Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function and exercise capacity in chronic thromboembolic pulmonary hypertension

TY - JOUR

T1 - Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function and exercise capacity in chronic thromboembolic pulmonary hypertension

AU - Kianzad, Azar

AU - Baccelli, Andrea

AU - Braams, Natalia J

AU - Andersen, Stine

AU - van Wezenbeek, Jessie

AU - Wessels, Jeroen N

AU - Celant, Lucas R

AU - Vos, Anna E

AU - Davies, Rachel

AU - Giudice, Francesco Lo

AU - Haji, Gulammehdi

AU - Rinaldo, Rocco F

AU - Vigo, Beatrice

AU - Gopalan, Deepa

AU - Symersky, Petr

AU - Winkelman, Jacobus A

AU - Boonstra, Anco

AU - Nossent, Esther J

AU - Tim Marcus, J

AU - Noordegraaf, Anton Vonk

AU - Meijboom, Lilian J

AU - de Man, Frances S

AU - Andersen, Asger

AU - Howard, Luke S

AU - Jan Bogaard, Harm

N1 - Copyright © 2023. Published by Elsevier Inc.

PY - 2024/4

Y1 - 2024/4

N2 - BACKGROUND: Long-term changes in exercise capacity and cardiopulmonary hemodynamics, after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described.METHODS: We analysed the data from two prospective surgical CTEPH cohorts in Hammersmith Hospital, London and Amsterdam UMC. A structured multi-modal follow-up was adopted, consisting of right heart catheterisation, cardiac MRI and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual PH (mPAP>20mmHg and PVR≥2WU) and long-term exercise intolerance (VO 2 max<80% at 18 months were analysed. RESULTS: 118 patients (61 London and 57 Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, RV function and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52% to 59% from 6 to 18 months). Long-term exercise intolerance was common and associated with pre-operative DLCO, pre-operative SvO 2, and post-operative PH and RVEF. Clinically significant RV deterioration (RVEF decline >3%; 5(9%) out of 57 patients) and recurrent PH (5(14%) out of 36 patients) rarely occurred beyond 6 months after PEA. Age and pre-operative DLCO were predictors of residual pulmonary hypertension post-PEA. CONCLUSIONS: Restoration in exercise tolerance, cardiopulmonary hemodynamics and RV function occurs within 6 months. No substantial changes occured between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function.

AB - BACKGROUND: Long-term changes in exercise capacity and cardiopulmonary hemodynamics, after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described.METHODS: We analysed the data from two prospective surgical CTEPH cohorts in Hammersmith Hospital, London and Amsterdam UMC. A structured multi-modal follow-up was adopted, consisting of right heart catheterisation, cardiac MRI and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual PH (mPAP>20mmHg and PVR≥2WU) and long-term exercise intolerance (VO 2 max<80% at 18 months were analysed. RESULTS: 118 patients (61 London and 57 Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, RV function and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52% to 59% from 6 to 18 months). Long-term exercise intolerance was common and associated with pre-operative DLCO, pre-operative SvO 2, and post-operative PH and RVEF. Clinically significant RV deterioration (RVEF decline >3%; 5(9%) out of 57 patients) and recurrent PH (5(14%) out of 36 patients) rarely occurred beyond 6 months after PEA. Age and pre-operative DLCO were predictors of residual pulmonary hypertension post-PEA. CONCLUSIONS: Restoration in exercise tolerance, cardiopulmonary hemodynamics and RV function occurs within 6 months. No substantial changes occured between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function.

KW - RV function

KW - cardiac MRI

KW - cardiopulmonary exercise testing

KW - cardiopulmonary hemodynamics

KW - chronic thromboembolic pulmonary hypertension

U2 - 10.1016/j.healun.2023.11.011

DO - 10.1016/j.healun.2023.11.011

M3 - Journal article

C2 - 38000764

SN - 1053-2498

VL - 43

SP - 580

EP - 593

JO - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

IS - 4

ER -