Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Int J Cardiovasc Imaging. 2020 Jun;36(6):1053-1060. doi: 10.1007/s10554-020-01798-5. Epub 2020 Feb 21.
Remodeling in the right-sided heart plays an important role in the management of pulmonary hypertension (PH) patients. However, the effect of balloon pulmonary angioplasty (BPA) on right ventricular (RV) and right atrial (RA) morphology of patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains uncertain. This study involved 45 CTEPH patients who underwent BPA with mean pulmonary artery pressure (mPAP) of 37.0 mmHg (all ≥ 25 mmHg). All patients underwent echocardiography and right-heart catheterization at baseline and 3 months after BPA. RV and RA remodeling was assessed as RV and the RA area, and RV systolic function was calculated by averaging peak speckle-tracking longitudinal strain of the RV free-wall (RV free-wall strain). Significant reverse remodeling in the right-sided heart was observed after BPA, resulting in improvement of mPAP and pulmonary vascular resistance (RV area: from 15.0 ± 5.3 to 9.6 ± 3.0 cm, p < 0.0001; RA area: from 17.3 ± 6.6 to 13.4 ± 3.8 cm, p = 0.0002; RV free-wall strain: from 15.9 ± 5.6 to 21.2 ± 4.9%, p < 0.0001). Furthermore, multiple regression analysis showed that the baseline RV area was an independent predictor of post-BPA normalization of RV systolic function defined as RV free-wall strain ≥ 20% (odds ratio = 1.16, p = 0.0305). Interestingly, significant RV reverse remodeling was also observed after additional BPA even in 18 CTEPH patients with residual pulmonary arterial stenosis, whose mPAP was normalized after BPA (RV area: from 11.5 ± 3.8 to 9.2 ± 3.8 cm, p = 0.0045; RV free-wall strain: from 17.2 ± 4.8 to 22.8 ± 7.4%, p = 0.0216). Significant reverse remodeling in the right-sided heart, as well as hemodynamic improvement, was observed in CTEPH patients after BPA.
右心重构在肺动脉高压（PH）患者的管理中起着重要作用。然而，球囊肺动脉成形术（BPA）对慢性血栓栓塞性肺动脉高压（CTEPH）患者右心室（RV）和右心房（RA）形态的影响尚不确定。这项研究涉及 45 例接受 BPA 治疗的 CTEPH 患者，平均肺动脉压（mPAP）为 37.0mmHg（均≥25mmHg）。所有患者在 BPA 前和 3 个月后均接受超声心动图和右心导管检查。RV 和 RA 重构通过 RV 游离壁（RV 游离壁应变）的峰值斑点追踪纵向应变的平均值来评估 RV 和 RA 面积，RV 收缩功能。BPA 后右心显著反向重构，导致 mPAP 和肺血管阻力改善（RV 面积：从 15.0±5.3cm 增加到 9.6±3.0cm，p<0.0001；RA 面积：从 17.3±6.6cm 增加到 13.4±3.8cm，p=0.0002；RV 游离壁应变：从 15.9±5.6%增加到 21.2±4.9%，p<0.0001）。此外，多元回归分析显示，BPA 前 RV 面积是 RV 收缩功能后 BPA 正常化的独立预测因子，定义为 RV 游离壁应变≥20%（比值比=1.16，p=0.0305）。有趣的是，即使在 18 例 BPA 后仍有残余肺动脉狭窄的 CTEPH 患者中，也观察到显著的 RV 反向重构，其 mPAP 在 BPA 后正常化（RV 面积：从 11.5±3.8cm 增加到 9.2±3.8cm，p=0.0045；RV 游离壁应变：从 17.2±4.8%增加到 22.8±7.4%，p=0.0216）。BPA 后，CTEPH 患者右心显著反向重构和血流动力学改善。
