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Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress.
J Cardiovasc Magn Reson. 2012 Jan 12; 14:5.JC

Abstract

BACKGROUND

Interventricular mechanical dyssynchrony is a characteristic of pulmonary hypertension. We studied the role of right ventricular (RV) wall stress in the recovery of interventricular dyssynchrony, after pulmonary endarterectomy (PEA) in chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS

In 13 consecutive patients with CTEPH, before and 6 months after pulmonary endarterectomy, cardiovascular magnetic resonance myocardial tagging was applied. For the left ventricular (LV) and RV free walls, the time to peak (Tpeak) of circumferential shortening (strain) was calculated. Pulmonary Artery Pressure (PAP) was measured by right heart catheterization within 48 hours of PEA. Then the RV free wall systolic wall stress was calculated by the Laplace law.

RESULTS

After PEA, the left to right free wall delay (L-R delay) in Tpeak strain decreased from 97 ± 49 ms to -4 ± 51 ms (P < 0.001), which was not different from normal reference values of -35 ± 10 ms (P = 0.18). The RV wall stress decreased significantly from 15.2 ± 6.4 kPa to 5.7 ± 3.4 kPa (P < 0.001), which was not different from normal reference values of 5.3 ± 1.39 kPa (P = 0.78). The reduction of L-R delay in Tpeak was more strongly associated with the reduction in RV wall stress (r = 0.69,P = 0.007) than with the reduction in systolic PAP (r = 0.53, P = 0.07). The reduction of L-R delay in Tpeak was not associated with estimates of the reduction in RV radius (r = 0.37,P = 0.21) or increase in RV systolic wall thickness (r = 0.19,P = 0.53).

CONCLUSION

After PEA for CTEPH, the RV and LV peak strains are resynchronized. The reduction in systolic RV wall stress plays a key role in this resynchronization.

Authors+Show Affiliations

Department of Pulmonary Diseases, University of Amsterdam, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22240072

Citation

Mauritz, Gert-Jan, et al. "Pulmonary Endarterectomy Normalizes Interventricular Dyssynchrony and Right Ventricular Systolic Wall Stress." Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, vol. 14, 2012, p. 5.
Mauritz GJ, Vonk-Noordegraaf A, Kind T, et al. Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress. J Cardiovasc Magn Reson. 2012;14:5.
Mauritz, G. J., Vonk-Noordegraaf, A., Kind, T., Surie, S., Kloek, J. J., Bresser, P., Saouti, N., Bosboom, J., Westerhof, N., & Marcus, J. T. (2012). Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress. Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, 14, 5. https://doi.org/10.1186/1532-429X-14-5
Mauritz GJ, et al. Pulmonary Endarterectomy Normalizes Interventricular Dyssynchrony and Right Ventricular Systolic Wall Stress. J Cardiovasc Magn Reson. 2012 Jan 12;14:5. PubMed PMID: 22240072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress. AU - Mauritz,Gert-Jan, AU - Vonk-Noordegraaf,Anton, AU - Kind,Taco, AU - Surie,Sulaiman, AU - Kloek,Jaap J, AU - Bresser,Paul, AU - Saouti,Nabil, AU - Bosboom,Joachim, AU - Westerhof,Nico, AU - Marcus,J Tim, Y1 - 2012/01/12/ PY - 2011/06/24/received PY - 2012/01/12/accepted PY - 2012/1/14/entrez PY - 2012/1/14/pubmed PY - 2012/6/5/medline SP - 5 EP - 5 JF - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JO - J Cardiovasc Magn Reson VL - 14 N2 - BACKGROUND: Interventricular mechanical dyssynchrony is a characteristic of pulmonary hypertension. We studied the role of right ventricular (RV) wall stress in the recovery of interventricular dyssynchrony, after pulmonary endarterectomy (PEA) in chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: In 13 consecutive patients with CTEPH, before and 6 months after pulmonary endarterectomy, cardiovascular magnetic resonance myocardial tagging was applied. For the left ventricular (LV) and RV free walls, the time to peak (Tpeak) of circumferential shortening (strain) was calculated. Pulmonary Artery Pressure (PAP) was measured by right heart catheterization within 48 hours of PEA. Then the RV free wall systolic wall stress was calculated by the Laplace law. RESULTS: After PEA, the left to right free wall delay (L-R delay) in Tpeak strain decreased from 97 ± 49 ms to -4 ± 51 ms (P < 0.001), which was not different from normal reference values of -35 ± 10 ms (P = 0.18). The RV wall stress decreased significantly from 15.2 ± 6.4 kPa to 5.7 ± 3.4 kPa (P < 0.001), which was not different from normal reference values of 5.3 ± 1.39 kPa (P = 0.78). The reduction of L-R delay in Tpeak was more strongly associated with the reduction in RV wall stress (r = 0.69,P = 0.007) than with the reduction in systolic PAP (r = 0.53, P = 0.07). The reduction of L-R delay in Tpeak was not associated with estimates of the reduction in RV radius (r = 0.37,P = 0.21) or increase in RV systolic wall thickness (r = 0.19,P = 0.53). CONCLUSION: After PEA for CTEPH, the RV and LV peak strains are resynchronized. The reduction in systolic RV wall stress plays a key role in this resynchronization. SN - 1532-429X UR - https://www.unboundmedicine.com/medline/citation/22240072/Pulmonary_endarterectomy_normalizes_interventricular_dyssynchrony_and_right_ventricular_systolic_wall_stress_ L2 - https://jcmr-online.biomedcentral.com/articles/10.1186/1532-429X-14-5 DB - PRIME DP - Unbound Medicine ER -