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Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study

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Abstract

To use cardiac magnetic resonance imaging (MRI) to investigate the effect of balloon pulmonary angioplasty (BPA) on interventricular dyssynchrony and its associations with ventricular interaction, which impairs LV function in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). This prospective observational study was approved by our institutional review board. Cardiac MRI and right heart catheterization were conducted before BPA sessions and at the follow up after BPA in 20 patients with CTEPH. We measured right ventricular (RV) and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using MRI. For the LV and RV free walls, the time to peak (Tpeak) of circumferential strain was calculated as a parameter for interventricular dyssynchrony. Following BPA, the RV-EDV and -ESV were significantly decreased, and the RVEF was significantly increased. Conversely, BPA led to significantly increased LV EDV and SV without changing LVESV. The left-to-right free wall delay (L–R delay) in Tpeak strain decreased from 105 ± 44 ms to 47 ± 67 ms (p < 0.001). Increased LV EDV (r = 0.65, p < 0.01), SV (r = 0.74, p < 0.001) and 6-minute walk distance (6MWD) (r = 0.54, p < 0.05) were correlated to the reduction in L–R delay. In patients with inoperable CPEPH, BPA improved interventricular dyssynchrony, which was strongly associated with increased SV and 6MWD. The assessment of interventricular dyssynchrony using cardiac MRI has an important role in evaluating ventricular interaction, which reduces LVSV and exercise tolerance.

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Acknowledgments

This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant Number: 15H06478).

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Authors and Affiliations

  1. Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yuzo Yamasaki, Takeshi Kamitani, Torahiko Yamanouchi & Hiroshi Honda

  2. Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Michinobu Nagao & Satoshi Kawanami

  3. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kohtaro Abe, Kazuya Hosokawa & Koshin Horimoto

  4. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hidetake Yabuuchi

Authors
  1. Yuzo Yamasaki
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  2. Michinobu Nagao
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  3. Kohtaro Abe
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  4. Kazuya Hosokawa
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  9. Hidetake Yabuuchi
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  10. Hiroshi Honda
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Correspondence to Yuzo Yamasaki.

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Conflict of interest

Nagao M. and Kawanami S: Bayer Healthcare Japan, Modest, Research Grant; Philips Electronics Japan, Modest, Research Grant. Other authors: None.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yamasaki, Y., Nagao, M., Abe, K. et al. Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study. Int J Cardiovasc Imaging 33, 229–239 (2017). https://doi.org/10.1007/s10554-016-0985-y

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  • DOI: https://doi.org/10.1007/s10554-016-0985-y

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