Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.
J Am Heart Assoc. 2023 Feb 7;12(3):e026466. doi: 10.1161/JAHA.122.026466. Epub 2023 Feb 3.
Background Balloon pulmonary angioplasty (BPA) is a promising treatment modality for nonoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, BPA for atypical CTEPH with concurrent chronic obstructive pulmonary disease (COPD) remains controversial owing to the risk of exacerbation of ventilation-perfusion mismatch. We aimed to evaluate the efficacy and safety of BPA for CTEPH with moderate or severe COPD. Methods and Results Data from 149 patients with CTEPH, who underwent BPA from March 2011 to June 2021, were retrospectively analyzed. Patients were divided based on COPD comorbidity: the COPD group (n=32, defined as forced expiratory volume in 1 second/forced vital capacity <70% and forced expiratory volume in 1 second <80% predicted) and the non-COPD group (n=101); patients with mild COPD (n=16) were excluded. Hemodynamic and respiratory parameters were compared between the groups. Hemodynamics improved similarly in both groups (reduction in pulmonary vascular resistance): -55.6±29.0% (COPD group) and -58.9±21.4% (non-COPD group); =nonsignificant. Respiratory function and oxygenation improved in the COPD group (forced expiratory volume in 1 second/forced vital capacity [61.8±7.0% to 66.5±10.2%, =0.02] and arterial oxygen partial pressure [60.9±10.6 mm Hg to 69.3±13.6 mm Hg, <0.01]). Higher vital capacity (=0.024) and higher diffusing capacity for lung carbon monoxide (=0.028) at baseline were associated with greater improvement in oxygenation in the multivariable linear analysis. Lung injury per BPA session was 1.6% in the COPD group. Conclusions The efficacy and safety of BPA for nonoperable CTEPH in patients with comorbid COPD were similar to those in patients without COPD. Oxygenation and forced expiratory volume in 1 second/forced vital capacity improved in patients with COPD. BPA should be considered in patients with CTEPH with concurrent COPD.
球囊肺动脉成形术（BPA）是治疗不能手术的慢性血栓栓塞性肺动脉高压（CTEPH）的一种有前途的治疗方法。然而，由于通气-灌注不匹配恶化的风险，BPA 治疗合并慢性阻塞性肺疾病（COPD）的非典型 CTEPH 仍然存在争议。我们旨在评估 BPA 治疗中重度 COPD 合并 CTEPH 的疗效和安全性。
回顾性分析了 2011 年 3 月至 2021 年 6 月期间接受 BPA 治疗的 149 例 CTEPH 患者的数据。根据 COPD 合并症将患者分为 COPD 组（n=32，定义为 1 秒用力呼气量/用力肺活量<70%，1 秒用力呼气量<80%预计值）和非 COPD 组（n=101）；排除了轻度 COPD（n=16）患者。比较两组间血流动力学和呼吸参数。两组患者的血流动力学改善情况相似（肺动脉阻力下降百分比）：-55.6±29.0%（COPD 组）和-58.9±21.4%（非 COPD 组）；无统计学意义。COPD 组呼吸功能和氧合改善（1 秒用力呼气量/用力肺活量[61.8±7.0%至 66.5±10.2%，=0.02]和动脉血氧分压[60.9±10.6mmHg 至 69.3±13.6mmHg，<0.01]）。多变量线性分析显示，基线时更高的肺活量（=0.024）和更高的肺一氧化碳弥散量（=0.028）与氧合改善程度更大相关。COPD 组每次 BPA 治疗的肺损伤率为 1.6%。
BPA 治疗合并 COPD 的不能手术 CTEPH 的疗效和安全性与无 COPD 患者相似。COPD 患者的氧合和 1 秒用力呼气量/用力肺活量改善。对于合并 COPD 的 CTEPH 患者，应考虑 BPA 治疗。
