Department of Cardiology, Royal Papworth Hospital, Cambridge, UK.
Department of Cardiology, Royal Free Hospital, London, UK.
J Heart Lung Transplant. 2021 Oct;40(10):1223-1234. doi: 10.1016/j.healun.2021.06.011. Epub 2021 Jul 1.
Balloon pulmonary angioplasty (BPA) is delivered as a series of treatments for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) however, there is little published data on the procedural determinants of outcome.
Pre- and post-BPA clinical and hemodynamic data, as well as serial hemodynamic and procedural data at each BPA session were evaluated to determine patient and procedure-related factors that influence hemodynamic response.
Per procedure data from 210 procedures in 84 patients and per patient data from 182 procedures in 63 patients with completed treatment and 3-month follow-up were analyzed. A median of 3 (range 1-6) BPA procedures treating a median of 2 segments per procedure (range 1-3) were performed per patient with a median interval between procedures of 42 (range 5-491) days. Clinical outcome correlated with hemodynamic change (pulmonary vascular resistance [ΔPVR] vs Cambridge Pulmonary Hypertension Outcome Review [CAMPHOR] symptom score: p < 0.001, Pearson's r = 0.48, n = 49). Responders to BPA had more severe disease at baseline and 37.5 % of non-responders were post-PEA. There was a dose-response relationship between per procedure and total number of segments treated and hemodynamic improvement (ΔPVR: 1 segment: -0.9%, 2: -14.5%, 3 or more: -16.1%, p < 0.001). Treating totally occluded vessels had a greater hemodynamic effect (mean pulmonary artery pressure [ΔmPAP]: sessions with occlusion: -8.0%, without occlusion treated: -3.2%, p < 0.05) without an increased complication rate.
The magnitude of clinical benefit is related to the hemodynamic effect of BPA which in turn is related to the number of segments treated and lesion severity. Patients who were post-PEA were less likely to respond to BPA.
球囊肺动脉成形术（BPA）作为一系列治疗手段用于治疗无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者，但目前关于影响疗效的操作相关决定因素的数据较少。
评估了 BPA 前后的临床和血流动力学数据，以及每次 BPA 治疗过程中的连续血流动力学和操作数据，以确定影响血流动力学反应的患者和操作相关因素。
对 84 例患者的 210 次操作和 63 例患者的 182 次操作的每个患者数据进行了分析，这些患者完成了治疗并进行了 3 个月的随访。中位数为 3（范围 1-6）次 BPA 治疗，每次治疗中位数为 2 个节段（范围 1-3），每位患者的操作中位数间隔为 42（范围 5-491）天。临床结局与血流动力学变化相关（肺血管阻力[ΔPVR]与剑桥肺高压预后评估[CAMPHOR]症状评分：p<0.001，Pearson r=0.48，n=49）。BPA 反应者的基线疾病更严重，37.5%的无反应者为 PEA 后。每次操作和治疗节段总数与血流动力学改善之间存在剂量反应关系（ΔPVR：1 个节段：-0.9%，2 个：-14.5%，3 个或更多：-16.1%，p<0.001）。治疗完全闭塞的血管具有更大的血流动力学效应（平均肺动脉压[ΔmPAP]：闭塞的治疗：-8.0%，无闭塞的治疗：-3.2%，p<0.05），但并发症发生率没有增加。
临床获益的程度与 BPA 的血流动力学效应相关，而血流动力学效应又与治疗的节段数量和病变严重程度相关。PEA 后的患者对 BPA 的反应性较低。
