Skip to main content
SpringerLink
Log in

Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 ± 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 ± 61.5 vs. 216.6 ± 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Piazza G, Goldhaber SZ (2011) Chronic thromboembolic pulmonary hypertension. N Engl J Med 364(4):351–360

    Article  CAS  PubMed  Google Scholar 

  2. Pengo V, Lensing AW, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264

    Article  CAS  PubMed  Google Scholar 

  3. Amano H, Toyoda S, Arikawa T et al (2013) Left ventricular function in pulmonary hypertension. Heart Vessels 28(4):505–509

    Article  PubMed  Google Scholar 

  4. Leitman M, Lysyansky P, Sidenko S et al (2004) Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 17:1021–1029

    Article  PubMed  Google Scholar 

  5. Sunbul M, Bozbay M, Mammadov C et al (2015) Effect of vitamin D deficiency and supplementation on myocardial deformation parameters and epicardial fat thickness in patients free of cardiovascular risk. Int J Cardiovasc Imaging. doi:10.1007/s10554-015-0622-1

    Google Scholar 

  6. Sunbul M, Kepez A, Kivrak T et al (2014) Right ventricular longitudinal deformation parameters and exercise capacity: prognosis of patients with chronic thromboembolic pulmonary hypertension. Herz 39(4):470–475

    Article  CAS  PubMed  Google Scholar 

  7. Vieira MJ, Teixeira R, Gonçalves L, Gersh BJ (2014) Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr 27(5):463–478

    Article  PubMed  Google Scholar 

  8. Olson N, Brown JP, Kahn AM et al (2010) Left ventricular strain and strain rate by 2D speckle tracking in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy. Cardiovasc Ultrasound 8:43

    Article  PubMed Central  PubMed  Google Scholar 

  9. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  10. Thistlethwaite PA, Kaneko K, Madani MM, Jamieson SW (2008) Technique and outcomes of pulmonary endarterectomy surgery. Ann Thorac Cardiovasc Surg 14(5):274–282

    PubMed  Google Scholar 

  11. Cheitlin MD, Armstrong WF, Aurigemma GP et al (2003) ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 16:1091–1110

    PubMed  Google Scholar 

  12. Delgado V, Ypenburg C, van Bommel RJ et al (2008) Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy. J Am Coll Cardiol 51:1944–1952

    Article  PubMed  Google Scholar 

  13. Tadic M, Cuspidi C, Pencic B et al (2014) Circadian blood pressure pattern and right ventricular and right atrial mechanics: a two- and three-dimensional echocardiographic study. J Am Soc Hypertens 8(1):45–53

    Article  PubMed  Google Scholar 

  14. Nagaya N, Sasaki N, Ando M et al (2003) Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Chest 123:338–343

    Article  CAS  PubMed  Google Scholar 

  15. Thenappan T, Shah SJ, Rich S, Tian L, Archer SL, Gomberg-Maitland M (2010) Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation. Eur Respir J 35:1079–1087

    Article  CAS  PubMed  Google Scholar 

  16. Li YD, Zhai ZG, Wu YF et al (2013) Improvement of right ventricular dysfunction after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: utility of echocardiography to demonstrate restoration of the right ventricle during 2-year follow-up. Thromb Res 131(5):e196–e201

    Article  CAS  PubMed  Google Scholar 

  17. Menzel T, Wagner S, Kramm T et al (2000) Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy. Chest 118(4):897–903

    Article  CAS  PubMed  Google Scholar 

  18. Kepez A, Sunbul M, Kivrak T et al (2014) Evaluation of improvement in exercise capacity after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: correlation with echocardiographic parameters. Thorac Cardiovasc Surg 62(1):60–65

    PubMed  Google Scholar 

  19. 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):281–288

    Article  CAS  PubMed  Google Scholar 

  20. Fukuda Y, Tanaka H, Sugiyama D et al (2011) Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 24:1101–1108

    Article  PubMed  Google Scholar 

  21. Motoji Y, Tanaka H, Fukuda Y et al (2015) Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension. Int J Cardiovasc Imaging 31(4):691–698

    Article  PubMed  Google Scholar 

  22. Fukuda Y, Tanaka H, Motoji Y et al (2014) Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension. Int J Cardiovasc Imaging 30(7):1269–1277

    Article  PubMed  Google Scholar 

  23. Gaynor SL, Maniar HS, Prasad SM, Steendijk P, Moon MR (2005) Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol 288(5):H2140–H2145

    Article  CAS  PubMed  Google Scholar 

  24. Hardegree EL, Sachdev A, Fenstad ER et al (2013) Impaired left ventricular mechanics in pulmonary arterial hypertension: identification of a cohort at high risk. Circ Heart Fail 6(4):748–755

    Article  PubMed  Google Scholar 

  25. Wranne B, Pinto FJ, Siegel LC, Miller DC, Schnittger I (1993) Abnormal postoperative interventricular motion: new intraoperative transesophageal echocardiographic evidence supports a novel hypothesis. Am Heart J 126:161–167

    Article  CAS  PubMed  Google Scholar 

  26. Louie EK, Rich S, Levitsky S, Brundage BH (1992) Doppler echocardiographic demonstration of the differential effects of right ventricular pressure and volume overload on left ventricular geometry and filling. J Am Coll Cardiol 19:84–90

    Article  CAS  PubMed  Google Scholar 

  27. Triposkiadis F, Tentolouris K, Androulakis A et al (1995) Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and transmitral flow velocity. J Am Soc Echocardiogr 8:801–809

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Marmara University School of Medicine, Fevzi Cakmak Mahallesi, Muhsin Yazicioglu Caddesi, No: 10, Ustkaynarca/Pendik, Istanbul, Turkey

    Murat Sunbul & Bulent Mutlu

  2. Department of Cardiology, Sivas Numune Hospital, Sivas, Turkey

    Tarik Kivrak

  3. Department of Cardiology, Silifke State Hospital, Mersin, Turkey

    Erdal Durmus

  4. Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey

    Bedrettin Yildizeli

Authors
  1. Murat Sunbul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarik Kivrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erdal Durmus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bedrettin Yildizeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bulent Mutlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Murat Sunbul.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sunbul, M., Kivrak, T., Durmus, E. et al. Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy. Int J Cardiovasc Imaging 31, 1159–1167 (2015). https://doi.org/10.1007/s10554-015-0682-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-015-0682-2

Keywords

Search

Navigation