Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Respir Res. 2019 Nov 8;20(1):250. doi: 10.1186/s12931-019-1211-y.
Balloon pulmonary angioplasty (BPA) has been demonstrated to improve cardiac function and exercise capacity in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its instant impact on cardiopulmonary function has seldom been evaluated. This study aims to determine the safety and efficacy of BPA and its immediate and lasting effects on cardiopulmonary function among CTEPH patients.
From May 2018 to January 2019, patients with inoperable CTEPH who underwent BPA sessions were consecutively enrolled. Hemodynamics were measured by right heart catheterization, selective pulmonary angiography and BPA were successively conducted. Hemodynamic variables, WHO functional class (WHO-FC), 6-min walk distance (6MWD) and serum NT-proBNP were evaluated before and after BPA sessions during hospitalization. Pulmonary function testing (PFT) and cardiopulmonary exercise testing (CPET) were performed within 1-3 days pre and post BPA to evaluate the effect of BPA on cardiopulmonary function.
Twenty-five patients with inoperable CTEPH who underwent a total of forty BPA sessions were consecutively enrolled. A total of 183 segmental or subsegmental vessels (4.6 ± 1.9 vessels per session) in 137 segments (3.4 ± 1.6 segments per session) were dilated. No procedure-related complications occurred. Instant hemodynamics, WHO-FC, 6MWD and NT-proBNP were all significantly improved after a single BPA session. Significant improvement in cardiopulmonary function was also evident as assessed by PFT indexes (forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation) and CPET parameters (peak work rate, peak VO, oxygen uptake efficiency slope). Further analysis among ten CTEPH patients receiving multiple BPA sessions (2-4 sessions) indicated BPA resulted in lasting improvements in hemodynamics and cardiopulmonary function.
BPA, a safe and effective approach, can bring instant improvements after a single session and lasting benefits after multiple sessions to hemodynamics and cardiopulmonary function for patients with inoperable CTEPH.
球囊肺动脉成形术（BPA）已被证明可改善不能手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的心脏功能和运动能力，但很少评估其对心肺功能的即时影响。本研究旨在确定 BPA 在 CTEPH 患者中的安全性和疗效，以及其对心肺功能的即时和长期影响。
2018 年 5 月至 2019 年 1 月，连续纳入接受 BPA 治疗的不能手术的 CTEPH 患者。通过右心导管检查、选择性肺动脉造影和 BPA 依次测量血流动力学。在住院期间的 BPA 前后评估血流动力学变量、世界卫生组织功能分级（WHO-FC）、6 分钟步行距离（6MWD）和血清 NT-proBNP。在 BPA 前后 1-3 天内进行肺功能检查（PFT）和心肺运动测试（CPET），以评估 BPA 对心肺功能的影响。
连续纳入 25 例接受总共 40 次 BPA 的不能手术的 CTEPH 患者。共扩张了 137 段中的 34 段（每段 1.6 个）和 183 个节段或亚节段血管（每个节段 1.9 个）。无与手术相关的并发症发生。单次 BPA 后即时血流动力学、WHO-FC、6MWD 和 NT-proBNP 均显著改善。PFT 指标（用力肺活量、第 1 秒用力呼气量、最大自主通气量）和 CPET 参数（峰值工作率、峰值 VO、摄氧效率斜率）也显示心肺功能显著改善。对接受多次 BPA 治疗（2-4 次）的 10 例 CTEPH 患者进行的进一步分析表明，BPA 可持久改善血流动力学和心肺功能。
BPA 是一种安全有效的方法，单次治疗后可即时改善，多次治疗后可持久改善不能手术的 CTEPH 患者的血流动力学和心肺功能。
