title: Right ventricular adaptation to pulmonary pressure load in patients with chronic thromboembolic pulmonary hypertension before and after successful pulmonary endarterectomy--a cardiovascular magnetic resonance study.
abstract: BACKGROUND
  The aim of the study was to characterize RV adaptation to varying loading conditions in patients with chronic thromboembolic hypertension (CTEPH) before and after pulmonary endarterectomy (PEA). Nearly 4% of patients with pulmonary embolism develop CTEPH. PEA offers a cure with excellent outcome. By use of cardiovascular magnetic resonance (CMR) combined with hemodynamic measurements pulmonary arterial elastance (Ea-pulm_i), end-systolic right ventricular elastance (Ees-RV_i) and ventriculo-arterial coupling (Ea-pulm_i/Ees-RV_i) can be studied before and after PEA.
  
  
  METHODS
  Sixty-five patients (mean age 41±12 years, 28 female) underwent CMR pre- and post-PEA. Ejection fraction (EF), end-diastolic (EDVi), end-systolic (ESVi), and stroke (SVi) volumes were indexed for body surface area. Ea-pulm_i was calculated as pulmonary artery mean pressure (mPAP)/SVi, and Ees-RV_i as mPAP/ESVi.
  
  
  RESULTS
  mPAP decreased from 47±12 to 25±9 mmHg, p=0.0001. Ea-pulm_i was increased before PEA and normalized afterwards (2.8±2.1 vs. 0.85±0.4 mmHg/ml/m2, p=0.0001). Ees-RV_i was depressed before and after PEA (0.72±0.27 vs. 0.66±0.3 mmHg/ml/m2, p=0.13). EF improved from 25±12% to 46±10%, p=0.0001, because ventriculo-arterial coupling was restored (4.2±3 vs. 1.4±0.6, p=0.0001). EDVi and ESVi mproved significantly (EDVi 92±32 to 72±23 ml, p=0.0001; ESVi 69±31 to 41±18 ml, p=0.0001).
  
  
  CONCLUSIONS
  RV function is largely determined by afterload and returns to normal once afterload is normalized. This is paralleled by a significant improvement of CMR indices of right ventricular remodelling.
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, Bad Nauheim 61231, Germany. andreas.rolf@me.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.forename: Won K
authors.initials: WK
authors.lastname: Kim
authors.forename: Johannes
authors.initials: J
authors.lastname: Börgel
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.forename: Thorsten
authors.initials: T
authors.lastname: Kramm
authors.forename: Stefan
authors.initials: S
authors.lastname: Guth
authors.forename: Gabriele A
authors.initials: GA
authors.lastname: Krombach
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling