Can my echo work as a crystal ball? - Echocardiographic parameters predicting residual pulmonary hypertension after pulmonary endarterectomy.

Abstract

Introduction and objectives: Pulmonary endarterectomy should be considered in all patients with chronic thromboembolic pulmonary hypertension. Twenty five percent of patients maintain pulmonary hypertension after pulmonary endarterectomy, with therapeutic and prognostic implications. We aimed to evaluate echocardiographic parameters at diagnosis as predictors for development of residual pulmonary hypertension.

Methods: Retrospective, observational, unicentric study of patients with confirmed chronic thromboembolic pulmonary hypertension who underwent pulmonary endarterectomy between January 2010 and October 2024. All patients underwent transthoracic echocardiogram at diagnosis. After pulmonary endarterectomy, patients had a right heart catheterization to exclude residual pulmonary hypertension (mean pulmonary artery pressure ≥30 mmHg). Right heart echocardiographic parameters were assessed and compared.

Results: Thirty-nine patients had chronic thromboembolic pulmonary hypertension and underwent pulmonary endarterectomy during the follow-up period. Mean age at diagnosis was 57.3 years-old. Eighteen patients had documented residual pulmonary hypertension. Tricuspid annular plane systolic excursion (p=0.010), end-diastolic right ventricular area (p<0.001), end-systolic right ventricular area (p<0.001), fractional area change (p=0.006), tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (p=0.002), diastolic (p=0.002) and systolic eccentric ratio (p=0.036) were significantly different between the two groups. End-systolic right ventricular area and end-diastolic right ventricular area were independently associated with residual pulmonary hypertension (p=0.023 and p=0.013), and those with end-diastolic right ventricular area above 27.13 cm² (area under the curve [AUC] 0.88, sensitivity 89%, specificity 85%, odds ratio 44) and end-systolic right ventricular area >19.54 cm² (AUC 0.875, sensitivity 88%, specificity 85%, odds ratio 38.5) had higher probability of developing residual pulmonary hypertension after pulmonary endarterectomy.

Conclusion: This study shows that certain echocardiographic parameters could be predictors of development of residual pulmonary hypertension after pulmonary endarterectomy; however, validation in larger cohorts is mandatory.