Wang Yeqing, Guo Dichen, Gong Juanni, Wang Jianfeng, Yang Yuanhua, Zhang Xinyuan, Hu Huimin, Ma Yaning, Lv Xiuzhang, Li Yidan
Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Int J Cardiol Heart Vasc. 2024 Feb 29;51:101363. doi: 10.1016/j.ijcha.2024.101363. eCollection 2024 Apr.
Balloon pulmonary angioplasty (BPA) is an established treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its efficacy in CTEPH patients with a pulmonary comorbidity has not been well-studied. Here, we compared post-BPA outcomes between CTEPH patients with and without chronic pulmonary disease at baseline and analyzed predictors of BPA success.
From August 2017 to October 2022, 62 patients with inoperable CTEPH who underwent BPA were consecutively enrolled and grouped based on the presence of a pulmonary comorbidity at baseline. All patients underwent transthoracic echocardiography, pulmonary function tests, and right heart catheterization. Pre- and post-BPA data were evaluated to identify factors that influence the success of BPA.
Among the 62 CTEPH patients, BPA was considered successful in 50 patients and unsuccessful in 12 patients. Responders to BPA had better exercise capacity and right heart function at baseline, but no differences in hemodynamic or respiratory function were detected between the groups. In CTEPH patients with chronic pulmonary disease (n = 14), BPA significantly improved mean pulmonary arterial pressure, pulmonary vascular resistance and right heart function parameters. Only CTEPH patients without chronic pulmonary disease (n = 48) exhibited significant improvement in 6-minute walk distance and respiratory function. Multivariate logistic regression analysis showed that pulmonary comorbidity at baseline was independently associated with the efficacy of BPA.
BPA provided significantly improvements in hemodynamics and right heart function in CTEPH patients, independent of pulmonary comorbidity at baseline. However, pulmonary comorbidity can negatively impact post-BPA outcomes.
球囊肺动脉血管成形术（BPA）是治疗无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）的既定疗法，但其在合并肺部疾病的CTEPH患者中的疗效尚未得到充分研究。在此，我们比较了基线时合并和未合并慢性肺部疾病的CTEPH患者BPA术后的结局，并分析了BPA成功的预测因素。
2017年8月至2022年10月，连续纳入62例接受BPA治疗的无法手术的CTEPH患者，并根据基线时是否存在肺部合并症进行分组。所有患者均接受经胸超声心动图、肺功能测试和右心导管检查。评估BPA术前和术后的数据，以确定影响BPA成功的因素。
在62例CTEPH患者中，50例患者的BPA被认为成功，12例患者失败。BPA有反应者在基线时具有更好的运动能力和右心功能，但两组之间在血流动力学或呼吸功能方面未检测到差异。在合并慢性肺部疾病的CTEPH患者（n = 14）中，BPA显著改善了平均肺动脉压、肺血管阻力和右心功能参数。只有未合并慢性肺部疾病的CTEPH患者（n = 48）在6分钟步行距离和呼吸功能方面有显著改善。多因素logistic回归分析显示，基线时的肺部合并症与BPA的疗效独立相关。
BPA在CTEPH患者中显著改善了血流动力学和右心功能，与基线时的肺部合并症无关。然而，肺部合并症会对BPA术后结局产生负面影响。
