Phd in ANGIO-CARDIO-THORACIC PATHOPHYSIOLOGY AND IMAGING

Thesis title: Functional and morphologic evaluation of the Right Ventricle-Pulmonary Artery Coupling in patients undergoing Major Lung Resections: a pilot study.

Abstract Objectives The aim of this study was to evaluate echocardiographic and Doppler changes in patients undergoing major lung resections, with a specific focus on right heart parameters. Methods A total of 64 adult patients (age >18 years) scheduled for major lung resection surgery (lobectomy, non-anatomic partial resection, or pneumonectomy) were enrolled. Only patients who had both preoperative and postoperative transthoracic echocardiography (TTE) performed within one year after surgery were included in the analysis. Patients with a history of previous lung resection (minor or major), underlying pulmonary fibrosis or emphysema, preexisting right or left heart failure (HF) with significant remodelling, or those without postoperative TTE within one year were excluded. Results The final enrolled study population consisted of 30 patients. A statistically significant difference was observed between preoperative and postoperative right ventricular (RV) basal diameters (30.4 ± 3.1 mm vs. 31.2 ± 2.9 mm; p = 0.011). Regarding right ventricular–pulmonary artery (RV–PA) coupling indices, a non-significant trend toward worsening was found three alternative measures: the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP), the TAPSE times pulmonary acceleration time product (TAPSE*pACT), and the ratio between TAPSE and peak tricuspid regurgitation velocity (TAPSE/TRV). Additionally, a statistically significant increase in left ventricular ejection fraction (LVEF), as assessed by the Simpson’s biplane method, was observed between preoperative and postoperative evaluations within one year after a major lung resection. Conclusions Our findings suggest that, in patients without significant cardiologic or pulmonary comorbidities, a major lung resection appears to be associated with a slight increase in RV basal diameter and a modest improvement in LVEF over time.