Right ventricular remodelling and long-term survival after pulmonary endarterectomy versus balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension.

IF 5.1 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Pub Date : 2024-10-28 DOI:10.1136/heartjnl-2024-324243
Håvard Ravnestad, Klaus Murbræch, Eyvind Gjønnæss, Rune Andersen, Natasha Moe, Sigurd Birkeland, Morten Svalebjørg, Per Snorre Lingaas, Einar Gude, Lars Gullestad, John-Peder Escobar Kvitting, Kaspar Broch, Arne K Andreassen
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Abstract

Background: Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), while balloon pulmonary angioplasty (BPA) is an alternative for inoperable patients. We aimed to compare right ventricular (RV) remodelling and late survival after PEA and BPA.

Methods: In this prospective observational cohort study, we performed echocardiography at baseline and follow-up in patients with CTEPH treated with PEA (n=54) or BPA (n=44) between 2011 and 2022.

Results: Follow-up echocardiography was performed at 5 months (IQR 4-7) after PEA and 3 months (IQR 2-4) after the last BPA. Both groups showed significant improvements in left ventricular end-systolic eccentricity index, RV basal diameter and RV fractional area change (RV FAC). Tricuspid regurgitation pressure decreased by 26±18 mm Hg after PEA and 13±21 mm Hg after BPA (p=0.02 for between-group difference). Tricuspid annular systolic excursion (TAPSE) decreased by 4±5 mm after PEA but increased by 1±4 mm after BPA (p<0.001). The TAPSE/systolic pulmonary artery pressure ratio improved similarly in both groups. Five-year survival was 96% (95% CI 86% to 99%) for PEA and 79% (95% CI 61% to 89%) for BPA (p=0.25). Change in RV FAC was an independent predictor of survival (HR 0.9, 95% CI 0.82 to 0.99, p=0.03).

Conclusions: Both PEA and BPA led to significant RV reverse remodelling, with no clear evidence of a difference in survival rates. Improvement in RV function, particularly RV FAC, was associated with better outcomes, highlighting the importance of RV recovery in CTEPH treatment.

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慢性血栓栓塞性肺动脉高压患者肺动脉内膜切除术与球囊肺血管成形术后的右心室重塑和长期存活率。
背景:肺动脉内膜剥脱术(PEA)是治疗慢性血栓栓塞性肺动脉高压(CTEPH)的首选方法,而球囊肺血管成形术(BPA)则是无法手术患者的另一种选择。我们旨在比较PEA和BPA术后右心室(RV)重塑和后期存活率:在这项前瞻性观察性队列研究中,我们对2011年至2022年间接受PEA(54例)或BPA(44例)治疗的CTEPH患者进行了基线和随访超声心动图检查:随访超声心动图分别在PEA后5个月(IQR 4-7)和最后一次BPA后3个月(IQR 2-4)进行。两组患者的左心室收缩末期偏心指数、RV 基底直径和 RV 面积分数变化(RV FAC)均有明显改善。PEA 后三尖瓣反流压力降低了 26±18 mm Hg,BPA 后降低了 13±21 mm Hg(组间差异 p=0.02)。PEA 后三尖瓣环收缩期偏移(TAPSE)减少了 4±5 mm,而 BPA 后增加了 1±4 mm(P结论:PEA 和 BPA 都导致了显著的 RV 逆重塑,但没有明确证据表明存活率存在差异。RV功能的改善,尤其是RV FAC,与更好的预后相关,这突出了RV恢复在CTEPH治疗中的重要性。
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来源期刊
Heart
Heart 医学-心血管系统
CiteScore
10.30
自引率
5.30%
发文量
320
审稿时长
3-6 weeks
期刊介绍: Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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