title: Right ventricular reverse remodeling after pulmonary endarterectomy: magnetic resonance imaging and clinical and right heart catheterization assessment.
abstract: The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right ventricular (RV) reverse remodeling using magnetic resonance imaging (MRI) and to correlate MRI findings with clinical and hemodynamic outcomes postsurgery. We performed a retrospective analysis in 72 patients undergoing PEA surgery in whom MRI and right heart catheterization (RHC) were performed preoperation and 3 months postoperation. RV volumes and mass were assessed by MRI. Continuous variables were expressed as means, changes were compared with a paired t test, and associations between the variables were explored using Pearson correlation coefficients. The mean age was 57 years, and 51% were male. Both RV end-diastolic volume (EDV; 176-117 mL; P < 0.001) and RV end-systolic volume (ESV; 129-64 mL; P < 0.001) reduced significantly following PEA. Preoperative pulmonary artery pressure (PAP) correlated moderately with ESV (r = 0.46, P < 0.001). Postoperatively, PAP correlated with EDV (r = 0.45, P < 0.001) and ESV (r = 0.44, P < 0.001). Moderate correlation was present between hemodynamic parameters: PAP, pulmonary vascular resistance, and right atrial pressure with pre- and postoperation end-systolic and end-diastolic RV mass (P < 0.001). RHC and MRI measurements of cardiac output and RV volumes were significantly different (P < 0.001). In conclusion, RV reverse remodeling, as measured by improvement in RV volumes and mass by MRI, was observed for 3 months in patients who underwent PEA surgery. This is the largest series of patients with pre- and post-PEA MRI assessment so far reported. MRI detects changes in parameters reflecting cardiac remodeling and pulmonary clearance, but measurements are significantly different from those of RHC.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Marius
authors.initials: M
authors.lastname: Berman
authors.affiliation: Department of Diagnostic and Imaging, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Deepa
authors.initials: D
authors.lastname: Gopalan
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharples
authors.affiliation: Department of Diagnostic and Imaging, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Screaton
authors.affiliation: Department of Diagnostic and Imaging, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Maccan
authors.affiliation: Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Sheares
authors.affiliation: Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pepke-Zaba
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Dunning
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Tsui
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: David P
authors.initials: DP
authors.lastname: Jenkins
keywords: chronic thromboembolic pulmonary hypertension (CTEPH); magnetic resonance; pulmonary endarterectomy