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Malik M, Malik S, Karur GR, Mafeld S, de Perrot M, McInnis MC. Cardiothoracic Imaging for Outcome Prediction in Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Endarterectomy or Balloon Pulmonary Angioplasty: A Scoping Review. J Clin Med 2024; 13:5045. [PMID: 39274257 PMCID: PMC11395896 DOI: 10.3390/jcm13175045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024] Open
Abstract
There has been a rapid expansion in centers performing balloon pulmonary angioplasty (BPA) and pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of this scoping review was to identify cardiothoracic imaging predictors of outcomes and to identify gaps to address in future work. A scoping review was conducted using the framework outlined by Arksey and O'Malley and Levac et al. in MEDLINE and EMBASE. The study protocol was preregistered in OSF Registries and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. There were 1117 identified studies, including 48 involving pulmonary thromboendarterectomy (n = 25) and balloon pulmonary angioplasty (n = 23). CT was the most common preoperative imaging modality used (n = 21) and CT level of disease was the most reported imaging predictor of outcomes for pulmonary thromboendarterectomy. Although must studies evaluated hemodynamic improvements, imaging was of additional use in predicting clinically significant procedural complications after balloon pulmonary angioplasty, as well as mortality and long-term outcome after pulmonary endarterectomy. Predictors reported in MRI and digital subtraction angiography were less commonly reported and warrant multicenter validation. Cardiothoracic imaging may predict clinically significant outcomes after balloon pulmonary angioplasty and pulmonary thromboendarterectomy. Radiologists involved in the assessment of CTEPH patients should be aware of key predictors and future investigations could focus on multicenter validation and new technologies.
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Affiliation(s)
- Mikail Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Shamir Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Gauri R Karur
- University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Division of Cardiothoracic Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Sebastian Mafeld
- University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Division of Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
| | - Micheal C McInnis
- University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Division of Cardiothoracic Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
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Cain MT, Schäfer M, Park S, Barker AJ, Vargas D, Stenmark KR, Yu YRA, Bull TM, Ivy DD, Hoffman JRH. Characterization of pulmonary arterial stiffness using cardiac MRI. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:425-439. [PMID: 37902921 DOI: 10.1007/s10554-023-02989-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
Pulmonary arterial stiffness (PAS) is a pathologic hallmark of all types of pulmonary hypertension (PH). Cardiac MRI (CMR), a gold-standard imaging modality for the evaluation of pulmonary flow, biventricular morphology and function has been historically reserved for the longitudinal clinical follow-up, PH phenotyping purposes, right ventricular evaluation, and research purposes. Over the last two decades, numerous indices combining invasive catheterization and non-invasive CMR have been utilized to phenotype the character and severity of PAS in different types of PH and to assess its clinically prognostic potential with encouraging results. Many recent studies have demonstrated a strong role of CMR derived PAS markers in predicting long-term clinical outcomes and improving currently gold standard risk assessment provided by the REVEAL calculator. With the utilization of a machine learning strategies, strong diagnostic and prognostic performance of CMR reported in multicenter studies, and ability to detect PH at early stages, the non-invasive assessment of PAS is on verge of routine clinical utilization. In this review, we focus on appraising important CMR studies interrogating PAS over the last 20 years, describing the benefits and limitations of different PAS indices, and their pathophysiologic relevance to pulmonary vascular remodeling. We also discuss the role of CMR and PAS in clinical surveillance and phenotyping of PH, and the long-term future goal to utilize PAS as a biomarker to aid with more targeted therapeutic management.
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Affiliation(s)
- Michael T Cain
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Michal Schäfer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA.
- Heart Institute, Children's Hospital Colorado, University of Colorado, Denver, USA.
| | - Sarah Park
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel Vargas
- Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Kurt R Stenmark
- Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Yen-Rei A Yu
- Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd M Bull
- Department of Critical Care and Pulmonary Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - D Dunbar Ivy
- Heart Institute, Children's Hospital Colorado, University of Colorado, Denver, USA
| | - Jordan R H Hoffman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA
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3
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Dong ML, Azarine A, Haddad F, Amsallem M, Kim YW, Yang W, Fadel E, Aubrege L, Loecher M, Ennis D, Pavec JL, Vignon-Clementel I, Feinstein JA, Mercier O, Marsden AL. 4D flow cardiovascular magnetic resonance recovery profiles following pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. J Cardiovasc Magn Reson 2022; 24:59. [PMID: 36372884 PMCID: PMC9661778 DOI: 10.1186/s12968-022-00893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) allows comprehensive assessment of pulmonary artery (PA) flow dynamics. Few studies have characterized longitudinal changes in pulmonary flow dynamics and right ventricular (RV) recovery following a pulmonary endarterectomy (PEA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This can provide novel insights of RV and PA dynamics during recovery. We investigated the longitudinal trajectory of 4D flow metrics following a PEA including velocity, vorticity, helicity, and PA vessel wall stiffness. METHODS Twenty patients with CTEPH underwent pre-PEA and > 6 months post-PEA CMR imaging including 4D flow CMR; right heart catheter measurements were performed in 18 of these patients. We developed a semi-automated pipeline to extract integrated 4D flow-derived main, left, and right PA (MPA, LPA, RPA) volumes, velocity flow profiles, and secondary flow profiles. We focused on secondary flow metrics of vorticity, volume fraction of positive helicity (clockwise rotation), and the helical flow index (HFI) that measures helicity intensity. RESULTS Mean PA pressures (mPAP), total pulmonary resistance (TPR), and normalized RV end-systolic volume (RVESV) decreased significantly post-PEA (P < 0.002). 4D flow-derived PA volumes decreased (P < 0.001) and stiffness, velocity, and vorticity increased (P < 0.01) post-PEA. Longitudinal improvements from pre- to post-PEA in mPAP were associated with longitudinal decreases in MPA area (r = 0.68, P = 0.002). Longitudinal improvements in TPR were associated with longitudinal increases in the maximum RPA HFI (r=-0.85, P < 0.001). Longitudinal improvements in RVESV were associated with longitudinal decreases in MPA fraction of positive helicity (r = 0.75, P = 0.003) and minimum MPA HFI (r=-0.72, P = 0.005). CONCLUSION We developed a semi-automated pipeline for analyzing 4D flow metrics of vessel stiffness and flow profiles. PEA was associated with changes in 4D flow metrics of PA flow profiles and vessel stiffness. Longitudinal analysis revealed that PA helicity was associated with pulmonary remodeling and RV reverse remodeling following a PEA.
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Affiliation(s)
- Melody L Dong
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Arshid Azarine
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Young-Wouk Kim
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Weiguang Yang
- Department of Pediatric Cardiology, Stanford University, Stanford, CA, USA
| | - Elie Fadel
- Biomedical Engineering Lab, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Université Paris-Saclay, Le Plessis Robinson, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | - Laure Aubrege
- Biomedical Engineering Lab, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Daniel Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Jérôme Le Pavec
- Department of Respirology, Marie Lannelongue Hospital, Le Plessis Robinson, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | | | | | - Olaf Mercier
- Biomedical Engineering Lab, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Université Paris-Saclay, Le Plessis Robinson, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Department of Pediatric Cardiology, Stanford University, Stanford, CA, USA.
- Department of Bioengineering and Pediatric Cardiology, Stanford University, Stanford, CA, USA.
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Boehm PM, Schwarz S, Thanner J, Veraar C, Gerges M, Gerges C, Lang I, Apfaltrer P, Prosch H, Taghavi S, Klepetko W, Ankersmit HJ, Moser B. Larger pulmonary artery to ascending aorta ratios are associated with decreased survival of patients undergoing pulmonary endarterectomy. JTCVS OPEN 2022; 10:62-72. [PMID: 36004247 PMCID: PMC9390379 DOI: 10.1016/j.xjon.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022]
Abstract
Objectives The ratio of pulmonary artery (PA) and ascending aorta (AA) diameters has recently been shown to be a useful indicator for disease severity and predictor of outcome in patients with pulmonary hypertension and heart failure. This study aimed at evaluating the applicability of this ratio for perioperative risk assessment of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Methods In this retrospective cohort study on 149 patients undergoing pulmonary endarterectomy between 2013 and 2020, the preoperative PA to AA ratio was analyzed on axial computed tomography. Variables of pulmonary hemodynamic status were assessed during preoperative right heart catheterization and postoperative Swan-Ganz catheter measurements. Perioperative survival was analyzed by Kaplan-Meier method and log-rank tests. Results Preoperative computed tomography measurements showed a median AA diameter of 31 mm (range, 19-47 mm), and a median PA diameter of 36 mm (range, 25-55 mm). The calculated median PA to AA ratio was 1.13 (range, 0.79-1.80). PA to AA ratio correlated positively with PA pressure (systolic, r = 0.352 [P < .001]; diastolic, r = 0.406 [P < .001]; mean, r = 0.318 [P < .001]) and inversely with age (r = −0.484 [P < .001]). Univariable Cox regression analysis identified PA diameter (P = .008) as a preoperative parameter predictive of survival. There was a significant difference (log-rank P = .037) in 30-day survival probability for patients with lower PA to AA ratios (<1.136; survival probability, 97.4%) compared with patients with higher ratios (>1.136; survival probability, 88.9%). Conclusions PA to AA ratio shows a correlation with other variables associated with pulmonary hypertension. In addition, patients with higher PA to AA ratios have lower survival probabilities after PEA. Further analysis of PA to AA ratio on the selection of chronic thromboembolic pulmonary hypertension for different treatment modalities—pulmonary endarterectomy, medical therapy, and or balloon pulmonary angioplasty—is warranted.
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Affiliation(s)
- Panja M. Boehm
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jürgen Thanner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Cecilia Veraar
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mario Gerges
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Gerges
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Paul Apfaltrer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Bernhard Moser
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Address for reprints: Bernhard Moser, MD, PhD, MBA, Department of Thoracic Surgery, Medical University of Vienna, Austria, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Yang F, Wang D, Cui S, Zhu Y, Liu L, Ji M, Zou D, Zhao R, Liu Q. Decreased pulmonary artery distensibility as a marker for severity in acute pulmonary embolism patients undergoing ECG-gated CTPA. J Thromb Thrombolysis 2021; 51:748-756. [PMID: 33738769 DOI: 10.1007/s11239-021-02397-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
To investigate the characteristics of pulmonary artery distensibility (PAD) in patients with acute pulmonary embolism (APE) and to assess whether a relationship exists between PAD and the disease severity. Clinical and radiological data of 30 APE patients who underwent retrospective electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) with a definite diagnosis of APE were retrospectively reviewed in the present study, including 15 subjects in severe (SPE) group and 15 subjects in non-severe (NSPE) group. PAD and cardiac function parameters were compared between the two groups, their relationships were investigated, and receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the above parameters for the diagnosis of APE severity. The PAD decreased in the following order: NSPE group (6.065 ± 2.114) × 10-3 (%/mmHg), and SPE group (4.334 ± 1.777) × 10-3 (%/mmHg) (P < 0.05). All the cardiac function parameters except RA/LAdiameter showed statistically significant different values between the two groups (P < 0.05). As APE severity increased, the cardiac morphological measurements of RV/LVdiameter, RV/LVarea, RVEDV/LVEDV and RVESV/LVESV increased. There was a weak to moderate negative correlation between PAD and PAmax, PAmin, PA/AAmin, PA/AAmax, RV/LVdiameter, RV/LVarea (r = -0.393 to -0.625), that is, PAD was inversely correlated with cardiac function parameters. There was a moderate negative correlation between PAD and hemoptysis(r = -0.672). The area under the ROC curve (AUC) of PAD was 0.724, the critical value was 4.137 × 10-3 mm/Hg, and the sensitivity and specificity were 60.0% and 93.3%, respectively. PAmin showed the strongest discriminatory power to identify high-risk patients (AUC = 0.827), with the highest sensitivity of 100%, which was also achieved by RA/LAarea. The PAD obtained by retrospective ECG-gated CTPA could be an indicator to be used in the evaluation of the presence and severity of APE.
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Affiliation(s)
- Fei Yang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China.
| | - Dawei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Shujun Cui
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Yuexiang Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Lan Liu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Mengmeng Ji
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Dianjun Zou
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Ru Zhao
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Qingxiao Liu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
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Niznansky M, Kavan J, Zemankova P, Prskavec T, Ambroz D, Jansa P, Lindner J. Computed tomography angiographic parameters of pulmonary artery as prognostic factors of residual pulmonary hypertension after pulmonary endarterectomy. J Int Med Res 2021; 49:3000605211002024. [PMID: 33761801 PMCID: PMC8166393 DOI: 10.1177/03000605211002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to retrospectively assess using computed tomography pulmonary angiography (CTPA) for predicting residual pulmonary hypertension (RPH) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA). METHODS We retrospectively analyzed data of 131 patients with CTEPH who underwent PEA in our center (2008-2015). We measured several diameters of the pulmonary artery and thoracic aorta preoperatively. We evaluated the relationship between these measurements (and their indices) and signs of RPH represented by pulmonary artery systolic pressure (PASP) estimated by echocardiography. RESULTS Significant correlations were observed between the aortopulmonary index and prediction of any residual hypertension and moderate/severe hypertension 1 year after PEA, and any residual hypertension and severe hypertension 2 years after PEA. The aortopulmonary index was significantly related to a reduction in PASP 1 year after the operation. A lower aortopulmonary index (≤0.88 for the ascending aorta and ≤0.64 for the descending aorta) predicted lower RPH. CONCLUSIONS Preoperative CTPA parameters can be used to assess the risk of RPH after PEA. The aortopulmonary index has significant predictive value for RPH and a reduction in PASP after PEA. Lower values of the aortopulmonary index suggest a better outcome after PEA.
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Affiliation(s)
- Matus Niznansky
- Department of Cardiovascular Surgery, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Jan Kavan
- Department of Radiology, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Petra Zemankova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Tomas Prskavec
- Department of Cardiovascular Surgery, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - David Ambroz
- Department of Cardiology and Angiology, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Pavel Jansa
- Department of Cardiology and Angiology, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Jaroslav Lindner
- Department of Cardiovascular Surgery, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Czech Republic
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Ruigrok D, Braams NJ, Nossent EJ, Bonta PI, Boonstra A, Lely RJ, Klok FA, Vonk Noordegraaf A, Symersky P, Bogaard HJ, Meijboom LJ. Dynamic vascular changes in chronic thromboembolic pulmonary hypertension after pulmonary endarterectomy. Pulm Circ 2020; 10:2045894020907883. [PMID: 33209297 PMCID: PMC7645796 DOI: 10.1177/2045894020907883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
Residual pulmonary hypertension is an important sequela after pulmonary
endarterectomy for chronic thromboembolic pulmonary hypertension. Recurrent
thrombosis or embolism could be a contributor to this residual pulmonary
hypertension but the potential extent of its role is unknown in part because
data on incidence are lacking. We aimed to analyze the incidence of new
intravascular abnormalities after pulmonary endarterectomy and determine
hemodynamic and functional implications. A total of 33 chronic thromboembolic
pulmonary hypertension patients underwent routine CT pulmonary angiography
before and six months after pulmonary endarterectomy, together with right heart
catheterization and exercise testing. New vascular lesions were defined as (1) a
normal pulmonary artery before pulmonary endarterectomy and containing a
thrombus, web, or early tapering six months after pulmonary endarterectomy or
(2) a pulmonary artery already containing thrombus, web, or early tapering at
baseline, but increasing six months after pulmonary endarterectomy. Nine of 33
(27%) chronic thromboembolic pulmonary hypertension patients showed new vascular
lesions on CT pulmonary angiography six months after pulmonary endarterectomy.
In a subgroup of patients undergoing CT pulmonary angiography 18 months after
pulmonary endarterectomy, no further changes in lesions were noted. Hemodynamic
and functional outcomes were not different between patients with and without new
vascular lesions. New vascular lesions are common after pulmonary endarterectomy
for chronic thromboembolic pulmonary hypertension; currently their origin,
dynamics, and long-term consequences remain unknown.
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Affiliation(s)
- Dieuwertje Ruigrok
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anco Boonstra
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rutger J Lely
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petr Symersky
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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8
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Pulmonary vascular imaging characteristics after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2020; 39:248-256. [DOI: 10.1016/j.healun.2019.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/17/2019] [Accepted: 11/27/2019] [Indexed: 01/24/2023] Open
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9
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Kayawake H, Aoyama A, Kinoshita H, Yoneda T, Baba S, Teramoto Y, Miyagawa-Hayashino A, Yamazaki K, Motoyama H, Hamaji M, Nakajima D, Chen-Yoshikawa TF, Date H. Diameter of the dilated main pulmonary artery in patients with pulmonary hypertension decreases after lung transplantation. Surg Today 2019; 50:275-283. [PMID: 31595367 DOI: 10.1007/s00595-019-01887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The pulmonary artery (PA) in patients with pulmonary hypertension (PH) becomes dilated. We analyzed the postoperative changes of the main PA after lung transplantation (LuTx). METHODS The subjects of this retrospective study were 68 LuTx recipients, divided into a PH group (n = 36) and a non-PH group (n = 32), based on preoperative right heart catheterization findings. The PA diameter was measured on chest computed tomography. We evaluated the correlation between the mean pulmonary arterial pressure (mPAP) and the main PA diameter and compared the main PA diameters before and 3 months after LuTx. RESULTS The main PA diameter was significantly correlated with the mPAP (r = 0.423, P < 0.001). Preoperatively, the mean main PA diameter in the PH group was significantly greater than that in the non-PH group. However, by 3 months after LuTx, the main PA diameter in the PH group had decreased significantly from 32.4 ± 6.7 to 26.9 ± 4.8 mm (P < 0.001), while that in the non-PH group had decreased minimally from 28.3 ± 4.9 to 26.4 ± 4.6 mm (P < 0.001), resulting in no significant difference in postoperative main PA diameters between the two groups. CONCLUSIONS The main PA diameter in recipients with PH was enlarged and correlated with the mPAP. The dilated main PA diameter in PH patients decreased shortly after LuTx.
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Affiliation(s)
- Hidenao Kayawake
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, 2 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | | | - Tomoya Yoneda
- Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan
| | - Shiro Baba
- Department of Pediatrics, Kyoto University, Kyoto, Japan
| | - Yuki Teramoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | | | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University, Kyoto, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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10
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Kratzert WB, Boyd EK, Saggar R, Channick R. Critical Care of Patients After Pulmonary Thromboendarterectomy. J Cardiothorac Vasc Anesth 2019; 33:3110-3126. [PMID: 30948200 DOI: 10.1053/j.jvca.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
Abstract
Pulmonary thromboendarterectomy (PTE) remains the only curative surgery for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative intensive care unit care challenges providers with unique disease physiology, operative sequelae, and the potential for detrimental complications. Central concerns in patients with CTEPH immediately after PTE relate to neurologic, pulmonary, hemodynamic, and hematologic aspects. Institutional experience in critical care for the CTEPH population, a multidisciplinary team approach, patient risk assessment, and integration of current concepts in critical care determine outcomes after PTE surgery. In this review, the authors will focus on specific aspects unique to this population, with integration of current available evidence and future directions. The goal of this review is to provide the cardiac anesthesiologist and intensivist with a comprehensive understanding of postoperative physiology, potential complications, and contemporary intensive care unit management immediately after pulmonary endarterectomy.
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Affiliation(s)
- Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajan Saggar
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Richard Channick
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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11
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Rahaghi FN, Ross JC, Agarwal M, González G, Come CE, Diaz AA, Vegas-Sánchez-Ferrero G, Hunsaker A, San José Estépar R, Waxman AB, Washko GR. Pulmonary vascular morphology as an imaging biomarker in chronic thromboembolic pulmonary hypertension. Pulm Circ 2016; 6:70-81. [PMID: 27162616 PMCID: PMC4860553 DOI: 10.1086/685081] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) have morphologic changes to the pulmonary vasculature. These include pruning of the distal vessels, dilation of the proximal vessels, and increased vascular tortuosity. Advances in image processing and computer vision enable objective detection and quantification of these processes in clinically acquired computed tomographic (CT) scans. Three-dimensional reconstructions of the pulmonary vasculature were created from the CT angiograms of 18 patients with CTEPH diagnosed using imaging and hemodynamics as well as 15 control patients referred to our Dyspnea Clinic and found to have no evidence of pulmonary vascular disease. Compared to controls, CTEPH patients exhibited greater pruning of the distal vasculature (median density of small-vessel volume: 2.7 [interquartile range (IQR): 2.5-3.0] vs. 3.2 [3.0-3.8]; P = 0.008), greater dilation of proximal arteries (median fraction of blood in large arteries: 0.35 [IQR: 0.30-0.41] vs. 0.23 [0.21-0.31]; P = 0.0005), and increased tortuosity in the pulmonary arterial tree (median: 4.92% [IQR: 4.85%-5.21%] vs. 4.63% [4.39%-4.92%]; P = 0.004). CTEPH was not associated with dilation of proximal veins or increased tortuosity in the venous system. Distal pruning of the vasculature was correlated with the cardiac index (R = 0.51, P = 0.04). Quantitative models derived from CT scans can be used to measure changes in vascular morphology previously described subjectively in CTEPH. These measurements are also correlated with invasive metrics of pulmonary hemodynamics, suggesting that they may be used to assess disease severity. Further work in a larger cohort may enable the use of such measures as a biomarker for diagnostic, phenotyping, and prognostic purposes.
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Affiliation(s)
- F N Rahaghi
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J C Ross
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - M Agarwal
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G González
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - C E Come
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A A Diaz
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - A Hunsaker
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - R San José Estépar
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - A B Waxman
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G R Washko
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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Cardiovascular imaging 2015 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2016; 32:697-709. [DOI: 10.1007/s10554-016-0877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Cimsit NC, Cimsit C, Onaygil C, Kuzan TY. Correlation of clot distribution with morphometric measurements and pleuroparenchymal findings in acute pulmonary embolism: experience with 692 cases. Clin Imaging 2015; 39:1012-7. [DOI: 10.1016/j.clinimag.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/19/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022]
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