Reverse right ventricular remodeling after lung transplantation in patients with pulmonary arterial hypertension under combination therapy of targeted medical drugs

Toshihiro Sarashina, Kazufumi Nakamura, Satoshi Akagi, Takahiro Oto, Hiroki Oe, Kentaro Ejiri, Koji Nakagawa, Nobuhiro Nishii, Hiromi Matsubara, Motomu Kobayashi, Hiroshi Morimatsu, Shinichiro Miyoshi, Hiroshi Itoh

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 languageEnglish
Pages (from-to)383-390
Number of pages8
JournalCirculation Journal
Volume81
Issue number3
DOIs
Publication statusPublished - 2017

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Ventricular Remodeling
Lung Transplantation
Pulmonary Hypertension
Pharmaceutical Preparations
Therapeutics
Echocardiography
Stroke
Right Ventricular Dysfunction
Right Ventricular Function
Ventricular Pressure
Vascular Resistance
Pulmonary Artery
Dilatation
Hemodynamics
Pressure

Keywords

  • Lung transplantation
  • Pulmonary arterial hypertension
  • Right ventricular function
  • Right ventricular reverse remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Reverse right ventricular remodeling after lung transplantation in patients with pulmonary arterial hypertension under combination therapy of targeted medical drugs",
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.",
keywords = "Lung transplantation, Pulmonary arterial hypertension, Right ventricular function, Right ventricular reverse remodeling",
author = "Toshihiro Sarashina and Kazufumi Nakamura and Satoshi Akagi and Takahiro Oto and Hiroki Oe and Kentaro Ejiri and Koji Nakagawa and Nobuhiro Nishii and Hiromi Matsubara and Motomu Kobayashi and Hiroshi Morimatsu and Shinichiro Miyoshi and Hiroshi Itoh",
year = "2017",
doi = "10.1253/circj.CJ-16-0838",
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volume = "81",
pages = "383--390",
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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

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