Chen Jiaxin, Ding Shangwei, Zhang Chenkai, Li Rifei, Guo Wenliang, Hong Chen, Tang Qing
Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2022 May;14(5):1401-1410. doi: 10.21037/jtd-21-1536.
Patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) are eligible for balloon pulmonary angioplasty (BPA). However, the short-term effects of BPA on pulmonary hemodynamics and right ventricular (RV) function in patients with CTEPH have not been elucidated. In the current study, echocardiography was conducted to explore the short-term effects of BPA on inoperable CTEPH patients.
A total of 30 inoperable CTEPH patients who underwent echocardiography before and after BPA were enrolled to the present retrospective study. Right heart catheterization (RHC) parameters, echocardiography function parameters, and echocardiography structural parameters of patients were evaluated at baseline and within 24 hours after BPA and the results were compared.
RHC parameters including pulmonary artery systolic pressure (PASP), pulmonary artery diastolic pressure (PADP), mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR), and echocardiography structural parameters including right atrium diameter (RAD), right ventricular end-diastolic area (RVEDA), right ventricular end-systolic area (RVESA), right atrium end-diastolic area (RAEDA) and right atrium end-systolic area (RAESA) significantly improved within 24 h after BPA compared with the baseline results (P<0.05). However, there were no significant differences in echocardiography function parameters including tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), tricuspid annular plane systolic excursion (TAPSE), right ventricular index of myocardial performance (RIMP), right ventricular fractional area change (RVFAC) and left ventricular stroke volume (LVSV) before and after BPA.
The findings show that a single BPA procedure significantly improves RV volume load and reduces the pulmonary blood pressure in CTEPH patients in the short-term. However, BPA does not improve RV systolic function 24 hours after the procedure. The results indicate that evaluation of RV structural and function with echocardiography is an effective approach for non-invasive monitoring of patient status after BPA.
无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者适合接受球囊肺动脉成形术（BPA）。然而，BPA对CTEPH患者肺血流动力学和右心室（RV）功能的短期影响尚未阐明。在本研究中，进行超声心动图检查以探讨BPA对无法手术的CTEPH患者的短期影响。
本回顾性研究纳入了30例在BPA前后接受超声心动图检查的无法手术的CTEPH患者。在基线时以及BPA后24小时内评估患者的右心导管检查（RHC）参数、超声心动图功能参数和超声心动图结构参数，并比较结果。
与基线结果相比，BPA后24小时内，包括肺动脉收缩压（PASP）、肺动脉舒张压（PADP）、平均肺动脉压（mPAP）和肺血管阻力（PVR）在内的RHC参数，以及包括右心房直径（RAD）、右心室舒张末期面积（RVEDA）、右心室收缩末期面积（RVESA）、右心房舒张末期面积（RAEDA）和右心房收缩末期面积（RAESA）在内的超声心动图结构参数均有显著改善（P<0.05）。然而，BPA前后包括组织多普勒衍生的三尖瓣侧环收缩速度（S'）、三尖瓣环平面收缩期位移（TAPSE）、右心室心肌性能指数（RIMP）、右心室面积变化分数（RVFAC）和左心室每搏输出量（LVSV）在内的超声心动图功能参数无显著差异。
研究结果表明，单次BPA手术可在短期内显著改善CTEPH患者的RV容量负荷并降低肺血压。然而术后24小时BPA并未改善RV收缩功能。结果表明，用超声心动图评估RV结构和功能是BPA术后无创监测患者状态的有效方法。
