Wiedenroth Christoph B, Ghofrani H Ardeschir, Adameit Miriam S D, Breithecker Andreas, Haas Moritz, Kriechbaum Steffen, Rieth Andreas, Hamm Christian W, Mayer Eckhard, Guth Stefan, Liebetrau Christoph
1 Department of Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany.
2 Department of Pulmonology, Kerckhoff Clinic, Bad Nauheim, Germany.
Pulm Circ. 2018 Jul-Sep;8(3):2045894018783996. doi: 10.1177/2045894018783996.
Riociguat is the treatment of choice for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). We addressed here whether additional balloon pulmonary angioplasty (BPA) provides further benefits. A prospective series of 36 consecutive patients with inoperable CTEPH were treated with riociguat at least three months before BPA. All patients underwent diagnostic workup at baseline, before BPA treatments, and six months after final intervention. The main outcome measures were pulmonary hemodynamic parameters and World Health Organization (WHO) functional class (FC). Significant improvements in pulmonary hemodynamics and physical capacity were observed for riociguat treatment, and subsequent BPA interventions yielded further benefits. With targeted medication, WHO FC improved by at least one class in 13 (36.1%) patients ( P = 0.01). Hemodynamic assessment showed significant improvements in mean pulmonary arterial pressure (mPAP) (49 ± 12 mmHg vs. 43 ± 12 mmHg; P = 0.003) and PVR (956 ± 501 dyn·s·cm vs. 517 ± 279 dyn·s·cm; P = 0.0001). Treatment with a combination of targeted medication and BPA resulted in WHO FC improvement in 34 (94.4%) patients. Hemodynamic assessment showed significant improvement in mPAP (43 ± 12 mmHg vs. 34 ± 14 mmHg; P = 0.0001) and PVR (517 ± 279 dyn·s·cm vs. 360 ± 175 dyn·s·cm; P = 0.0001). These findings provide, for the first time, support for the therapeutic strategy recommended by current guidelines.
利奥西呱是无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的首选治疗药物。我们在此探讨额外的球囊肺动脉血管成形术（BPA）是否能带来更多益处。对36例连续的无法手术的CTEPH患者进行了一项前瞻性研究，这些患者在接受BPA至少三个月前接受了利奥西呱治疗。所有患者在基线、BPA治疗前以及最终干预后六个月均接受了诊断性检查。主要结局指标为肺血流动力学参数和世界卫生组织（WHO）功能分级（FC）。观察到利奥西呱治疗使肺血流动力学和身体能力有显著改善，随后的BPA干预带来了更多益处。通过靶向药物治疗，13例（36.1%）患者的WHO FC至少提高了一级（P = 0.01）。血流动力学评估显示平均肺动脉压（mPAP）有显著改善（49 ± 12 mmHg对43 ± 12 mmHg；P = 0.003）以及肺血管阻力（PVR）有显著改善（956 ± 501 dyn·s·cm对517 ± 279 dyn·s·cm；P = 0.0001）。靶向药物与BPA联合治疗使34例（94.4%）患者的WHO FC得到改善。血流动力学评估显示mPAP有显著改善（43 ± 12 mmHg对34 ± 14 mmHg；P = 0.0001）以及PVR有显著改善（517 ± 279 dyn·s·cm对360 ± 175 dyn·s·cm；P = 0.0001）。这些发现首次为当前指南推荐的治疗策略提供了支持。
