Title: Tricuspid annular plane systolic excursion in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy
Abstract: Background Right ventricular function is impaired in chronic thromboembolic pulmonary hypertension ( CTEPH ). Tricuspid annular plane systolic excursion ( TAPSE ) and right ventricular fractional area change ( RVFAC ) have been shown to help assess right ventricular function in pulmonary hypertension. Our goal was to (1) assess TAPSE and RVFAC before and after PTE , and (2) assess correlation of these variables with right heart catheterization data and PVR . Methods We evaluated 67 consecutive patients with CTEPH for pulmonary thromboendarterectomy ( PTE ). Of these 67 patients, 48 were deemed surgical candidates. Preoperative right heart catheterization was performed within 1.3±1.2 days of the preoperative echocardiogram. All postoperative right heart catheterizations were performed on the first postoperative day. Results TAPSE dropped from 18±6 to 10±3 mm after PTE ( P <.0001). RVFAC remained the same (25%±10% vs 30%±12%). Mean pulmonary artery ( mPAP ) pressure dropped from 45±12 to 28±6 mm Hg after PTE , and pulmonary vascular resistance ( PVR ) decreased from 757±406 to 306±147 dyne‐s/cm 5 ( P <.0001 for both). Before PTE , TAPSE correlated inversely with PVR ( r =−.57, P <.0001, TAPSE =−5.904×ln[ PVR ]+56.318). RVFAC did not correlate well with PVR or mean pulmonary artery pressure. After PTE , both TAPSE and RVFAC correlated poorly with PVR ( r =−.12 and .01, respectively). Conclusion In patients with CTEPH , TAPSE paradoxically decreased by 50% early after PTE . TAPSE correlated inversely with PVR prior to PTE , but this correlation was lost completely after PTE . Thus, despite the immediate and marked decrease in afterload postoperatively, TAPSE did not improve; thus, TAPSE cannot be used as an early marker for surgical success.
Publication Year: 2016
Publication Date: 2016-09-07
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 15
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