Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease.

Symptomatic patients with chronic thromboembolic disease (CTED) without pulmonary hypertension often show an excessive increase in mean pulmonary arterial pressure (MPAP) during exercise.We report on the impact of pulmonary endarterectomy (PEA) on pulmonary haemodynamics in a prospective series of 32 consecutive CTED patients who underwent PEA. All patients had a comprehensive diagnostic work-up including right heart catheterisation at baseline and 12 months after PEA. Furthermore, in 12 patients exercise right heart catheterisation was performed before and after PEA.After PEA, MPAP was lower at rest (20±3 versus 17±3 mmHg; p=0.008) and during maximal exercise (39±8 versus 31±6 mmHg; p=0.016). The mean total pulmonary resistance (TPR) decreased from 3.6±0.8 Wood Units (WU) pre-operatively to 2.7±0.7 WU 1 year after PEA (p=0.004) and the mean slope of the MPAP/cardiac output (CO) relationship decreased from 3.6±1.0 to 2.3±0.8 WU (p=0.002). Peak oxygen uptake increased from 1.2±0.4 to 1.5±0.3 L·min ^-1 (p=0.014) and ventilatory equivalents of carbon dioxide decreased from 39±2 to 30±2 (p=0.002). There was a significant improvement in quality of life assessed by the Cambridge Pulmonary Hypertension Outcome Review questionnaire.In CTED patients, PEA resulted in haemodynamic and clinical improvements. The means of TPR and MPAP/CO slopes decreased to <3.0 WU.
Competing Interests: Conflict of interest: S. Guth reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; personal fees from Actelion Pharmaceuticals, Bayer, Pfizer and GSK, outside the submitted work. Conflict of interest: C.B. Wiedenroth reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; personal fees from Actelion, Bayer AG, BTG, MSD and Pfizer, outside the submitted work. Conflict of interest: A. Rieth reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; personal fees from Actelion Pharmaceuticals, Novartis, Servier and St Jude Medical, and grants from Pfizer, outside the submitted work. Conflict of interest: M.J. Richter reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; personal fees and nonfinancial support from Actelion Pharmaceuticals, personal fees from Bayer, Mundipharma, OMT and Roche, outside the submitted work. Conflict of interest: H.A. Ghofrani reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; grants and personal fees from Actelion Pharmaceuticals, Bayer, Pfizer and Novartis, personal fees from Bellerophon Pulse Technologies, Medscape, OMT, UCB Celltech, WebMD Global, Gilead Sciences, GSK and Merck, outside the submitted work. Conflict of interest: C. Liebetrau reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; personal fees from Abbott, Bayer, Pfizer, AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Daiichi Sankyo and Elixir Medical, outside the submitted work. Conflict of interest: A. Rolf reports personal fees from AstraZeneca, Boehringer Ingelheim and Pfizer-Bristol-Myers Squibb, outside the submitted work. Conflict of interest: C.W. Hamm reports nonfinancial support from the German Center for Lung Research, during the conduct of the study. Conflict of interest: E. Mayer reports nonfinancial support from the German Center for Lung Research, during the conduct of the study; personal fees from Actelion Pharmaceuticals, Bayer, Pfizer, GSK and MSD, outside the submitted work. Conflict of interest: E. Gruenig has received fees for lectures and/or consultations from Actelion Pharmaceuticals, Bayer/MSD, GSK, United Therapeutics and Pfizer.
(Copyright ©ERS 2018.)