Abstract
Background: Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated. Methods and Results: A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly. Conclusions: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.
| Original language | English |
|---|---|
| Pages (from-to) | 383-390 |
| Number of pages | 8 |
| Journal | Circulation Journal |
| Volume | 81 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2017 |
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Keywords
- Lung transplantation
- Pulmonary arterial hypertension
- Right ventricular function
- Right ventricular reverse remodeling
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Reverse right ventricular remodeling after lung transplantation in patients with pulmonary arterial hypertension under combination therapy of targeted medical drugs. / Sarashina, Toshihiro; Nakamura, Kazufumi; Akagi, Satoshi; Oto, Takahiro; Oe, Hiroki; Ejiri, Kentaro; Nakagawa, Koji; Nishii, Nobuhiro; Matsubara, Hiromi; Kobayashi, Motomu; Morimatsu, Hiroshi; Miyoshi, Shinichiro; Itoh, Hiroshi.
In: Circulation Journal, Vol. 81, No. 3, 2017, p. 383-390.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Reverse right ventricular remodeling after lung transplantation in patients with pulmonary arterial hypertension under combination therapy of targeted medical drugs
AU - Sarashina, Toshihiro
AU - Nakamura, Kazufumi
AU - Akagi, Satoshi
AU - Oto, Takahiro
AU - Oe, Hiroki
AU - Ejiri, Kentaro
AU - Nakagawa, Koji
AU - Nishii, Nobuhiro
AU - Matsubara, Hiromi
AU - Kobayashi, Motomu
AU - Morimatsu, Hiroshi
AU - Miyoshi, Shinichiro
AU - Itoh, Hiroshi
PY - 2017
Y1 - 2017
N2 - Background: Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated. Methods and Results: A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly. Conclusions: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.
AB - Background: Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated. Methods and Results: A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly. Conclusions: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.
KW - Lung transplantation
KW - Pulmonary arterial hypertension
KW - Right ventricular function
KW - Right ventricular reverse remodeling
UR - http://www.scopus.com/inward/record.url?scp=85013901411&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013901411&partnerID=8YFLogxK
U2 - 10.1253/circj.CJ-16-0838
DO - 10.1253/circj.CJ-16-0838
M3 - Article
C2 - 28100891
AN - SCOPUS:85013901411
VL - 81
SP - 383
EP - 390
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 3
ER -