Traditional screening tool in the era of modern treatment for chronic thromboembolic pulmonary hypertension

Right ventricular (RV) dysfunction is one of the leading causes of death in patients with pulmonary hypertension (PH) [ [1] Vonk Noordegraaf A. Galiè N. The role of the right ventricle in pulmonary arterial hypertension. Eur. Respir. Rev. 2011; 20: 243-253 Crossref PubMed Scopus (181) Google Scholar ]. In the early stage of PH, RV pressure overload induces adaptive cardiac hypertrophy to maintain its performance. As the disease progresses, RV dilation occurs with fibrotic changes, losing both systolic and diastolic functions and resulting in RV failure and death. Several clinical studies have reported that RV dysfunction is a strong determinant of poor prognosis in both chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) [ 1 Vonk Noordegraaf A. Galiè N. The role of the right ventricle in pulmonary arterial hypertension. Eur. Respir. Rev. 2011; 20: 243-253 Crossref PubMed Scopus (181) Google Scholar , 2 Fedullo P.F. Auger W.R. Kerr K.M. Kim N.H. Chronic thromboembolic pulmonary hypertension. Semin. Respir. Crit. Care Med. 2003; 24: 273-286 Crossref PubMed Scopus (38) Google Scholar , 3 Vonk-Noordegraaf A. Haddad F. Chin K.M. Forfia P.R. Kawut S.M. Lumens J. et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J. Am. Coll. Cardiol. 2013; 62: D22-D33 Crossref PubMed Scopus (652) Google Scholar ]. Prolonged QRS duration as a predictor of right ventricular dysfunction after balloon pulmonary angioplastyInternational Journal of CardiologyVol. 280PreviewBalloon pulmonary angioplasty (BPA) has shown beneficial effects for chronic thromboembolic pulmonary hypertension (CTEPH). However, previous studies have shown less cardiac output improvement and symptoms remaining after BPA, implying poor right ventricular (RV) function recovery. Therefore, we investigated the residual RV dysfunction after BPA to reveal risk factors, clinical effects, and possible underlying histopathological mechanisms. Full-Text PDF