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Pulmonary vascular remodeling before and after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a cardiac magnetic resonance study

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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.

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The authors declare, that they have no conflict of interest related to this work.

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Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart and Lung Centre, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Andreas Rolf, Won K. Kim, Helge Möllmann, Christoph Liebetrau & Christian W. Hamm

  2. Department of Thoracic Surgery, Kerckhoff Heart and Lung Centre, Bad Nauheim, Germany

    Stefan Guth, Thorsten Kramm & Eckhard Mayer

  3. Department of Cardiology, University of Giessen, Giessen, Germany

    Andreas Rolf, Johannes Rixe, Nils Körlings, Holger M. Nef & Christian W. Hamm

  4. Department of Radiology, University of Giessen, Giessen, Germany

    Gabriele Krombach

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  1. Andreas Rolf
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Correspondence to Andreas Rolf.

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Rolf, A., Rixe, J., Kim, W.K. et al. Pulmonary vascular remodeling before and after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a cardiac magnetic resonance study. Int J Cardiovasc Imaging 31, 613–619 (2015). https://doi.org/10.1007/s10554-014-0580-z

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