Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study.
To use cardiac magnetic resonance imaging (MRI) to investigate the effect of balloon pulmonary angioplasty (BPA) on interventricular dyssynchrony and its associations with ventricular interaction, which impairs LV function in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). This prospective observational study was approved by our institutional review board. Cardiac MRI and right heart catheterization were conducted before BPA sessions and at the follow up after BPA in 20 patients with CTEPH. We measured right ventricular (RV) and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using MRI. For the LV and RV free walls, the time to peak (Tpeak) of circumferential strain was calculated as a parameter for interventricular dyssynchrony. Following BPA, the RV-EDV and -ESV were significantly decreased, and the RVEF was significantly increased. Conversely, BPA led to significantly increased LV EDV and SV without changing LVESV. The left-to-right free wall delay (L-R delay) in Tpeakstrain decreased from 105 ± 44 ms to 47 ± 67 ms (p < 0.001). Increased LV EDV (r = 0.65, p < 0.01), SV (r = 0.74, p < 0.001) and 6-minute walk distance (6MWD) (r = 0.54, p < 0.05) were correlated to the reduction in L-R delay. In patients with inoperable CPEPH, BPA improved interventricular dyssynchrony, which was strongly associated with increased SV and 6MWD. The assessment of interventricular dyssynchrony using cardiac MRI has an important role in evaluating ventricular interaction, which reduces LVSV and exercise tolerance.
Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yyama@radiol.med.kyushu-u.ac.jp.
Yuzo
Y
Yamasaki
Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Michinobu
M
Nagao
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Kohtaro
K
Abe
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Kazuya
K
Hosokawa
Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Satoshi
S
Kawanami
Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Takeshi
T
Kamitani
Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Torahiko
T
Yamanouchi
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Koshin
K
Horimoto
Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hidetake
H
Yabuuchi
Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Hiroshi
H
Honda
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D017079:Exercise Tolerance; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D000070857:Walk Test
D000959:Antihypertensive Agents; D014665:Vasodilator Agents
Balloon pulmonary angioplasty; Cardiac MRI; Chronic thromboembolic pulmonary hypertension; Interventricular dyssynchrony
Circ Cardiovasc Interv. 2012 Dec;5(6):748-55
23192917
Eur Respir Rev. 2015 Jun;24(136):246-52
26028636
Eur Radiol. 2005 Aug;15(8):1586-97
15875193
Circulation. 2014 Aug 5;130(6):508-18
25092279
Eur Radiol. 2014 Dec;24(12):3289-99
25113649
Radiology. 2011 May;259(2):421-8
21330565
Int J Cardiol. 2015 Jun 1;188:81-3
25889333
Eur Heart J. 2007 May;28(10):1250-7
17242010
Circulation. 2011 Nov 1;124(18):1973-81
21969018
J Thorac Imaging. 2014 Mar;29(2):68-79
24552882
Eur J Heart Fail. 2015 Jan;17(1):1-2
25597868
J Nucl Med. 2000 Jul;41(7):1127-33
10914900
Front Cardiovasc Med. 2015 Feb 17;2:4
26664876
Eur Heart J. 2009 Sep;30(18):2266-74
19561027
Circulation. 2004 Sep 7;110(10 ):1308-12
15337703
Am J Physiol Heart Circ Physiol. 2004 May;286(5):H1872-80
14726304
Chest. 1982 Feb;81(2):151-8
7056079
Chest. 2011 May;139(5):1003-1009
20864614
J Am Soc Echocardiogr. 2008 Sep;21(9):1028-34
18558476
J Am Coll Cardiol. 2006 Apr 18;47(8):1732-3
16631018
Eur Respir J. 2014 May;43(5):1394-402
24627536
J Am Coll Cardiol. 2008 Feb 19;51(7):750-7
18279740
Am J Physiol Heart Circ Physiol. 2006 Apr;290(4):H1528-33
16284226
Am J Physiol Heart Circ Physiol. 2009 Nov;297(5):H1752-9
19734361
Int Heart J. 2014;55(6):512-8
25310930
Proc Am Thorac Soc. 2006 Sep;3(7):584-8
16963538
J Cardiovasc Magn Reson. 2012 Jan 12;14:5
22240072
PLoS One. 2014 Apr 11;9(4):e94587
24728482
J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D92-9
24355646
Radiology. 1992 Feb;182(2):393-8
1732955
Br Heart J. 1992 Jul;68(1):16-20
1515286
J Magn Reson Imaging. 2003 Jul;18(1):25-32
12815636
Cardiovasc Ultrasound. 2005 Aug 29;3:23
16129028
Congenit Heart Dis. 2015 May-Jun;10(3):271-80
25159310
Eur J Radiol. 2015 Aug;84(8):1493-1501
26047824