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- Title
Tricuspid annular plane systolic excursion in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.
- Authors
Wong, Darrin J.; Sampat, Unnati; Gibson, Michael A.; Auger, William R.; Madani, Michael M.; Daniels, Lori B.; Raisinghani, Ajit B.; DeMaria, Anthony N.; Blanchard, Daniel G.
- 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/cm5 ( 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.
- Subjects
RIGHT heart ventricle; LUNG physiology; PULMONARY hypertension diagnosis; TRICUSPID valve; PULMONARY artery; BLOOD pressure; CARDIAC catheterization; CHRONIC diseases; ECHOCARDIOGRAPHY; ENDARTERECTOMY; CARDIAC patients; LONGITUDINAL method; MEDICAL needs assessment; PULMONARY hypertension; THROMBOSIS; VEIN surgery; DATA analysis; DATA analysis software; DESCRIPTIVE statistics; PHYSIOLOGY; ANATOMY
- Publication
Echocardiography, 2016, Vol 33, Issue 12, p1805
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13364