Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic
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Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis Wen Li 1 & Tao Yang 1 & Rui-lin Quan 1 & Xiao-xi Chen 1 & Jing An 2 & Zhi-hui Zhao 1 & Zhi-hong Liu 1 & Chang-ming Xiong 1 & Jian-guo He 1 & Qing Gu 1 Received: 25 August 2020 / Revised: 12 October 2020 / Accepted: 5 November 2020 # European Society of Radiology 2020
Abstract Objectives Right ventricular (RV) function is considered the major determinant of prognosis in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this meta-analysis was to evaluate RV remodelling and function following balloon pulmonary angioplasty (BPA) in patients with inoperable CTEPH or persistent/recurrent pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). Methods We reviewed all studies evaluating RV function by cardiac magnetic resonance (CMR) and/or echocardiography preand post-BPA from PubMed/Medline prior to 15 December 2019. Ten (299 patients) of the 29 studies retrieved met the inclusion criteria: 5 CMR and 5 echocardiography studies. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Results Pooled data from CMR studies revealed BPA resulted in a significantly decreased RV end-diastolic volume index (weighted mean difference (WMD) − 28.33 ml/m2, p < 0.00001) and RV end-systolic volume index (WMD − 29.06 ml/m2, p < 0.00001) accompanied by an increased RV ejection fraction (RVEF, WMD 8.97%, p < 0.00001). Data from the echocardiography studies showed BPA resulted in decreased RV basal diameter (WMD − 0.37 cm, p = 0.0009) and an increase of RV fractional area change (WMD 5.97 %, p = 0.003), but improvements of tricuspid annular plane systolic excursion (TAPSE) and S ′ were not significant. Conclusions BPA improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA. Key Points • Balloon pulmonary angioplasty improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/ recurrent PH after PEA. Keywords Pulmonary hypertension . Balloon angioplasty . Right ventricular function . Meta-analysis Wen Li and Tao Yang contributed equally to this article as first authors. Jian-guo He and Qing Gu contributed equally to this article as corresponding authors. * Jian-guo He [email protected] * Qing Gu [email protected] 1
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2
Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
Abbreviations and acronyms 6MWD 6-min walk distance BNP Brain natriuretic peptide BPA Balloon pulmonary angioplasty CI Cardiac index CMR Cardiac magnetic resonance CO Cardiac output CTEPH Chronic thromboembolic pulmonary hypertension EDVI End-diastolic volume index EF Ejection f
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