scholarly journals The Usefulness of a Three Dimensional Roadmap and Pressure-Wire Assisted Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

2014 ◽  
Vol 44 (4) ◽  
pp. 278
Author(s):  
Atsushi Mizuno ◽  
Koichiro Niwa
Keyword(s):  
Pulmonary Hypertension ◽  
Three Dimensional ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pressure Wire ◽  
Thromboembolic Pulmonary Hypertension

scholarly journals Right Ventricular Diastolic Performance in Patients With Chronic Thromboembolic Pulmonary Hypertension Assessed by Echocardiography

2021 ◽  
Vol 8 ◽  
Author(s):  
Hong Meng ◽  
Wu Song ◽  
Sheng Liu ◽  
David Hsi ◽  
Lin-Yuan Wan ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Characteristic Curve ◽  
Three Dimensional ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Right Atrial ◽  
Pulmonary Endarterectomy ◽  
Thromboembolic Pulmonary Hypertension

Background: There have been no systemic studies about right heart filling pressure and right ventricular (RV) distensibility in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Therefore, we aimed to explore combinations of echocardiographic indices to assess the stages of RV diastolic dysfunction.Methods and Results: We recruited 32 healthy volunteers and 71 patients with CTEPH. All participants underwent echocardiography, cardiac catheterization (in patients with CTEPH), and a 6-min walk test (6MWT). The right atrial (RA) end-systolic area was adjusted for body surface area (BSA) (indexed RA area). RV global longitudinal diastolic strain rates (SRs) and RV ejection fraction (EF) were measured by speckle tracking and three-dimensional echocardiography (3D echo), respectively. All 71 patients with CTEPH underwent pulmonary endarterectomy. Of the 71 patients, 52 (73%) had decreased RV systolic function; 12 (16.9%), 26 (36.6%), and 33 (46.5%) patients had normal RV diastolic pattern, abnormal relaxation (stage 1), and pseudo-normal patterns (stage 2), respectively. The receiver operating characteristic curve analysis showed that the optimal cut-off values of early diastolic SR <0.8 s−1 and indexed RA area > 8.8 cm2/BSA had the best accuracy in identifying patients with RV diastolic dysfunction, with 87% sensitivity and 82% specificity. During a mean follow-up of 25.2 months after pulmonary endarterectomy, the preoperative indexed RA area was shown as an independent risk factor of the decreased 6MWT distance.Conclusions: Measuring early diastolic SR and indexed RA area would be useful in stratifying RV diastolic function.

Usefulness of peripheral-pressure-directed balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Nagamatsu ◽  
T Inami ◽  
C Nakata ◽  
K Takeuchi ◽  
H Kikuchi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Oxygen Consumption ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Peak Oxygen Consumption ◽  
Pressure Wire ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Arterial

Abstract Background Balloon pulmonary angioplasty (BPA) in expert center may be considered in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are technically non-operable for pulmonary endarterectomy. BPA based on objective quantitative methods has not been established. The endpoint at BPA sessions has not been clarified yet. Objectives The purpose of this study was to investigate the usefulness of BPA according to peripheral pressure measured by pressure wire or catheter. Methods This study included consecutive 143 CTEPH who underwent cardiopulmonary exercise test with right heart catheterization after BPA. All patients were divided into 2 groups such as angio-guided (n=47) group or pressure-guidedgroup (n=96). In pressure-guided group, the pulmonary arterial pressure (PAP) proximal and distal to the target lesion and the ratio of the 2 pressures were measured by the pressure wire or catheter. the endpoint was determined to when the pressure ratio of distal to proximal pressures was >0.7 to 0.8 finally. The dilation was stopped when the distal mean PAP after each dilation reached 35 mm Hg and when the baseline mean PAP was >35 mm Hg. Changes of hemodynamic parameters such as PAP and pulmonary vascular resistance (PVR) from baseline, and mean PAP and PVR at peak oxygen consumption, and pulmonary arterial pressure – cardiac output (PA-CO) slope were compared between two groups. All data except changes of hemodynamics from baseline were expressed by median [25th percentile-75th percentile]. Changes of hemodynamics from baseline were expressed by average [95% confidence interval] Results The median age and male were 66 [56–72] years old and 35. There were no significant differences in number of sessions and dilated vessels between two groups (Angio-guided group vs. Pressure-guided group: 4 [3–6] vs. 4 [3–5], P>0.05; 19 [12–22] vs. 17 [13–22], P>0.05). Changes of PAP and PVR from baseline in pressure-guided group was significantly higher than in angio-guided groups (Angio-guided group vs. Pressure-guided group; ΔPAP: −19 [−20 to −17] vs. −20 [−21 to −20], P>0.05; ΔPVR: −6.0 [−6.3 to −5.7] vs. −6.6 [−6.8 to −6.3], P<0.01). Mean PAP and PVR at peak oxygen consumption (VO2) and PA-CO slope in pressure-guided group were significantly lower than in angio-guided group (Angio-guided group vs. Pressure-guided group; PAP at VO2: 43 [36–50] vs. 39 [34–43], P<0.05; PVR at VO2: 2.7 [1.9–4.5] vs. 2.2 [1.6–2.9], P<0.01; PA-CO slope: 3.8 [2.1–5.2] vs. 2.9 [1.9–4.0], P<0.05). Conclusions Peripheral-pressure-directed BPA can improve hemodynamics at rest and exercise more effectively. Funding Acknowledgement Type of funding source: None

scholarly journals Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yidan Li ◽  
Lirong Liang ◽  
Dichen Guo ◽  
Yuanhua Yang ◽  
Juanni Gong ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Clinical Outcomes ◽  
Heart Function ◽  
Three Dimensional ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Heart Catheterization ◽  
Right Heart ◽  
Thromboembolic Pulmonary Hypertension ◽  
Rv Function

Background: Right ventricular (RV) function plays a vital role in the prognosis of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We used new machine learning (ML)-based fully automated software to quantify RV function using three-dimensional echocardiography (3DE) to predict adverse clinical outcomes in CTEPH patients.Methods: A total of 151 consecutive CTEPH patients were registered in this prospective study between April 2015 and July 2019. New ML-based methods were used for data management, and quantitative analysis of RV volume and ejection fraction (RVEF) was performed offline. RV structural and functional parameters were recorded using 3DE. CTEPH was diagnosed using right heart catheterization, and 62 patients underwent cardiac magnetic resonance to assess right heart function. Adverse clinical outcomes were defined as PH-related hospitalization with hemoptysis or increased RV failure, including conditions requiring balloon pulmonary angioplasty or pulmonary endarterectomy, as well as death.Results: The median follow-up time was 19.7 months (interquartile range, 0.5–54 months). Among the 151 CTEPH patients, 72 experienced adverse clinical outcomes. Multivariate Cox proportional-hazard analysis showed that ML-based 3DE analysis of RVEF was a predictor of adverse clinical outcomes (hazard ratio, 1.576; 95% confidence interval (CI), 1.046~2.372; P = 0.030).Conclusions: The new ML-based 3DE algorithm is a promising technique for rapid 3D quantification of RV function in CTEPH patients.

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