Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function, and exercise capacity in chronic thromboembolic pulmonary hypertension
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Long-term changes in exercise capacity and cardiopulmonary hemodynamics after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described.
METHODS: We analyzed the data from 2 prospective surgical CTEPH cohorts in Hammersmith Hospital, London, and Amsterdam UMC. A structured multimodal follow-up was adopted, consisting of right heart catheterization, cardiac magnetic resonance imaging, and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual pulmonary hypertension (PH; mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance ≥2 WU) and long-term exercise intolerance (VO2max <80%) at 18 months were analyzed.
RESULTS: A total of 118 patients (61 from London and 57 from Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, right ventricular (RV) function, and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function, but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52%-59% from 6 to 18 months). Long-term exercise intolerance was common and associated with preoperative diffusion capacity for carbon monoxide (DLCO), preoperative mixed venous oxygen saturation, and postoperative PH and right ventricular ejection fraction (RVEF). Clinically significant RV deterioration (RVEF decline >3%; 5 [9%] of 57 patients) and recurrent PH (5 [14%] of 36 patients) rarely occurred beyond 6 months after PEA. Age and preoperative DLCO were predictors of residual PH post-PEA.
CONCLUSIONS: Restoration in exercise tolerance, cardiopulmonary hemodynamics, and RV function occurs within 6 months. No substantial changes occurred between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:43 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 43(2024), 4 vom: 13. März, Seite 580-593 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kianzad, Azar [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac MRI |
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| Anmerkungen: |
Date Completed 18.03.2024 Date Revised 18.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2023.11.011 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364920157 |
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| 100 | 1 | |a Kianzad, Azar |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function, and exercise capacity in chronic thromboembolic pulmonary hypertension |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 18.03.2024 | ||
| 500 | |a Date Revised 18.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Long-term changes in exercise capacity and cardiopulmonary hemodynamics after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described | ||
| 520 | |a METHODS: We analyzed the data from 2 prospective surgical CTEPH cohorts in Hammersmith Hospital, London, and Amsterdam UMC. A structured multimodal follow-up was adopted, consisting of right heart catheterization, cardiac magnetic resonance imaging, and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual pulmonary hypertension (PH; mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance ≥2 WU) and long-term exercise intolerance (VO2max <80%) at 18 months were analyzed | ||
| 520 | |a RESULTS: A total of 118 patients (61 from London and 57 from Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, right ventricular (RV) function, and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function, but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52%-59% from 6 to 18 months). Long-term exercise intolerance was common and associated with preoperative diffusion capacity for carbon monoxide (DLCO), preoperative mixed venous oxygen saturation, and postoperative PH and right ventricular ejection fraction (RVEF). Clinically significant RV deterioration (RVEF decline >3%; 5 [9%] of 57 patients) and recurrent PH (5 [14%] of 36 patients) rarely occurred beyond 6 months after PEA. Age and preoperative DLCO were predictors of residual PH post-PEA | ||
| 520 | |a CONCLUSIONS: Restoration in exercise tolerance, cardiopulmonary hemodynamics, and RV function occurs within 6 months. No substantial changes occurred between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a RV function | |
| 650 | 4 | |a cardiac MRI | |
| 650 | 4 | |a cardiopulmonary exercise testing | |
| 650 | 4 | |a cardiopulmonary hemodynamics | |
| 650 | 4 | |a chronic thromboembolic pulmonary hypertension | |
| 700 | 1 | |a Baccelli, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Braams, Natalia J |e verfasserin |4 aut | |
| 700 | 1 | |a Andersen, Stine |e verfasserin |4 aut | |
| 700 | 1 | |a van Wezenbeek, Jessie |e verfasserin |4 aut | |
| 700 | 1 | |a Wessels, Jeroen N |e verfasserin |4 aut | |
| 700 | 1 | |a Celant, Lucas R |e verfasserin |4 aut | |
| 700 | 1 | |a Vos, Anna E |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Lo Giudice, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Haji, Gulammehdi |e verfasserin |4 aut | |
| 700 | 1 | |a Rinaldo, Rocco F |e verfasserin |4 aut | |
| 700 | 1 | |a Vigo, Beatrice |e verfasserin |4 aut | |
| 700 | 1 | |a Gopalan, Deepa |e verfasserin |4 aut | |
| 700 | 1 | |a Symersky, Petr |e verfasserin |4 aut | |
| 700 | 1 | |a Winkelman, Jacobus A |e verfasserin |4 aut | |
| 700 | 1 | |a Boonstra, Anco |e verfasserin |4 aut | |
| 700 | 1 | |a Nossent, Esther J |e verfasserin |4 aut | |
| 700 | 1 | |a Tim Marcus, J |e verfasserin |4 aut | |
| 700 | 1 | |a Vonk Noordegraaf, Anton |e verfasserin |4 aut | |
| 700 | 1 | |a Meijboom, Lilian J |e verfasserin |4 aut | |
| 700 | 1 | |a de Man, Frances S |e verfasserin |4 aut | |
| 700 | 1 | |a Andersen, Asger |e verfasserin |4 aut | |
| 700 | 1 | |a Howard, Luke S |e verfasserin |4 aut | |
| 700 | 1 | |a Bogaard, Harm Jan |e verfasserin |4 aut | |
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