Abstract 18719: Reduction of Right Ventricular Pressure Overload by Lung Transplantation Reverses Right Ventricular Function and Remodeling in Patients With End-Stage Pulmonary Arterial Hypertension
Introduction: Right ventricular (RV) dysfunction has been regarded as an independent determinant of the worse outcome in patients with pulmonary arterial hypertension (PAH). Although several PAH-specific medications have become available, the long-term outcome of medically treated PAH patients has remained unfavorable. It remains unknown that RV dysfunction in patients with severe PAH is reversible or not after the treatment to PAH.
Hypothesis: To test whether RV dysfunction is reversible or not, we investigated the changes in RV size and function in patients with end-stage PAH undergoing lung transplantation (LTx).
Methods: We retrospectively analyzed temporal changes in laboratory data, hemodynamics and echocardiograms before LTx and at 2 and 12 months after LTx in 14 consecutive patients with PAH who underwent LTx from 2005 to 2014.
Results: Before LTx, RV was markedly dilated (RV basal diameter 50.0 ± 12.0 mm) with substantially reduced right ventricular fractional area change (RVFAC) (14.7 ± 5.5%) and increased right ventricular stroke work index (RVSWI) (20.4 ± 10.0 g/m2/beat). After LTx, mean pulmonary artery pressure (15.4 ± 5.0 mmHg), pulmonary vascular resistance [155.5 (77.5 - 232.3) dyne•sec/cm5] and RVSWI (6.4 ± 2.1 g/m2/beat, P = 0.002 vs. before) are normalized. RV size decreased at 2 months after LTx (RV basal diameter 30.0 ± 5.6 mm, P < 0.01 vs. before). RVFAC also improved at 2 months after LTx (32.9 ± 8.5%, P = 0.002 vs. before) and was normalized at 12 months after LTx. RV wall thickness gradually decreased until 12 months after LTx (before vs. 12 months, 8.7 ± 1.4 mm vs 6.0 ± 1.5 mm, P <0.01).
Conclusions: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH, RV function and morphology are improved after reduction of RV pressure load by LTx. Thus, the reduction of RV pressure overload should be the primary goal of PAH treatment.
Author Disclosures: T. Sarashina: None. K. Nakamura: None. K. Ejiri: None. S. Akagi: None. H. Oe: None. H. Ito: None.
- © 2016 by American Heart Association, Inc.