Kim Soo Han, Lee Jae Won, Ahn Jung-Min, Kim Dae-Hee, Song Jong-Min, Lee Sang-Do, Lee Jae Seung
Department of Internal Medicine, Center for Pulmonary Hypertension and Venous Thrombosis, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Center for Pulmonary Hypertension and Venous Thrombosis, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Intern Med. 2017 Sep;32(5):855-864. doi: 10.3904/kjim.2016.049. Epub 2016 Oct 13.
BACKGROUND/AIMS: Pulmonary endarterectomy (PEA) is the gold standard for treating chronic thromboembolic pulmonary hypertension (CTEPH) in Western countries. The aim of this study was to investigate the long-term outcomes of performing PEA on CTEPH patients in comparison with medical therapy at a single Korean center.
This retrospective study included 88 CTEPH patients. These patients were classified into the PEA group (n = 37) or non-PEA group (i.e., medical therapy; n = 51). The clinical characteristics, hemodynamic data, and long-term survival rates were compared. Independent prognostic factors for CTEPH were also investigated.
CTEPH was not associated with either gender, and the mean age at diagnosis was 53.3 ± 13.7 years. Echocardiography revealed that the mean peak velocity of the tricuspid regurgitation jet was 4.2 ± 0.7 m/sec and the mean pulmonary arterial pressure was 51.7 ± 15.1 mmHg. The PEA and non-PEA groups demonstrated no significant differences, except in terms of the right ventricular end-diastolic diameter. The survival rates of the PEA group were significantly higher than the non-PEA group at 1, 3, 5, and 10 years ( = 0.032). Multivariate analyses indicated that World Health Organization class IV and PEA were significant predictors of poorer and better outcomes, respectively.
PEA demonstrates more favorable effects on long-term survival than medical therapy in Korean CTEPH patients who were considered operable.
背景/目的：在西方国家，肺动脉内膜剥脱术（PEA）是治疗慢性血栓栓塞性肺动脉高压（CTEPH）的金标准。本研究的目的是在韩国的一个单一中心，比较对CTEPH患者进行PEA与药物治疗的长期疗效。
这项回顾性研究纳入了88例CTEPH患者。这些患者被分为PEA组（n = 37）或非PEA组（即药物治疗组；n = 51）。比较了两组的临床特征、血流动力学数据和长期生存率。还研究了CTEPH的独立预后因素。
CTEPH与性别无关，诊断时的平均年龄为53.3±13.7岁。超声心动图显示，三尖瓣反流峰值速度平均为4.2±0.7米/秒，平均肺动脉压为51.7±15.1毫米汞柱。PEA组和非PEA组除右心室舒张末期直径外，无显著差异。PEA组在1年、3年、5年和10年的生存率显著高于非PEA组（P = 0.032）。多因素分析表明，世界卫生组织IV级和PEA分别是预后较差和较好的显著预测因素。
对于韩国可手术治疗的CTEPH患者，PEA在长期生存方面比药物治疗显示出更有利的效果。
