Search

Purpose Chronic thrombo-embolic pulmonary hypertension (CTEPH) leads to right ventricular (RV) adverse remodeling if left untreated. We recently compared RV features between CTEPH patients and healthy controls. We found that capillary rarefaction, myocardial fibrosis, cardiomyocytes hypertrophy and increased macrophages infiltration were associated with impaired ventricular-arterial coupling, RV dysfunction and increased glucose uptake. Pulmonary endarterectomy (PE) is the treatment of choice for CTEPH, resulting in a marked decrease in RV afterload. In this study, we sought to investigate the correlations between preoperative RV pathological features and postoperative RV function and metabolism. Methods We followed 9 CTEPH patients undergoing PE during which we performed RV biopsies. RV phenotype was assessed using cardiac magnetic resonance, resting echocardiography and 18-Fluoro-Deoxi-Glucose Positron Emission Tomography before PE, and at 1- and 6-months post operatively. Results RV systolic pressures decreased in all patients at 1 month follow-up. Similarly, indices of RV function, remodeling, glucose uptake and coupling as assessed by the Stroke Volume/End Systolic Volume ratio significantly improved at 6 months follow-up. Improvement of RV ejection fraction and RV end systolic volume index were correlated to pre-operative cardiomyocytes hypertrophy (Figure 1). There was a trend for an association between RV fibrosis and moderate improvement in RV systolic function after PE. Preoperative macrophage infiltration and capillary density did not impact on postoperative RV functional recovery. Conclusion After PE, RV phenotype was associated with marked improvement in RV systolic function 6 months, which correlated with pre-operative cardiomyocytes hypertrophy. RV fibrosis was not associated with impaired outcomes and did not limit RV functional recovery in this study. [ABSTRACT FROM AUTHOR]

Purpose Patients with chronic thromboembolic pulmonary hypertension (CTEPH) display features of systemic inflammation. This study assesses whether high preoperative C-reactive protein (CRP) levels are associated with in-hospital outcomes after pulmonary endarterectomy. Methods This study included 159 patients who underwent pulmonary endarterectomy from 2009 to 2013 (derivation cohort) and 238 patients from 2015 to 2016 (validation cohort) from the French national CTEPH registry. The correlations between pro-inflammatory markers (CRP, interleukins 1 and 6, fibrinogen and leukocytes) and hemodynamics were assessed in the derivation cohort. Pre-, perioperative characteristics and 30-day outcomes (primary endpoint: death or lung transplant or extracorporeal membrane oxygenation need or inotropic or vasopressor need more than 2 days) of patients with high or low CRP levels were compared. Results Median age of the derivation cohort was 63 [52-73] years with 48% of female, 80% in NYHA class III/IV. CRP levels moderately correlated with fibrinogen, interleukin-6 and neutrophils count (r range 0.28-0.47). The validation cohort had similar demographics and disease severity. Patients with high CRP had higher resistance levels and lower cardiac index than those with low CRP in both cohorts. The primary endpoint was reached in 38% (derivation) and 42% (validation) of patients. In multivariable logistic regression analysis, CRP higher than 10 mg/L was associated with the primary endpoint in both the derivation cohort (odd ratio = 2.49 [1.11-5.61], independently of NYHA class IV and aortic clamping duration) and the validation cohort (odd ratio = 1.89 [1.09-3.61], independently of age and aortic clamping duration). Conclusion Preoperative CRP level higher than 10 mg/L is independently associated with adverse early outcomes after pulmonary endarterectomy. [ABSTRACT FROM AUTHOR]