Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension

作者：Marston Nicholas A; Auger William R; Madani Michael M; Kimura Bruce J; Strachan G Monet; Raisinghani Ajit B; DeMaria Anthony N; Blanchard Daniel G^*

来源：Cardiovascular Ultrasound, 2014, 12(1): 32.

DOI：10.1186/1476-7120-12-32

• Left atrial volume
• Chronic thromboembolic pulmonary hypertension
• Pulmonary thromboendarterectomy

Background: Impaired left ventricular diastolic filling is common in chronic thromboembolic pulmonary hypertension (CTEPH), and recent studies support left ventricular underfilling as a cause. To investigate this further, we assessed left atrial volume index (LAVI) in patients with CTEPH before and after pulmonary thromboendarterectomy (PTE).
Methods: Forty-eight consecutive CTEPH patients had pre- & post-PTE echocardiograms and right heart catheterizations. Parameters included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, LAVI, & mitral E/A ratio. Echocardiograms were performed 6 +/- 3 days pre-PTE and 10 +/- 4 days post-PTE. Regression analyses compared pre- and post-PTE LAVI with other parameters.
Results: Pre-op LAVI (mean 19.0 +/- 7 mL/m(2)) correlated significantly with pre-op PVR (R = -0.45, p = 0.001), mPAP (R = -0.28, p = 0.05) and cardiac index (R = 0.38, p = 0.006). Post-PTE, LAVI increased by 18% to 22.4 +/- 7 mL/m(2) (p = 0.003). This change correlated with change in PVR (765 to 311 dyne-s/cm(5), p = 0.01), cardiac index (2.6 to 3.2 L/min/m(2), p = 0.02), and E/A (. 95 to 1.44, p = 0.002).
Conclusion: In CTEPH, smaller LAVI is associated with lower cardiac output, higher mPAP, and higher PVR. LAVI increases by similar to 20% after PTE, and this change correlates with changes in PVR and mitral E/A. The rapid increase in LAVI supports the concept that left ventricular diastolic impairment and low E/A pre-PTE are due to left heart underfilling rather than inherent left ventricular diastolic dysfunction.

• 出版日期2014-8-11