University of Twente Student Theses


Preload reducing therapies on right heart function in pulmonary hypertension

Rover, Jari de (2023) Preload reducing therapies on right heart function in pulmonary hypertension.

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Abstract:Introduction: Right heart function determines the prognosis of pre-capillary pulmonary hypertension (PH) patients. Current therapies aim at afterload reduction to restore right heart function. Less is known about preload reducing therapies. This study assessed the effect of preload reduction by both loop diuretics and shunting of blood through a patent foramen ovale (PFO) on right heart function in pre-capillary PH. Methods: For assessment of loop diuretics, an interventional study was designed. Right heart function was assessed in clinically stable pulmonary arterial hypertension (PAH) and chronic-thrombo-embolic PH (CTEPH) patients using cardiac magnetic resonance imaging (CMR) before and one week after diuretic withdrawal. PAH and CTEPH patients with a PFO were retrospectively identified using gas-exchange criteria by cardiopulmonary exercise testing. Right heart function and hemodynamics at rest and during exercise were evaluated using CMR and right heart catheterization and compared to patients without PFO. Results: No clear increase in cardiac volumes or change in right heart function can be observed one week after diuretic withdrawal in 2 PAH patients. In treatment naïve PAH patients with PFO, right ventricular end-diastolic volume right ventricular end-systolic volume, end-diastolic pressure and end-diastolic elastance were significantly higher and right ventricular ejection fraction was significantly lower. No differences were found in hemodynamics and functional parameters. Hemodynamic exercise response was significantly lower in patients with PFO for cardiac index (P-interaction = 0.049), mean pulmonary artery pressure (P-interaction = 0.020) and systolic pulmonary artery pressure (P-interaction = 0.028). Conclusions: No indications were observed for altered right heart volumes and function in clinically stable PAH patients after diuretic withdrawal. Treatment-naïve PAH patients with a PFO have a dilated right ventricle and worse right ventricular function, while hemodynamics were similar at rest. Hemodynamic exercise response was lower in patients with a PFO. Opening of a PFO is caused by severe disease in pre-capillary PH patients and did not result in a preload reduction.
Item Type:Essay (Master)
Amsterdam UMC, Amsterdam, the Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
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