Objectives: To clarify the echocardiographic indices for evaluating the effectiveness of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
Methods: We reviewed 28 CTEPH patients who underwent BPA from January 2010 to February 2012. Right heart catheterization and echocardiograms were performed before and after BPA. We compared the echocardiographic indices to hemodynamic data. Hemodynamic data included mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). Echocardiographic indices included the tricuspid annular plain systolic excursion (TAPSE), the tricuspid annular systolic velocity obtained by Doppler tissue imaging, the right ventricular myocardial performance index (RVIMP), the area ratio of the right ventricle to the left ventricle, the area ratio of the right atrium to the left atrium and the eccentricity index in echocardiography.
Results: After BPA, the mPAP and PVR were improved significantly (mPAP: before 43±11 mmHg, after 31±7 mmHg, p<0.01; PVR: before 908±367 dyne·s/cm⁵, after 480±174 dyne·s/cm⁵, p<0.01.) Although most echocardiographic indices also improved significantly, TAPSE did not improve. Multivariable analysis revealed that the eccentricity index was the best index to reflect the degree of effectiveness of BPA.
Conclusions: The eccentricity index was judged to be the most useful echocardiographic index to evaluate the degree of effectiveness of BPA in CTEPH patients.

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[in Japanese]

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Background: Left ventricular outflow tract diameter (LVOTD) is an important component in the calculation of aortic valve area (AVA). The timing when and the site where it is measured are different among each laboratory. We investigated the influence of the methods of measuring LVOTD on the assessment of AVA.
Methods: We included 200 aortic stenosis (AS) patients with AVA below 2.0 cm² with use of the B method describing below. We retrospectively measured LVOTD in three different ways (A, B and C) and calculated AVA from each LVOTD measurement using the continuity equation. (A: at end-diastole, 5 mm below the aortic valve annulus, B: at early systole, 5 mm below the aortic valve annulus, C: at early systole at aortic valve annulus) We also measured the valve area using planimetry method (D) in 144 patients. We compared AVA from the four methods. We also checked grading of AS between B and C.
Results: The mean AVA was 1.25±0.42 cm² with A method, 1.26±0.41 cm² with B method, 1.40±0.48 cm² in C method and 1.54±0.50 cm² in D method. AVA was similar between A and B methods as well as between C and D methods. AVA was 18% smaller with B method and 10% smaller with C methods than with D method. AS was graded severe with B method than D method.
Conclusion: There is difference in the AVA assessment by different measurement methods of LVOTD, leading to the misleading of AS grading, probably because of the oval shape of the left ventricular outflow tract. LVOTD measurement at the aortic annulus should be considered to have better assessment.

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