Right ventricular reverse remodelling after balloon pulmonary angioplasty
Right ventricular reverse remodelling after balloon pulmonary angioplasty
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DOI：
10.1183/09031936.00012914
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发表时间：
2014-05-01
影响因子：
24.3
通讯作者：
Nakanishi, Norifumi
中科院分区：
文献类型：
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作者：
Fukui, Shigefumi;Ogo, Takeshi;Nakanishi, Norifumi
据报道，球囊肺血管成形术（BPA）可改善不适合肺动脉内膜切除术的慢性血栓形成性肺动脉高压（CTEPH）患者的血流动力学和功能能力，风险可接受。然而，右心室（RV）功能，CTEPH的一个重要预测因素，仍有待阐明。我们的目的是研究BPA对RV重塑和功能障碍的影响，相对于血流动力学的改善不能手术的CTEPH患者。20例连续的不能手术的CTEPH患者在BPA之前和之后接受BPA与心血管磁共振进行了回顾性研究。BPA导致平均肺动脉压，心脏指数和肺血管阻力（PVR）的显着改善，没有死亡或重大并发症。此外，BPA显著改善了右侧心力衰竭的症状和体征，以及运动能力。心血管磁共振显示，BPA治疗后，RV舒张末期和收缩末期容积指数显著改善，同时RV射血分数、质量和室间隔弯曲也得到改善。RV体积的变化与心脏指数和PVR的变化密切相关。BPA诱导RV逆转重构，并通过改善无法手术的CTEPH患者的血流动力学安全地改善收缩功能障碍。心血管磁共振评价RV功能可能是有效的非侵入性监测BPA的疗效。
Balloon pulmonary angioplasty (BPA) has been reported to improve haemodynamics and functional capacity, with an acceptable risk, in patients with chronic thromboembofic pulmonary hypertension (CTEPH) who are not candidates for pulmonary endarterectomy. However, right ventricular (RV) function, an important predictor in CTEPH, remains to be elucidated. We aimed to examine the impact of BPA on RV remodelling and dysfunction relative to haemodynamic improvements in patients with inoperable CTEPH.20 consecutive patients with inoperable CTEPH who underwent BPA with cardiovascular magnetic resonance before and after BPA were retrospectively studied.BPA led to significant amelioration of the mean pulmonary arterial pressure, cardiac index and pulmonary vascular resistance (PVR), without death or major complications. Furthermore, BPA significantly ameliorated right-sided heart failure symptoms and signs, and exercise capacity. Cardiovascular magnetic resonance revealed a marked improvement in RV end-diastolic and end-systolic volume index, with concomitant improvements in RV ejection fraction, mass and interventricular septal bowing after BPA. Changes in RV volumes strongly correlated with changes in cardiac index and PVR.BPA induced RV reverse remodelling and improved systolic dysfunction safely by ameliorating haemodynamics in patients with inoperable CTEPH. Evaluating RV function with cardiovascular magnetic resonance may be effective for noninvasively monitoring BPA efficacy.