Chronic Thrombo-embolic Pulmonary Hypertension and Pulmonary Arterial Hypertension Clinical Trial
Official title:
Determinants of Postoperative Right Heart Remodeling in Patients With Chronic Thrombo-Embolic Pulmonary Hypertension After Endarterectomy, or Pulmonary Arterial Hypertension After Lung Transplantation
Right heart failure is the main cause of morbi-mortality in patients with pulmonary
hypertension (PH), including patients of chronic thrombo-embolic pulmonary hypertension
(CTEPH) or pulmonary arterial hypertension (PAH) etiologies. Endarterectomy is an effective
treatment for patients with CTEPH to lower pulmonary pressure. Evidence of postoperative
right heart remodeling are contrasted according to the studies and determinants of right
heart failure are still unclear. Similarly, few evidence exists on right ventricular
remodeling after bilateral lung transplantation for patients with pulmonary arterial
hypertension (PAH). Recent evidence have supported the role of inflammation and immunity in
the pathophysiology of PAH . While several cytokines have been shown to predict survival ,
little is known on the implication of inflammation and immunity in postoperative Right
Ventricular failure in patients with PAH.
• The specific translational goal of this current project is to elucidate the role of immune
biomarkers in 6 months postoperative right heart adverse remodeling in patients with CTEPH or
PAH. We speculate that selected immune biomarkers (such as CXCL9, interleukin -18 or
interferon) and growth factors (such as HGF) are correlated with mid-term postoperative right
heart failure.
All consecutive adults with either CTEPH referred to our center for endarterectomy, or PAH
referred for lung transplantation, will be included, aiming for 150 CTEPH and 50 PAH. After
inclusion, patients will undergo assessment of right heart dimensions and function by cardiac
magnetic resonance imaging (MRI, including 4-Dimensions blood flow sequences) and 2D and 3D
trans-thoracic echocardiography (TTE), as well as immune panel analysis. All patients will
undergo as part of routine care right heart catheterization within a week after TTE and MRI
imaging. On the day of surgery, pulmonary pressure will be measured by right heart
catheterization monitoring (as part of routine care) in order to estimate the drop of
pressure and to adjust for the extent of endarterectomy for patients with CTEPH. TTE will
also be performed on the day of surgery if possible. At 7 days post-endarterectomy or
transplant, clinical outcomes will be collected and peripheral blood will be collected.
Patients will be prospectively follow-up for 6 months. Death, need for reintervention,
duration of vasopressor after surgery and number, duration and cause of readmission will be
recorded. At 6 months after surgery, all survivors will undergo the same biological sampling,
as well as an 4D MRI and a 2D and 3D TTE. Data of right heart catheterization at 6 months (as
part of routine care) will be collected as well.
n/a