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Am J Cardiol. 2014 Jul 1;114(1):136-40. doi: 10.1016/j.amjcard.2014.04.016. Epub 2014 Apr 18.

Effect of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension on stroke volume response to exercise.

Author information

  • 1Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: s.surie@umcg.nl.
  • 2Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
  • 3Department of Physics and Medical Technology, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
  • 4Department of Pulmonary Medicine, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
  • 5Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
  • 6Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

In pulmonary hypertension, exercise is limited by an impaired right ventricular (RV) stroke volume response. We hypothesized that improvement in exercise capacity after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is paralleled by an improved RV stroke volume response. We studied the extent of PEA-induced restoration of RV stroke volume index (SVI) response to exercise using cardiac magnetic resonance imaging (cMRI). Patients with CTEPH (n = 18) and 7 healthy volunteers were included. Cardiopulmonary exercise testing and cMRI were performed before and 1 year after PEA. For cMRI studies, pre- and post-operatively, all patients exercised at 40% of their preoperative cardiopulmonary exercise testing-assessed maximal workload. Post-PEA patients (n = 13) also exercised at 40% of their postoperative maximal workload. Control subjects exercised at 40% of their predicted maximal workload. Preoperatively, SVI (n = 18) decreased during exercise from 35.9 ± 7.4 to 33.0 ± 9.0 ml·m(2) (p = 0.023); in the control subjects, SVI increased (46.6 ± 7.6 vs 57.9 ± 11.8 ml·m(-2), p = 0.001). After PEA, the SVI response (ΔSVI) improved from -2.8 ± 4.6 to 4.0 ± 4.6 ml·m(2) (p <0.001; n = 17). On exercise at 40% of the postoperative maximal workload, SVI did not increase further and was still significantly lower compared with controls. Moreover, 4 patients retained a negative SVI response, despite (near) normalization of their pulmonary hemodynamics. The improvement in SVI response was accompanied by an increased exercise tolerance and restoration of RV remodeling. In conclusion, in CTEPH, exercise is limited by an impaired stroke volume response. PEA induces a restoration of SVI response to exercise that appears, however, incomplete and not evident in all patients.

Copyright © 2014 Elsevier Inc. All rights reserved.

PMID:
24819907
[PubMed - indexed for MEDLINE]
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