title: Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  Impaired left ventricular diastolic filling is common in chronic thromboembolic pulmonary hypertension (CTEPH), and recent studies support left ventricular underfilling as a cause. To investigate this further, we assessed left atrial volume index (LAVI) in patients with CTEPH before and after pulmonary thromboendarterectomy (PTE).
  
  
  METHODS
  Forty-eight consecutive CTEPH patients had pre- & post-PTE echocardiograms and right heart catheterizations. Parameters included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, LAVI, & mitral E/A ratio. Echocardiograms were performed 6 ± 3 days pre-PTE and 10 ± 4 days post-PTE. Regression analyses compared pre- and post-PTE LAVI with other parameters.
  
  
  RESULTS
  Pre-op LAVI (mean 19.0 ± 7 mL/m2) correlated significantly with pre-op PVR (R = -0.45, p = 0.001), mPAP (R = -0.28, p = 0.05) and cardiac index (R = 0.38, p = 0.006). Post-PTE, LAVI increased by 18% to 22.4 ± 7 mL/m2 (p = 0.003). This change correlated with change in PVR (765 to 311 dyne-s/cm5, p = 0.01), cardiac index (2.6 to 3.2 L/min/m2, p = 0.02), and E/A (.95 to 1.44, p = 0.002).
  
  
  CONCLUSIONS
  In CTEPH, smaller LAVI is associated with lower cardiac output, higher mPAP, and higher PVR. LAVI increases by ~20% after PTE, and this change correlates with changes in PVR and mitral E/A. The rapid increase in LAVI supports the concept that left ventricular diastolic impairment and low E/A pre-PTE are due to left heart underfilling rather than inherent left ventricular diastolic dysfunction.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Marston
authors.forename: William R
authors.initials: WR
authors.lastname: Auger
authors.forename: Michael M
authors.initials: MM
authors.lastname: Madani
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Kimura
authors.forename: G Monet
authors.initials: GM
authors.lastname: Strachan
authors.forename: Ajit B
authors.initials: AB
authors.lastname: Raisinghani
authors.forename: Anthony N
authors.initials: AN
authors.lastname: DeMaria
authors.affiliation: School of Medicine and Sulpizio Cardiovascular Center, University of California San Diego, 9444 Medical Center Drive, #7411, La Jolla, CA 92037, USA. dblanchard@ucsd.edu.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Blanchard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004452:Echocardiography / Q000379:methods*; D004691:Endarterectomy; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Semin Thorac Cardiovasc Surg. 2006 Fall;18(3):257-64
references.pmid: 17185189
references.citation: J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67
references.pmid: 2698218
references.citation: JACC Cardiovasc Imaging. 2009 Feb;2(2):143-9
references.pmid: 19356547
references.citation: Am J Physiol Heart Circ Physiol. 2010 Oct;299(4):H1083-91
references.pmid: 20675564
references.citation: Circulation. 1999 Jul 27;100(4):427-36
references.pmid: 10421605
references.citation: J Am Coll Cardiol. 2014 Feb 18;63(6):493-505
references.pmid: 24291276
references.citation: J Am Coll Cardiol. 1986 Dec;8(6):1298-306
references.pmid: 3782636
references.citation: Am J Respir Crit Care Med. 2011 Jun 15;183(12):1605-13
references.pmid: 21330453
references.citation: Ann Thorac Cardiovasc Surg. 2008 Oct;14(5):274-82
references.pmid: 18989242
references.citation: Ann Intern Med. 1987 Oct;107(4):560-5
references.pmid: 3631790
references.citation: J Am Coll Cardiol. 2011 Oct 4;58(15):1624-34
references.pmid: 21958891
references.citation: J Am Coll Cardiol. 2002 Jul 17;40(2):318-24
references.pmid: 12106938
references.citation: J Am Coll Cardiol. 2007 Mar 27;49(12):1334-9
references.pmid: 17394966
references.citation: N Engl J Med. 2001 Nov 15;345(20):1465-72
references.pmid: 11794196
references.citation: Echocardiography. 2013 Nov;30(10):1126-9
references.pmid: 23710685
references.citation: J Am Coll Cardiol. 2006 Mar 7;47(5):1018-23
references.pmid: 16516087
references.citation: Br J Haematol. 2010 May;149(4):478-83
references.pmid: 20331466
references.citation: Circulation. 1989 Oct;80(4):823-30
references.pmid: 2791245
references.citation: Am J Physiol. 1993 Jun;264(6 Pt 2):H1781-7
references.pmid: 8322906