Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
JACC Cardiovasc Interv. 2014 Nov;7(11):1297-306. doi: 10.1016/j.jcin.2014.06.010. Epub 2014 Nov 17.
This study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA).
PTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel.
We included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of <35.4 with PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure <35 mm Hg with pressure-wire guidance.
The occurrence of clinically critical reperfusion pulmonary edema and vessel injuries were lowest in the group using the guidance of both pressure wire and PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed.
The combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension.
本研究旨在证明压力导丝引导下经皮腔内肺血管成形术（PTPA）的安全性和有效性。
PTPA 已被证明对治疗慢性血栓栓塞性肺动脉高压有效。然而，PTPA 后一个主要且偶尔致命的并发症是再灌注肺水肿。为了避免这种情况，我们开发了 PEPSI（肺水肿预测评分指数）。压力导丝已被用于检测血管内血流不足。
我们纳入了 2009 年 1 月 1 日至 2013 年 12 月 31 日期间 103 例慢性血栓栓塞性肺动脉高压患者的 350 例连续 PTPA 治疗。在这 5 年期间，140 例 PTPA 治疗未进行指导，65 例仅采用 PEPSI 指导，145 例采用 PEPSI 和压力导丝联合指导。在采用 PEPSI 指导时，每个 PTPA 治疗完成后，PEPSI 评分均<35.4；在采用压力导丝指导时，每个目标病变的肺动脉平均压均<35mmHg。
在采用压力导丝和 PEPSI 联合指导的组中，临床临界再灌注肺水肿和血管损伤的发生率最低（分别为 0%和 6.9%）。此外，采用压力导丝和 PEPSI 联合指导的组，在治疗的目标病变和治疗次数较少的情况下，实现了相同的血流动力学改善。
采用压力导丝和 PEPSI 联合的方法可产生更有效的临床结果，并显著降低再灌注肺水肿和血管并发症的发生。这进一步证明了 PTPA 是治疗慢性血栓栓塞性肺动脉高压的一种替代策略。
