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European Radiology
Published in: European Radiology 6/2021

01-06-2021 | Echocardiography | Cardiac

Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Authors: Wen Li, Tao Yang, Rui-lin Quan, Xiao-xi Chen, Jing An, Zhi-hui Zhao, Zhi-hong Liu, Chang-ming Xiong, Jian-guo He, Qing Gu

Published in: European Radiology | Issue 6/2021

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Abstract

Objectives

Right ventricular (RV) function is considered the major determinant of prognosis in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this meta-analysis was to evaluate RV remodelling and function following balloon pulmonary angioplasty (BPA) in patients with inoperable CTEPH or persistent/recurrent pulmonary hypertension (PH) after pulmonary endarterectomy (PEA).

Methods

We reviewed all studies evaluating RV function by cardiac magnetic resonance (CMR) and/or echocardiography pre- and post-BPA from PubMed/Medline prior to 15 December 2019. Ten (299 patients) of the 29 studies retrieved met the inclusion criteria: 5 CMR and 5 echocardiography studies. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines.

Results

Pooled data from CMR studies revealed BPA resulted in a significantly decreased RV end-diastolic volume index (weighted mean difference (WMD) − 28.33 ml/m2, p < 0.00001) and RV end-systolic volume index (WMD − 29.06 ml/m2, p < 0.00001) accompanied by an increased RV ejection fraction (RVEF, WMD 8.97%, p < 0.00001). Data from the echocardiography studies showed BPA resulted in decreased RV basal diameter (WMD − 0.37 cm, p = 0.0009) and an increase of RV fractional area change (WMD 5.97 %, p = 0.003), but improvements of tricuspid annular plane systolic excursion (TAPSE) and S′ were not significant.

Conclusions

BPA improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA.

Key Points

• Balloon pulmonary angioplasty improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA.
Appendix
Available only for authorised users
Literature
1.
Galiè N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119CrossRef
2.
Wilkens H, Konstantinides S, Lang IM et al (2018) Chronic thromboembolic pulmonary hypertension (CTEPH): updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol 272S:69–78CrossRef
3.
Pepke-zaba J, Delcroix M, Lang I et al (2011) Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 124(18):1973–1981CrossRef
4.
Ghofrani HA, D'Armini AM, Grimminger F et al (2013) Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 369(4):319–329
5.
Lang I, Meyer BC, Ogo T et al (2017) Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Respir Rev 26(143):160119CrossRef
6.
Sakurai Y, Takami Y, Amano K et al (2019) Predictors of outcomes after surgery for chronic thromboembolic pulmonary hypertension. Ann Thorac Surg 108(4):1154–1161CrossRef
7.
Saouti N, De Man F, Westerhof N et al (2009) Predictors of mortality in inoperable chronic thromboembolic pulmonary hypertension. Respir Med 103(7):1013–1019CrossRef
8.
Kataoka M, Inami T, Kawakami T, Fukuda K, Satoh T (2019) Balloon pulmonary angioplasty (percutaneous transluminal pulmonary angioplasty) for chronic thromboembolic pulmonary hypertension: a Japanese perspective. JACC Cardiovasc Interv 12(14):1382–1388CrossRef
9.
Simonneau G, Torbicki A, Dorfmüller P, Kim N (2017) The pathophysiology of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 26(143):160112CrossRef
10.
Delcroix M, Vonk Noordegraaf A, Fadel E, Lang I, Simonneau G, Naeije R (2013) Vascular and right ventricular remodelling in chronic thromboembolic pulmonary hypertension. Eur Respir J 41(1):224–232CrossRef
11.
Asano R, Ogo T, Ohta-ogo K et al (2019) Prolonged QRS duration as a predictor of right ventricular dysfunction after balloon pulmonary angioplasty. Int J Cardiol 280:176–181CrossRef
12.
Fukui S, Ogo T, Morita Y et al (2014) Right ventricular reverse remodelling after balloon pulmonary angioplasty. Eur Respir J 43(5):1394–1402CrossRef
13.
Yamasaki Y, Nagao M, Abe K et al (2017) Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension : a cardiac MR imaging study. Int J Cardiovasc Imaging 33(2):229–239CrossRef
14.
Sato H, Ota H, Sugimura K et al (2016) Balloon pulmonary angioplasty improves biventricular functions and pulmonary flow in chronic thromboembolic pulmonary hypertension. Circ J 80(6):1470–1477CrossRef
15.
Schoenfeld C, Hinrichs JB, Olsson KM et al (2019) Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients. Eur Radiol 29(4):1693–1702CrossRef
16.
Broch K, Murbraech K, Ragnarsson A et al (2016) Echocardiographic evidence of right ventricular functional improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 35(1):80–86CrossRef
17.
Kanar BG, Mutlu B, Atas H, Akaslan D, Yıldızeli B (2019) Improvements of right ventricular function and hemodynamics after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Echocardiography 36(11):2050–2056CrossRef
18.
Kwon W, Yang JH, Park TK et al (2018) Impact of balloon pulmonary angioplasty on hemodynamics and clinical outcomes in patients with chronic thromboembolic pulmonary hypertension : the initial Korean experience. J Korean Med Sci 33(4):e24CrossRef
19.
Moriyama H, Murata M, Tsugu T et al (2018) The clinical value of assessing right ventricular diastolic function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiovasc Imaging 34(6):875–882
20.
Tsugu T, Murata M, Kawakami T (2014) Significance of echocardiographic assessment for right ventricular function after balloon pulmonary angioplasty in patients with chronic thromboembolic induced pulmonary hypertension. Am J Cardiol 115(2):256–261CrossRef
21.
Kawakubo M, Yamasaki Y, Kamitani T et al (2019) Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension : comparison with 2D feature-tracking MRI. Eur Radiol 29(9):4583–4592
22.
Tanabe N, Kawakami T, Satoh T et al (2018) Original article Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension : a systematic review. Respir Investig 56(4):332–341CrossRef
23.
Phan K, Jo HE, Xu J, Lau EM (2018) Medical therapy and balloon angioplasty for inoperable chronic thromboembolic pulmonary hypertension : a systematic review and meta-analysis. Heart Lung Circ 27(1):89–98CrossRef
24.
Crowe T, Jayasekera G, Peacock AJ (2017) Non-invasive imaging of global and regional cardiac function in pulmonary hypertension. Pulm Circ 8(1):2045893217742000PubMedPubMedCentral
25.
Swift AJ, Wild JM, Nagle SK et al (2014) Quantitative magnetic resonance imaging of pulmonary hypertension a practical approach to the current state of the art. J Thorac Imaging 29(2):68–79CrossRef
26.
van Wolferen SA, Marcus JT, Boonstra A et al (2007) Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 28(10):1250–1257CrossRef
27.
van de Veerdonk MC, Kind T, Marcus JT, Mauritz GJ et al (2011) Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol 58(24):2511–2519CrossRef
28.
Lang RM, Badano LP, Mor-avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults : an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270CrossRef
29.
Forfia PR, Fisher MR, Mathai SC et al (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174(9):1034–1041CrossRef
30.
Tadic M (2015) Multimodality evaluation of the right ventricle: an updated review. Clin Cardiol 38(12):770–776CrossRef
31.
Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R (2019) Anatomy, function, and dysfunction of the right ventricle: JACC state-of-the-art review. J Am Coll Cardiol 73(12):1463–1482CrossRef
32.
Haber I, Metaxas DN, Geva T, Axel L (2005) Three-dimensional systolic kinematics of the right ventricle. Am J Physiol Heart Circ Physiol 289(5):H1826–H1833CrossRef
33.
Carlsson M, Ugander M, Heiberg E, Arheden H (2007) The quantitative relationship between longitudinal and radial function in left, right, and total heart pumping in humans. Am J Physiol Heart Circ Physiol 293(1):H636–H644CrossRef
34.
Hashimoto I, Watanabe K (2016) Geometry-related right ventricular systolic function assessed by longitudinal and radial right ventricular contractions. Echocardiography 33(2):299–306CrossRef
35.
Lindberg H, Smith H, Smevik B, Smiseth OA, Andersen K (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49(25):2450–2456CrossRef
36.
Maschke SK, Schoenfeld CO, Kaireit TF et al (2018) MRI-derived regional biventricular function in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Acad Radiol 25(12):1540–1547CrossRef
37.
Park DW, Sebastiani A, Yap CH, Simon MA, Kim K (2016) Quantification of coupled stiffness and fiber orientation remodeling in hypertensive rat right-ventricular myocardium using 3D ultrasound speckle tracking with biaxial testing. PLoS One 11(10):e0165320CrossRef
38.
Giusca S, Dambrauskaite V, Scheurwegs C et al (2010) Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring. Heart 96(4):281–288CrossRef
39.
Smolarek D, Gruchała M, Sobiczewski W (2017) Echocardiographic evaluation of right ventricular systolic function : the traditional and innovative approach. Cardiol J 24(5):563–572CrossRef
40.
D'Armini AM, Zanotti G, Ghio S et al (2007) Reverse right ventricular remodeling after pulmonary endarterectomy. J Thorac Cardiovasc Surg 133(1):162–168CrossRef
41.
Reesink HJ, Marcus JT, Tulevski II et al (2007) Reverse right ventricular remodeling after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: utility of magnetic resonance imaging to demonstrate restoration of the right ventricle. J Thorac Cardiovasc Surg 133(1):58–64CrossRef
42.
Hosokawa K, Abe K, Oi K, Mukai Y, Hirooka Y, Sunagawa K (2015) Negative acute hemodynamic response to balloon pulmonary angioplasty does not predicate the long-term outcome in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiol 188:81–83CrossRef
43.
Kemp CD, Conte JV (2012) The pathophysiology of heart failure. Cardiovasc Pathol 21(5):365–371CrossRef
Metadata
Title
Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis
Authors
Wen Li
Tao Yang
Rui-lin Quan
Xiao-xi Chen
Jing An
Zhi-hui Zhao
Zhi-hong Liu
Chang-ming Xiong
Jian-guo He
Qing Gu
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07481-6

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