scholarly journals Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Xin Li ◽  
Yi Zhang ◽  
Qin Luo ◽  
Qing Zhao ◽  
Qixian Zeng ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Pulmonary Hypertension ◽  
Area Under The Curve ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Diffusing Capacity ◽  
Characteristic Analysis ◽  
Logistic Analysis ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension

Background: The hemodynamic results of balloon pulmonary angioplasty vary among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies revealed that microvasculopathy accounted for residual pulmonary hypertension after pulmonary endarterectomy, which could be reflected by the diffusing capacity for carbon monoxide (DLCO). We aimed to identify whether the DLCO could predict the BPA response.Materials and Methods: We retrospectively analyzed 75 consecutive patients with inoperable CTEPH who underwent BPA from May 2018 to January 2021 at Fuwai Hospital. According to the hemodynamics at follow-up after the last BPA, patients were classified as “BPA responders” (defined as a mean pulmonary arterial pressure ≤ 30 mmHg and/or a reduction of pulmonary vascular resistance ≥ 30%) or “BPA nonresponders.”Results: At the baseline, BPA responders had significantly higher DLCO values than nonresponders, although the other variables were comparable. In BPA responders, the DLCO decreased after the first BPA session and then returned to a level similar to the baseline at follow-up. Conversely, the DLCO increased constantly from the baseline to follow-up in nonresponders. Multivariate logistic analysis showed that a baseline DLCO of <70% and a percent change in DLCO between the baseline and the period within 7 days after the first BPA session (ΔDLCO) of > 6% were both independent predictors of an unfavorable response to BPA. Receiver operator characteristic analysis showed that the combination of a baseline DLCO < 70% and ΔDLCO > 6% demonstrated a better area under the curve than either of these two variables used alone.Conclusions: A baseline DLCO < 70% and ΔDLCO > 6% could independently predict unfavorable responses to BPA. Measuring the DLCO dynamically facilitates the identification of patients who might have unsatisfactory hemodynamic results after BPA.

scholarly journals Comparison of 2-years follow-up of optimal medical therapy versus balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A R Pereira ◽  
R Cale ◽  
F Ferreira ◽  
S Alegria ◽  
S Sebaiti ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Functional Capacity ◽  
Oxygen Therapy ◽  
Elevated Serum ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Medium Term ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension

Abstract Introduction Balloon pulmonary angioplasty (BPA) has emerged as a therapeutic option for chronic thromboembolic pulmonary hypertension (CTEPH) considered ineligible for pulmonary endarterectomy (PEA). The initial publications showed very good short-term outcomes for the technique, but there are limited data regarding medium-term outcomes and its comparison with optimal medical treatment (OMT). Objectives To evaluate and compare the medium-term outcomes of OMT versus (vs) BPA in inoperable CTEPH. Methods Retrospective study of consecutive patients (pts) with CTEPH followed in a referral centre for Pulmonary Hypertension. Selected those pts considered ineligible for PEA and with at least 2 years of follow-up. Comparison between two treatment strategies: OMT alone [maximum tolerated doses of pulmonary vasodilator drugs (PVD), as indicated] vs BPA (pts who completed the program with or without OMT). Endpoint was a composite of all-cause death and unplanned right heart failure admission at 2-year. Results From 62 pts, 19 pts were included (11 pts were excluded due to recent diagnosis; 32 were submitted to EAP): mean age 65.0±15.3 years, 89.5% female. At diagnosis, all pts had functional capacity limitation and elevated serum NTproBNP levels (median value 1255.0 pg/mL). Mean pulmonary arterial pressure (mPAP) was 46.2±9.3 mmHg and pulmonary vascular resistance (PVR) 15.3±8.3 Wood units (WU). Concerning treatment, 12 pts (63.2%) underwent OMT alone. These pts had higher NTproBNP levels (2670.0 vs 538.0 pg/mL, p<0.01) and PVR values (19.7±7.6 vs 9.7±5.4 WU, p=0.01) and lower CI (1.6±0.3 vs 2.4±0.5 L/min/m2, p<0.01), at baseline; the remaining basal features didn't differ among groups (Fig.A). At 2-year follow-up, pts submitted to BPA were under PVD in 71.4% of cases with a mean of 1±0.8 drugs per patient and no difference compared to OMT group (83.3%, 1.7±0.9 drugs per patient), although oxygen therapy was higher in medical group (50% vs 0%, p=0.04). A significant overall improvement was observed in BPA group (Table – A): all pts were in functional class I (p<0.01), no one had right ventricular dysfunction (p<0.01) and mPAP decreased to 25.1±6.7 mmHg (p=0.01) and RVP to 2.9±0.8 WU (p=0.01). Inversely, no change was observed in pts under OMT alone (p>0.05 in all, Table – A). Endpoint rate was 31.6% with all adverse events occurring in the OMT group (50% vs 0%, p=0.04). After adjustment by Cox regression, no difference in baseline or follow-up features besides treatment influenced the outcome. Kaplan-Meier analysis (Graphic – B) confirmed significant benefit of BPA in 2-year outcome occurrence (long rank 4.6, p=0.03). Conclusions BPA strategy seems to improve medium-term functional capacity, right ventricular function and haemodynamics and decrease oxygen therapy dependence in inoperable CTEPH. Pts under OMT alone have a poor prognosis. These data encourage the development and implementation of the technique for inoperable CTEPH. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Balloon pulmonary angioplasty improves right atrial reservoir and conduit functions in chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 21 (8) ◽  
pp. 855-862 ◽  
Author(s):  
Yuzo Yamasaki ◽  
Kohtaro Abe ◽  
Takeshi Kamitani ◽  
Kazuya Hosokawa ◽  
Masateru Kawakubo ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Feature Tracking ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Right Atrial ◽  
Resonance Imaging ◽  
Active Function ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Rv Function

Abstract Aims Right atrial (RA) function largely contributes to the maintenance of right ventricular (RV) function. This study investigated the effect of balloon pulmonary angioplasty (BPA) on RA functions in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) using cardiac magnetic resonance imaging (CMRI). Methods and results CMRI and RV catheterization were performed before BPA sessions and at the follow-up periods in 29 CTEPH patients. Reservoir [RA longitudinal strain (RA-LS)], passive conduit [RA early LS rate (LSR)], and active (RA late LSR) phases were assessed by using cine CMRI and a feature-tracking algorithm. The relationships between the changes in RA functions and in brain natriuretic peptide (BNP) were evaluated in both the dilated and non-dilated RA groups. RA-LS (32.4% vs. 42.7%), RA LSR (6.3% vs. 8.3%), and RA early LSR (−2.3% vs. −4.3%) were improved after BPA, whereas no significant change was seen in RA late LSR. The changes in RA peak LS and in RA early LSR were significantly correlated with the changes in BNP (ΔRA-LS: r = −0.63, ΔRA-early LSR: r = 0.65) and pulmonary vascular resistance (PVR) (ΔRA-LS: r = −0.69, ΔRA-early LSR: r = 0.66) in the nondilated RA group. Conclusion The RA reservoir and passive conduit functions were impaired in inoperable CTEPH, whereas RA active function was preserved. BPA markedly reversed these impaired functions. The improvements in RA reservoir and conduit functions were significantly correlated with the changes in BNP levels and PVR in CTEPH patients with normal RA sizes.

Abstract 9978: Effect of Balloon Pulmonary Angioplasty on Respiratory Function in Patients With Chronic Thromboembolic Pulmonary Hypertension: Different Effects According to the Lung Field Involved

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mina Akizuki ◽  
Naoki Serizawa ◽  
Atuko Ueno ◽  
Taku Adachi ◽  
Nobuhisa Hagiwara
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Function ◽  
Lower Lobe ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Lung Field ◽  
Lower Lung Field ◽  
Balloon Pulmonary Angioplasty ◽  
Lower Lung ◽  
Thromboembolic Pulmonary Hypertension

Background: Treatment of chronic thromboembolic pulmonary hypertension (CTEPH) with balloon pulmonary angioplasty (BPA) reportedly improves hemodynamics, exercise capacity, and right ventricular function. However, the effect of BPA on respiratory functions is unclear. Methods: We enrolled consecutive patients with inoperable CTEPH who underwent BPA. BPA was performed primarily on the lower lobe arteries during the first series and on the upper and middle lobe arteries during the second series. We examined right heart catheterization, the respiratory function test, and the cardiopulmonary exercise test, and compared the change in these parameters according to the BPA performed field (divided into the upper-middle and lower lobe before BPA, after BPA, and the follow-up period). Results: In total, 62 BPA sessions were performed in 13 CTEPH patients. Hemodynamics significantly improved after BPA (mPAP: 44±8 to 24±5 mmHg, PVR: 818±383 to 293±68 dyne/s/cm-5), and WHO-FC improved from 3.1±0.3 to 2.2±0.6 after BPA. Hemodynamic improvement tended to be larger in BPA in the lower lung field. The %DLco significantly decreased (p=0.001) in BPA in the lower lung field, and did not appear to recover during the follow-up period. In contrast, %DLco significantly increased in BPA in the upper-middle lung field (p=0.030), and tended to increase until the follow-up period (p=0.077) (Fig). In addition, VE/VCO2 slope significantly improved after BPA in the lower lung field (p=0.014), and showed further improvement at the follow-up period (p=0.007); however, VE/VCO2 slope remained unchanged after BPA in the upper-middle lung field (Fig). Furthermore, during follow-up, change in %DLco and VE/VCO2 slope were significantly different between lower and upper-middle lung field BPA performed (p<0.001 and p=0.020, respectively, Fig). Conclusions: We observed that the effect of BPA in CTEPH patients may have a different effect on respiratory function according to the lung field.

scholarly journals Exercise tolerance and quality of life in hemodynamically partially improved patients with chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255180
Author(s):  
Kotaro Miura ◽  
Yoshinori Katsumata ◽  
Takashi Kawakami ◽  
Hidehiko Ikura ◽  
Toshinobu Ryuzaki ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Hypertension ◽  
Exercise Tolerance ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Peak Vo2 ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Hemodynamic Improvement

The efficacy of extensive balloon pulmonary angioplasty (BPA) beyond hemodynamic improvement in chronic thromboembolic pulmonary hypertension (CTEPH) patients has been verified. However, the relationship between extensive BPA in CTEPH patients after partial hemodynamic improvement and exercise tolerance or quality of life (QOL) remains unclear. We prospectively enrolled 22 CTEPH patients (66±10 years, females: 59%) when their mean pulmonary artery pressure initially decreased to <30 mmHg during BPA sessions. Hemodynamic and echocardiographic data, cardiopulmonary exercise testing, and QOL scores using the 36-item short form questionnaire (SF-36) were evaluated at enrollment (entry), just after the final BPA session (finish), and at the 6-month follow-up (follow-up). We analyzed whether extensive BPA improves exercise capacity and QOL scores over time. Moreover, the clinical characteristics leading to improvement were elucidated. The peak oxygen uptake (VO2) showed significant improvement at entry, finish, and follow-up (17.3±5.5, 18.4±5.9, and 18.9±5.3 mL/kg/min, respectively; P<0.001). Regarding the QOL, the physical component summary (PCS) scores significantly improved (32±11, 38±13, and 43±13, respectively; P<0.001), but the mental component summary scores remained unchanged. Linear regression analysis revealed that age and a low peak VO2 at entry were predictors of improvement in peak VO2, while low PCS scores and low TAPSE at entry were predictors of improvement in PCS scores. In conclusion, extensive BPA led to improved exercise tolerance and physical QOL scores, even in CTEPH patients with partially improved hemodynamics.

scholarly journals Soluble ST2 as a Biomarker for Early Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension Treated with Balloon Pulmonary Angioplasty

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 133
Author(s):  
Marta Banaszkiewicz ◽  
Arkadiusz Pietrasik ◽  
Michał Florczyk ◽  
Piotr Kędzierski ◽  
Michał Piłka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Troponin T ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Early Complications ◽  
Dynamic Changes ◽  
Soluble St2 ◽  
Time Points ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Discharge From Hospital

Background: The aim of the study was to assess soluble ST2 (sST2) concentration and its dynamic changes in the periprocedural period in patients with chronic thromboembolic pulmonary hypertension (CTEPH) treated with balloon pulmonary angioplasty (BPA). Methods: We prospectively analyzed 57 procedures of BPA performed in 37 patients with CTEPH. Biomarkers, such as N-terminal pro B-type natriuretic peptide (NT-proBNP), troponin T (TnT), and sST2 were assessed at four time points: Before the BPA procedure, 24 h and 48 h after the procedure, and at the discharge from hospital. Each postprocedural period was assessed for complications. Results: Before the BPA procedure, median sST2 concentration was 26.56 ng/mL (IQR: 16.66–40.83 ng/mL). sST2 concentration was significantly higher 24 h and 48 h after the BPA compared to the baseline measurements (33.31 ng/mL (IQR: 20.81–62.56), p = 0.000 and 27.45 ng/mL (IQR: 17.66–54.45), p = 0.028, respectively). sST2 level 24 h after the BPA procedure was significantly higher in the group with complications compared to the group without complications in the postprocedural period (97.66 ng/mL (IQR: 53.07–126.18) vs. 26.86 ng/mL (IQR: 19.10–40.12), p = 0.000). Conclusions: sST2 concentration in patients with CTEPH treated with BPA changes significantly in the postprocedural period and is significantly higher in the group with complications in postprocedural period.

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