Effects of BPA on right ventricular mechanical dysfunction in patients with inoperable CTEPH – A cardiac magnetic resonance study. Issue 147 (February 2022)

• Record Type: Journal Article
• Authors: Roller, Fritz C.; Schüssler, Armin; Hasse, Alexander; Kriechbaum, Steffen; Richter, Manuel; Guth, Stefan; Tello, Khodr; Breithecker, Andreas; Liebetrau, Christoph; Hamm, Christian W.; Mayer, Eckhard; Seeger, Werner; Krombach, Gabriele A.; Wiedenroth, Christoph B.
• Is Part Of: European journal of radiology. Issue 147(2022)
• Publication Date: 2022-02
• Subjects: Hypertension -- Pulmonary -- Ventricular Function -- Right -- Ventricular Dysfunction, Right -- Ventricular Remodelling -- Magnetic Resonance Imaging; BPA balloon pulmonary angioplasty -- BSA body surface area -- CMR cardiac magnetic resonance -- CTEPH chronic thromboembolic pulmonary hypertension -- CV chamber view -- ECV extracellular volume fraction -- EDV end-diastolic volume -- EF ejection fraction -- EMB endomyocardial biopsy -- ESD end-systolic diameter -- ESV end-systolic volume -- GCS global circumferential strain -- GLS global longitudinal strain -- GRS global radial strain -- LGE late gadolinium enhancement -- LV left ventricular -- mPAP mean pulmonary arterial pressure -- PA pulmonary artery -- PEA pulmonary endarterectomy -- PH pulmonary hypertension -- RVEF right ventricular ejection fraction -- RVIP right ventricular insertion point -- RV-PA right ventricular pulmonary arterial coupling -- PVR pulmonary vascular resistance -- RHC right heart catheterization -- RV right ventricle -- SA short axis -- SD standard deviation -- SV stroke volume; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.110111
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Right ventricular function, pulmonary haemodynamics and right ventricular strain values improved significantly after BPA. GLS showed significant correlations with right ventricular function, pulmonary haemodynamics, and remodelling. In the future, non-invasive therapy monitoring and prognosis may be supported by strain assessment. Abstract: Purpose: The aim of this study was to assess effects of balloon pulmonary angioplasty (BPA) on right ventricular (RV) mechanical dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) via MRI. Method: MRI at 1.5 Tesla and right heart catheterization were performed before and 6 months after BPA in 30 CTEPH patients (mean age 63.4 ± 10.6 years; 17 female). Feature-tracking strain analysis, including global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain, was performed and compared with right ventricular function, myocardial remodelling (assessed by native T1 times), and pulmonary haemodynamics (mean pulmonary arterial pressure and pulmonary vascular resistance). Results: RVEF (35.9% to 48.4%) increased and mPAP (42.1 mmHg to 33.1 mmHg) and PVR (551.8 to 377.7 dyn∙s/cm 5 ) decreased after BPA (all p < 0.0001). Moreover, RV strain increased (GLS −19.9 to −24.0%, p = 0.0003; GCS −9.4 to −11.0%, p = 0.0022; GRS 38.2 to 50.7%, p = 0.001) and septal native area-adjusted T1 time (AA-T1) decreased (1019.4 to 988.7 ms, p < 0.0001). GLS revealed the best correlations with RVEF (before BPA r = -0.75; after BPA r = -0.54), mPAP (r = 0.36; r = 0.52), PVR (r = 0.49; r = 0.48), and AA-T1 (r = 0.44; 0.19). Conclusion: RV mechanical dysfunction, pulmonary haemodynamics, and myocardial remodelling are markedly improved by BPA. Moreover, RV strain values showed good correlations with RV function, pulmonary haemodynamics, and myocardial remodelling. Therefore, strain analysis might provide new insights regarding therapy outcome, monitoring, and prognosis.