OBJECTIVES: Pulmonary arterial hypertension (PAH) is a progressive and often fatal disease characterized by increased pulmonary vascular resistance (PVR) and right ventricular (RV) failure. End-stage PAH is often an indication for a lung transplant (LTX). Our goal was to study ventricular recovery using cardiac magnetic resonance imaging late after LTX.
METHODS: We studied 10 patients with PAH who underwent isolated bilateral LTX. RV and left ventricular (LV) volumes, function and mass were measured. In addition, the RV stroke volume/end-systolic ratio (SV/ESV), the LV eccentricity index, the RV/LV volume ratio, the area of the tricuspid valve annulus and the severity of tricuspid regurgitation (TR) were calculated.
RESULTS: The median age was 44 [30-54] years and the mean PVR was 1020 +/- 435 dynes.s.cm(-5). Six patients had >= moderate TR. After LTX, the RV ejection fraction increased from 32 to 64% (P <0.001) and both RV volume (from 118 to 51 ml/m(2), P <0.001) and RV mass (from 69 to 33 g/m(2), P <0.001) decreased. The mean SV/ESV ratio increased from 0.5 to 1.9 (P <0.001) and the LV mass increased from 55 to 61 g/m(2) (P = 0.005). There was a decrease in both the LV eccentricity index (from 2.8 to 1.1, P <0.001) and the RV/LV volume ratio (from 2.3 to 0.8, P <0.001). The area of the tricuspid valve annulus also decreased (from 9.8 to 4.6 cm(2)/m(2), P <0.001); no patient had >= mild TR post-LTX.
CONCLUSIONS: Cardiac magnetic resonance imaging confirms ventricular recovery after isolated bilateral LTX for end-stage PAH.
- Pulmonary arterial hypertension
- Right ventricular failure
- Lung transplantation
- Cardiac magnetic resonance imaging
- CARDIOVASCULAR MAGNETIC-RESONANCE
- TRICUSPID REGURGITATION
- PRESSURE LOAD