. 2022; 10(10):926-927. DOI: 10.1016/S2213-2600(22)00227-2. View

16.

Ghofrani H, Simonneau G, DArmini A, Fedullo P, Howard L, Jais X . Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study. Lancet Respir Med. 2017; 5(10):785-794. DOI: 10.1016/S2213-2600(17)30305-3. View

17.

Tsukada J, Yamada Y, Kawakami T, Matsumoto S, Inoue M, Nakatsuka S . Treatment effect prediction using CT after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Radiol. 2021; 31(8):5524-5532. DOI: 10.1007/s00330-021-07711-5. View

18.

Park J, Kusunose K, Kwon D, Park M, Erzurum S, Thomas J . Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension. Korean Circ J. 2015; 45(5):398-407. PMC: 4580699. DOI: 10.4070/kcj.2015.45.5.398. View

19.

Chen B, Xing H, Gong J, Guo X, Xi X, Yang Y . Imaging of cardiac fibroblast activation in patients with chronic thromboembolic pulmonary hypertension. Eur J Nucl Med Mol Imaging. 2021; 49(4):1211-1222. DOI: 10.1007/s00259-021-05577-9. View

20.

Rako Z, Kremer N, Yogeswaran A, Richter M, Tello K . Adaptive versus maladaptive right ventricular remodelling. ESC Heart Fail. 2022; 10(2):762-775. PMC: 10053363. DOI: 10.1002/ehf2.14233. View