MRI-derived Regional Biventricular Function in Patients with Chronic Thromboembolic Pulmonary Hypertension Before and After Pulmonary Endarterectomy.

RATIONALE AND OBJECTIVES

The aim of this study was to assess regional myocardial function in patients with chronic thromboembolic hypertension (CTEPH) before and after successful pulmonary endarterectomy (PEA) using magnetic resonance imaging.

METHODS

Twenty-two patients with CTEPH underwent cardiac magnetic resonance imaging before and 12 (11, 17) days after PEA. Mean pulmonary artery pressure was evaluated preoperatively by right heart catheterization and during post-PEA intensive care unit-stay using a Swan-Ganz catheter. Biventricular peak systolic longitudinal, radial, circumferential strain and time-to-peak strain were obtained by tissue-tracking analysis.

RESULTS

Mean pulmonary artery pressure decreased (46 mm Hg (34.5, 55) to 24 mm Hg (16, 27); P < .0001) and stroke volume increased (P < .0001) after PEA. In the right ventricle (RV) peak radial strain increased in the anterior (P = .04) and in the inferior wall (P = .0012) and slightly missed statistical significance in the lateral wall (P = .051) and septum (P = .07). Circumferential strain increased in the lateral (P = .0002) and inferior wall of the RV (P = .03) and in the lateral as well as in the inferior wall of the left ventricle (P = .01; P = .03). Radial, longitudinal, and circumferential time-to-peak strain shortened (P < .0001) with resynchronization of the ventricles 12 days after PEA.

CONCLUSION

While biventricular resynchronization and recovery of global predominantly RV function was observed, regional circumferential function mainly improved in the lateral and inferior walls of both ventricles and regional radial function in the RV wall and septum 12 days after PEA, suggesting fibers primarily affected by myocardial stress in patients with CTEPH possibly need a relatively longer recovery time.