Right ventricular reverse remodeling after pulmonary endarterectomy: magnetic resonance imaging and clinical and right heart catheterization assessment

The objective of this study was to assess the effect of pulmonary endarterectomy ( PEA) on right ventricular ( RV) reverse remodeling using magnetic resonance imaging (MRI) and to correlate MRI findings with clinical and hemodynamic outcomes postsurgery. We performed a retrospective analysis in 72 patients undergoing PEA surgery in whom MRI and right heart catheterization (RHC) were performed preoperation and 3 months postoperation. RV volumes and mass were assessed by MRI. Continuous variables were expressed as means, changes were compared with a paired t test, and associations between the variables were explored using Pearson correlation coefficients. The mean age was 57 years, and 51% were male. Both RV end-diastolic volume ( EDV; 176-117 mL; P < 0.001) and RV end-systolic volume (ESV; 129-64 mL; P < 0.001) reduced significantly following PEA. Preoperative pulmonary artery pressure ( PAP) correlated moderately with ESV ( r = 0.46, P < 0.001). Postoperatively, PAP correlated with EDV ( r = 0.45, P < 0.001) and ESV ( r = 0.44, P < 0.001). Moderate correlation was present between hemodynamic parameters: PAP, pulmonary vascular resistance, and right atrial pressure with pre-and postoperation end-systolic and end-diastolic RV mass ( P < 0.001). RHC and MRI measurements of cardiac output and RV volumes were significantly different ( P < 0.001). In conclusion, RV reverse remodeling, as measured by improvement in RV volumes and mass by MRI, was observed for 3 months in patients who underwent PEA surgery. This is the largest series of patients with pre-and post-PEA MRI assessment so far reported. MRI detects changes in parameters reflecting cardiac remodeling and pulmonary clearance, but measurements are significantly different from those of RHC.