Patterns of right ventricular reverse remodeling and hemodynamic drivers in serial balloon pulmonary angioplasty

Balloon pulmonary angioplasty (BPA) effectively treats chronic thromboembolic pulmonary hypertension (CTEPH); however, its effects on right ventricular (RV) remodeling remains unclear. This study investigates RV reverse remodeling patterns and key hemodynamic determinants in patients undergoing sequential BPA therapy.

In this retrospective study, 46 patients who underwent BPA at monthly intervals were included. Serial echocardiography was used to monitor cardiac structure and function, while right heart catheterization assessed hemodynamic parameters before and after treatment. Longitudinal changes were analyzed using mixed-effects models with piecewise assessment of early and late treatment phases.

Significant improvements in right ventricular structure and function were observed across BPA sessions. Notably, right atrial transverse diameter and tricuspid annular systolic velocity demonstrated early responses to BPA, with significant changes evident during the initial treatment phase. In longitudinal analyses, early treatment phases (baseline to BPA₃) were characterized by marked reverse remodeling, including reductions in right atrial area (RAA), RV end-diastolic transverse diameter, and wall thickness, accompanied by improvements in tricuspid annular plane systolic excursion, enhanced RV function. Greater reductions in pulmonary vascular resistance (PVR) were associated with more pronounced RV reverse remodeling, particularly in RAA.

A temporal pattern of RV reverse remodeling is observed during serial BPA, characterized by substantial early improvements followed by a plateau in later sessions. These changes are closely associated with reductions in PVR, supporting a central role of afterload reduction in driving RV recovery. This pattern may help inform the optimization of BPA treatment strategies.