title: Pulmonary vascular remodeling before and after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a cardiac magnetic resonance study.
abstract: Phase-contrast magnetic resonance imaging (PC-MRI) offers a range of surrogate markers to quantify the hemodynamic changes associated with chronic thromboembolic pulmonary hypertension (CTEPH). Our aim was to noninvasively monitor effects of pulmonary vascular remodeling before and after endarterectomy (PEA) in patients with CTEPH by using PC-MRI. Fifty-seven consecutive patients (mean age 56.7 ± 16, 28 female) underwent PC-MRI before and after PEA as part of their peri-operative routine workup. Pulmonary artery (PA) maximum flow velocity (maxV), acceleration time/ejection time (AT/ET), distensibility [(PA maximum area - PA minimum area)/PA minimum area], mid-systolic flow deceleration (notch), and the timing of deceleration (notch ratio) were recorded. Mean PA pressure was obtained from standard right heart catheter procedures. maxV and AT/ET were decreased before PEA and significantly improved afterwards (60.8 ± 16 vs. 73.8 ± 19 cm/s, p = 0.007; 0.32 ± 0.06 vs. 0.36 ± 0.09, p = 0.0015). Surprisingly, distensibility did not change significantly (30 ± 19 vs. 26 ± 12%, p = 0.11). Forty-five patients (78%) had a systolic notch before PEA that persisted in only 10 (18%; p = 0.00001). Among patients with a persisting notch, the notch ratio did not significantly increase (1.3 ± 0.2 vs. 1.6 ± 1.5, p = 0.32). Our data show early PA reverse remodeling after PEA. Flow velocities increase while PA flow wave reflections represented by mid-systolic flow deceleration are abolished. In some patients a mid-systolic notch persists, suggesting increased downstream resistance as a consequence of small vessel arteriopathy.
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Lung Centre, Benekestrasse 2-8, 61231, Bad Nauheim, Germany, a.rolf@kerckhoff-klinik.de.
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: Stefan
authors.initials: S
authors.lastname: Guth
authors.forename: Nils
authors.initials: N
authors.lastname: Körlings
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: Gabriele
authors.initials: G
authors.lastname: Krombach
authors.forename: Thorsten
authors.initials: T
authors.lastname: Kramm
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D002908:Chronic Disease; D004691:Endarterectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D066253:Vascular Remodeling; D014655:Vascular Resistance