Tricuspid annular plane systolic excursion in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.
BACKGROUND
Right ventricular function is impaired in chronic thromboembolic pulmonary hypertension (CTEPH). Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) have been shown to help assess right ventricular function in pulmonary hypertension. Our goal was to (1) assess TAPSE and RVFAC before and after PTE, and (2) assess correlation of these variables with right heart catheterization data and PVR.


METHODS
We evaluated 67 consecutive patients with CTEPH for pulmonary thromboendarterectomy (PTE). Of these 67 patients, 48 were deemed surgical candidates. Preoperative right heart catheterization was performed within 1.3±1.2 days of the preoperative echocardiogram. All postoperative right heart catheterizations were performed on the first postoperative day.


RESULTS
TAPSE dropped from 18±6 to 10±3 mm after PTE (P<.0001). RVFAC remained the same (25%±10% vs 30%±12%). Mean pulmonary artery (mPAP) pressure dropped from 45±12 to 28±6 mm Hg after PTE, and pulmonary vascular resistance (PVR) decreased from 757±406 to 306±147 dyne-s/cm5(P<.0001 for both). Before PTE, TAPSE correlated inversely with PVR (r=-.57, P<.0001, TAPSE=-5.904×ln[PVR]+56.318). RVFAC did not correlate well with PVR or mean pulmonary artery pressure. After PTE, both TAPSE and RVFAC correlated poorly with PVR (r=-.12 and .01, respectively).


CONCLUSIONS
In patients with CTEPH, TAPSE paradoxically decreased by 50% early after PTE. TAPSE correlated inversely with PVR prior to PTE, but this correlation was lost completely after PTE. Thus, despite the immediate and marked decrease in afterload postoperatively, TAPSE did not improve; thus, TAPSE cannot be used as an early marker for surgical success.
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Darrin J
DJ
Wong
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Unnati
U
Sampat
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Michael A
MA
Gibson
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
William R
WR
Auger
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Michael M
MM
Madani
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Lori B
LB
Daniels
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Ajit B
AB
Raisinghani
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Anthony N
AN
DeMaria
UCSD School of Medicine, University of California San Diego Cardiovascular Center, La Jolla, California.
Daniel G
DG
Blanchard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D017131:Thrombectomy / Q000379:methods*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014655:Vascular Resistance; D016278:Ventricular Function, Right / Q000502:physiology; D055815:Young Adult

TAPSE
; chronic thromboembolic pulmonary hypertension; pulmonary hypertension; pulmonary vascular resistance