Abstract 14456: Evaluation of Right Ventricular Function Using Real-Time Three-Dimensional Echocardiography in Patients with Chronic Thromboembolic Pulmonary Hypertension Treated with Percutaneous Transluminal Pulmonary Angioplasty

Abstract

OBJECTIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition characterized by a pulmonary vascular bed that is obstructed with the organized thrombi, promoting increased pulmonary vascular resistance (PVR), progressive pulmonary artery hypertension (PAH) and right heart failure. It has been reported that percutaneous transluminal pulmonary angioplasty (PTPA) may be useful for distal-type CTEPH. Real-time three-dimensional echocardiography (3DE) allows us to measure right ventricular (RV) volume and RV ejection fraction (RVEF) irrespective of its shape. We sought to investigate the improvement of PAH and RV dysfunction treated with PTPA using 3DE.

METHODS: We performed 3DE and right heart catheterization in 24 patients with CTEPH before and after PTPA. We measured 3D-RV end-diastolic volume index (3D-RVEDVI), 3D-RV end-systolic volume index (3D-RVESVI), and 3D-RVEF. Systolic pulmonary artery pressure (sPAP), mean PAP (mPAP), and PVR were measured by right heart catheterization.

RESULTS: PTPA reduced sPAP (88±15 to 60±19 mmHg; p=0.0035), mPAP (45±8 to 31±9 mmHg; p=0.0022), and PVR (11±5 to 5±2 mmHg; p=0.0028). 3D-RVEDVI (92±34 to 70±23 ml; p=0.0482) and 3D-RVESVI (63±30 to 31±9 ml; p=0.0324) decreased significantly after PTPA. 3D-RVEF improved significantly after PTPA (30±8 to 46±8 %; p=0.0011).

CONCLUSION: PTPA is effective in improving the pulmonary hemodynamics and RV function. 3DE gives useful insights in the quantitative assessment of RV function in CTEPH patients before and after PTPA.