Kiko Takatoyo, Asano Ryotaro, Endo Hiroyuki, Nishi Naruhiro, Hayashi Hiroya, Kotoku Akiyuki, Horinouchi Hiroki, Ueda Jin, Aoki Tatsuo, Tsuji Akihiro, Fukuda Tetsuya, Ogo Takeshi
Division of Pulmonary Circulation, Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Osaka Japan.
Department of Vascular Physiology National Cerebral and Cardiovascular Center Research Institute Suita Osaka Japan.
Pulm Circ. 2024 Jul 2;14(3):e12409. doi: 10.1002/pul2.12409. eCollection 2024 Jul.
Balloon pulmonary angioplasty (BPA) is beneficial for patients with chronic thromboembolic pulmonary disease (CTEPD) with pulmonary hypertension (PH). However, the clinical benefit of BPA for the patients with CTEPD without PH remains unknown. In this study, we aimed to evaluate the efficacy, safety, and long-term outcomes of BPA in patients with CTEPD without PH. We retrospectively analyzed the data from 84 CTEPD patients with mean pulmonary artery pressure (mPAP) < 25 mmHg and 39 CTEPD patients with mPAP ≤ 20 mmHg (without PH). Among the 39 patients with CTEPD without PH, 14 underwent BPA (BPA-treated group), and the remaining 25 received no treatment (untreated group). In the patients with CTEPD without PH, BPA led to improvements in symptoms, pulmonary vascular resistance (3.6 ± 1.6 to 2.6 ± 1.1 Wood units, < 0.001), peak oxygen consumption (16.1 ± 4.0 to 18.8 ± 4.3 mL/kg/min, = 0.033), minute ventilation versus carbon dioxide production slope (41.4 ± 12.2 to 35.1 ± 6.7, = 0.026), and mPAP/cardiac output slope (7.0 ± 2.6 to 4.4 ± 2.0 mmHg/L/min, = 0.004) and facilitated the discontinuation of home oxygenation therapy, with no serious complications. Kaplan-Meier analysis showed no significant difference in all-cause mortality between the untreated and BPA-treated groups. BPA may be a safe treatment option for the patients with CTEPD without PH that can alleviate symptoms, improve exercise capacity, and facilitate weaning from home oxygen therapy. Further prospective randomized trials are needed to confirm these findings.
球囊肺动脉血管成形术（BPA）对患有慢性血栓栓塞性肺动脉疾病（CTEPD）并伴有肺动脉高压（PH）的患者有益。然而，BPA对无PH的CTEPD患者的临床益处仍不明确。在本研究中，我们旨在评估BPA对无PH的CTEPD患者的疗效、安全性和长期预后。我们回顾性分析了84例平均肺动脉压（mPAP）<25 mmHg的CTEPD患者和39例mPAP≤20 mmHg（无PH）的CTEPD患者的数据。在39例无PH的CTEPD患者中，14例接受了BPA治疗（BPA治疗组），其余25例未接受治疗（未治疗组）。在无PH的CTEPD患者中，BPA使症状得到改善，肺血管阻力降低（从3.6±1.6降至2.6±1.1 Wood单位，<0.001），峰值耗氧量增加（从16.1±4.0增至18.8±4.3 mL/kg/min，=0.033），分钟通气量与二氧化碳产生斜率降低（从41.4±12.2降至35.1±6.7，=0.026），mPAP/心输出量斜率降低（从7.0±2.6降至4.4±2.0 mmHg/L/min，=0.004），并有助于停止家庭氧疗，且无严重并发症。Kaplan-Meier分析显示，未治疗组和BPA治疗组的全因死亡率无显著差异。BPA可能是无PH的CTEPD患者的一种安全治疗选择，可缓解症状、提高运动能力并有助于从家庭氧疗中脱机。需要进一步的前瞻性随机试验来证实这些发现。
