SPC365

Right heart remodeling after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

Session: Comunicações Orais (Sessão 4) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 1 - Foco no TEP e Hipertensão Pulmonar
Speaker: Rita Calé

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Calé; Filipa Ferreira; Ana Rita Pereira; Sofia Alegria; Mariana Martinho; Débora Repolho; Ângela Manuel; Pedro Santos; Silvia Vitorino; Isabel João; Maria José Loureiro; Hélder Pereira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt">Introduction: </span></strong><span style="font-size:12pt">In chronic thromboembolic pulmonary hypertension (CTEPH) there is right chambers (RC) remodeling to compensate for the increased resistance in the lung circulation. Furthermore,&nbsp;right ventricular (RV) function is a prognostic marker in these patients (pts). The aim of this study was to evaluate the effects on RC remodeling of a hybrid therapeutic approach with pulmonary vasodilators and balloon pulmonary angioplasty (BPA) in CTEPH.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt">Methods:</span></strong><span style="font-size:12pt"> Prospective single-centre study that included consecutive CTEPH pts submitted to BPA from 2017 to 2020. All patients underwent two-dimensional transthoracic echocardiography and right-heart catheterization at the time of diagnosis before starting vasodilator therapy, before and 6 months after BPA. RC remodeling was assessed as RV area and right atrial (RA) volume. For RV function the following parameters were measured: tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular peak systolic velocity by pulsed tissue Doppler imaging (RV S&acute;) and RV fractional area change (RVFAC). LV geometry was assessed by calculation of LV eccentricity index (EI).&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt">Results:</span></strong><span style="font-size:12pt"> 70 BPA sessions were performed in 13 CTEPH pts (</span><span style="font-size:12pt"><span style="color:black">69.2% inoperable disease). Eleven pts (84.6%) were treated with specific vasodilator therapy (guanylate cyclase stimulators in 9; endothelin receptor antagonists in 6; phosphodiesterase type 5 inhibitors in 2, prostacyclin analogues in 4 and selexipag in 1).&nbsp;</span></span><span style="font-size:12pt"><span style="color:black">Mean number of BPA sessions was 5.4</span></span><span style="font-size:12pt"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="font-size:12pt"><span style="color:black">1.9 per pt (min 2-max 8) and mean number of total vascular segments treated 9.9</span></span><span style="font-size:12pt"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="font-size:12pt"><span style="color:black">2.3 per pt (min 6-max 15).</span></span> <span style="font-size:12pt"><span style="color:black">We observed the reduction of the diastolic RV dimensions after starting vasodilator therapy, but a significant reverse remodeling of the RA and RV in systole was only observed after a BPA strategy on top of pulmonary vasodilator therapy. &nbsp;There was also an increased RVFAC and an improved LV eccentricity index after BPA, in proportion to the decrease in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) induced by the treatment&nbsp;(Table 1).&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt">Conclusions: </span></strong><span style="font-size:12pt"><span style="color:black">BPA on top of pulmonary vasodilator therapy is associated with significant hemodynamic improvement and consequently right chambers remodeling and normalization of LV geometry.</span></span></span></span></span></p>

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