用于无法手术的慢性血栓栓塞性肺动脉高压的球囊肺动脉血管成形术：英国的经验
Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: the UK experience.
作者信息
Hoole Stephen P, Coghlan John G, Cannon John E, Taboada Dolores, Toshner Mark, Sheares Karen, Fletcher Andrew John, Martinez Guillermo, Ruggiero Alessandro, Screaton Nicholas, Jenkins David, Pepke-Zaba Joanna
机构信息
Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom.
Department of Cardiology, Royal Free Hospital, London, United Kingdom.
出版信息
Open Heart. 2020 Feb 27;7(1):e001144. doi: 10.1136/openhrt-2019-001144. eCollection 2020.
OBJECTIVE
Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) managed medically has a poor prognosis. Balloon pulmonary angioplasty (BPA) offers a new treatment for inoperable patients. The national BPA service for the UK opened in October 2015 and we now describe the treatment of our initial patient cohort.
METHODS
Thirty consecutive, inoperable, anatomically suitable, symptomatic patients on stable medical therapy for CTEPH were identified and offered BPA. They initially underwent baseline investigations including Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) quality of life (QoL) questionnaire, cardiopulmonary exercise test, 6 min walk distance (6MWD), transthoracic echocardiography, N-terminal probrain natriuretic peptide (NT pro-BNP) and right heart catheterisation. Serial BPA sessions were then performed and after completion, the treatment effect was gauged by comparing the same investigations at 3 months follow-up.
RESULTS
A median of 3 (IQR 1-6) BPA sessions per patient resulted in a significant improvement in functional status (WHO functional class ≥3: 24 vs 4, p<0.0001) and QoL (CAMPHOR symptom score: 8.7±5.4 vs 5.6±6.1, p=0.0005) with reductions in pulmonary pressures (mean pulmonary artery pressure: 44.7±11.0 vs 34.4±8.3 mm Hg, p<0.0001) and resistance (pulmonary vascular resistance: 663±281 vs 436±196 dyn.s.cm, p<0.0001). Exercise capacity improved (minute ventilation/carbon dioxide production: 55.3±12.2 vs 45.0±7.8, p=0.03 and 6MWD: 366±107 vs 440±94 m, p<0.0001) and there was reduction in right ventricular (RV) stretch (NT pro-BNP: 442 (IQR 168-1607) vs 202 (IQR 105-447) pg/mL, p<0.0001) and dimensions (mid RV diameter: 4.4±1.0 vs 3.8±0.7 cm, p=0.002). There were no deaths or life-threatening complications and the mild-moderate per-procedure complication rate was 10.5%.
CONCLUSIONS
BPA is safe and improves the functional status, QoL, pulmonary haemodynamics and RV dimensions of patients with inoperable CTEPH.
目的
药物治疗的无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）预后较差。球囊肺动脉血管成形术（BPA）为无法手术的患者提供了一种新的治疗方法。英国的国家BPA服务于2015年10月启动，我们现在描述我们最初患者队列的治疗情况。
方法
连续确定30例无法手术、解剖结构合适、有症状且接受CTEPH稳定药物治疗的患者，并为其提供BPA治疗。他们最初接受了基线检查，包括剑桥肺动脉高压结局评估（CAMPHOR）生活质量（QoL）问卷、心肺运动试验、6分钟步行距离（6MWD）、经胸超声心动图、N末端脑钠肽前体（NT pro-BNP）和右心导管检查。然后进行系列BPA治疗，完成后，通过比较3个月随访时的相同检查来评估治疗效果。
结果
每位患者平均接受3次（四分位间距1-6次）BPA治疗后，功能状态（世界卫生组织功能分级≥3级：24例对4例，p<0.0001）和QoL（CAMPHOR症状评分：8.7±5.4对5.6±6.1，p=0.0005）有显著改善，肺动脉压力降低（平均肺动脉压：44.7±11.0对34.4±8.3 mmHg，p<0.0001），阻力降低（肺血管阻力：663±281对436±196 dyn.s.cm，p<0.0001）。运动能力提高（分钟通气量/二氧化碳产生量：55.3±12.2对45.0±7.8，p=0.03；6MWD：366±107对440±94 m，p<0.0001），右心室（RV）伸展降低（NT pro-BNP：442（四分位间距168-1607）对202（四分位间距105-447）pg/mL，p<0.0001），尺寸减小（RV中部直径：4.4±1.0对3.8±0.7 cm，p=0.002）。无死亡或危及生命的并发症，轻度至中度的每次治疗并发症发生率为10.5%。
结论
BPA安全有效，可改善无法手术的CTEPH患者的功能状态、QoL、肺血流动力学和RV尺寸。
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