{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:34:15Z","timestamp":1788474855333,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,2,21]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension improves resting hemodynamics and right ventricular (RV) function. Because exercise tolerance frequently remains impaired, RV function may not have completely normalized after PEA. Therefore, we performed a detailed invasive hemodynamic study to investigate the effect of PEA on RV function during exercise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In this prospective study, all consenting patients with chronic thromboembolic pulmonary hypertension eligible for surgery and able to perform cycle ergometry underwent cardiac magnetic resonance imaging, a maximal cardiopulmonary exercise test, and a submaximal invasive cardiopulmonary exercise test before and 6\u2009months after PEA. Hemodynamic assessment and analysis of RV pressure curves using the single\u2010beat method was used to determine load\u2010independent RV contractility (end systolic elastance), RV afterload (arterial elastance), RV\u2013arterial coupling (end systolic elastance\u2013arterial elastance), and stroke volume both at rest and during exercise. RV rest\u2010to\u2010exercise responses were compared before and after PEA using 2\u2010way repeated\u2010measures analysis of variance with Bonferroni post hoc correction. A total of 19 patients with chronic thromboembolic pulmonary hypertension completed the entire study protocol. Resting hemodynamics improved significantly after PEA. The RV exertional stroke volume response improved 6\u2009months after PEA (79\u00b132 at rest versus 102\u00b128\u2009mL during exercise;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). Although RV afterload (arterial elastance) increased during exercise, RV contractility (end systolic elastance) did not change during exercise either before (0.43 [0.32\u20130.58] mm\u2009Hg\/mL versus 0.45 [0.22\u20130.65] mm\u2009Hg\/mL;\n                      <jats:italic>P<\/jats:italic>\n                      =0.6) or after PEA (0.32 [0.23\u20130.40] mm\u2009Hg\/mL versus 0.28 [0.19\u20130.44] mm\u2009Hg\/mL;\n                      <jats:italic>P<\/jats:italic>\n                      =0.7). In addition, mean pulmonary artery pressure\u2013cardiac output and end systolic elastance\u2013arterial elastance slopes remained unchanged after PEA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The exertional RV stroke volume response improves significantly after PEA for chronic thromboembolic pulmonary hypertension despite a persistently abnormal afterload and absence of an RV contractile reserve. This may suggest that at mildly elevated pulmonary pressures, stroke volume is less dependent on RV contractility and afterload and is primarily determined by venous return and conduit function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.122.027638","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T07:16:51Z","timestamp":1676963811000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Right Ventricular Function During Exercise After Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8541-6088","authenticated-orcid":false,"given":"Natalia J.","family":"Braams","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1238-4139","authenticated-orcid":false,"given":"Azar","family":"Kianzad","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7528-8307","authenticated-orcid":false,"given":"Lilian J.","family":"Meijboom","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Westenberg","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onno A.","family":"Spruijt","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9828-0407","authenticated-orcid":false,"given":"Josien","family":"Smits","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4057-758X","authenticated-orcid":false,"given":"Anton","family":"Vonk Noordegraaf","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anco","family":"Boonstra","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3854-4137","authenticated-orcid":false,"given":"Esther J.","family":"Nossent","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Oosterveer","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8942-7865","authenticated-orcid":false,"given":"M. Louis","family":"Handoko","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5181-881X","authenticated-orcid":false,"given":"Petr","family":"Symersky","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Onze Lieve Vrouwe Gasthuis Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5776-7793","authenticated-orcid":false,"given":"Frances S.","family":"de Man","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5371-0346","authenticated-orcid":false,"given":"Harm Jan","family":"Bogaard","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00153613"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.07.021"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.05.083"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001602"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201412-2271OC"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.11.024"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019470"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.016522"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/674884"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-014-0096-7"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00109-2020"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1159\/000398815"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.167.2.211"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1325951"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.1980.326737"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2012.09.022"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201802-0283LE"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI104136"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2004.013037"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00458-2018"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01900-2018"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.08.059"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.87.3.359"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.052899"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.027638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T08:57:31Z","timestamp":1715590651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.027638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,2,21]]}},"alternative-id":["10.1161\/JAHA.122.027638"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.027638","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]},"assertion":[{"value":"2022-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e027638"}}