title: A novel echocardiographic predictor of in-hospital mortality and mid-term haemodynamic improvement after pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension.
abstract: OBJECTIVE
  To study whether pre-operative assessment, using echocardiography, of the timing of a particular feature in the pulmonary flow (pulmonary flow systolic notch) may predict in-hospital mortality and mid-term haemodynamic improvement after pulmonary endarterectomy (PEA) for chronic thrombo-embolic pulmonary hypertension (CTEPH).
  
  
  RESULTS
  Fifty-eight of 61 consecutive CTEPH patients (aged 53 +/- 14 years; 36 women) who underwent PEA between June 2002 and June 2005 were studied. Clinical, haemodynamic, and echocardiographic variables were assessed pre-operatively and at 3 months post-PEA. Timing of the notch was expressed as notch ratio (NR). Pre-operatively, seven patients had no notch, 33 had NR < 1.0, and 18 had NR > 1.0. NR was associated with in-hospital mortality (P < 0.01). Moreover, multivariable analysis revealed that among pre-operative variables, NR was an independent predictor of residual-increased pulmonary artery systolic pressure (>40 mmHg) at 3 months post-PEA (P = 0.01). Receiver operator characteristic analysis established NR = 1.0 as optimal cutoff to distinguish patients at risk of such unfavourable outcomes, with NR > 1.0 conferring higher risk.
  
  
  CONCLUSIONS
  NR is related with in-hospital mortality and residual pulmonary hypertension after PEA. NR > 1.0 is associated with a higher risk of such unfavourable outcomes. NR may be considered a determinant of eligibility for PEA.
authors.affiliation: Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Maxim
authors.initials: M
authors.lastname: Hardziyenka
authors.forename: Herre J
authors.initials: HJ
authors.lastname: Reesink
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.forename: H A C M Rianne
authors.initials: HA
authors.lastname: de Bruin-Bon
authors.forename: Maria E
authors.initials: ME
authors.lastname: Campian
authors.forename: Michael W T
authors.initials: MW
authors.lastname: Tanck
authors.forename: Renée B A
authors.initials: RB
authors.lastname: van den Brink
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Kloek
authors.forename: Hanno L
authors.initials: HL
authors.lastname: Tan
authors.forename: Paul
authors.initials: P
authors.lastname: Bresser
mesh_terms: D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D011652:Pulmonary Circulation / Q000502:physiology; D013923:Thromboembolism / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography