Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Heart. 2024 Aug 26;110(18):1133-1138. doi: 10.1136/heartjnl-2024-323883.
Decreased diffusing capacity of the lungs for carbon monoxide (DLco) is associated with microvascular damage in chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an effective treatment for CTEPH, but the efficacy of BPA in patients with CTEPH with low DLco remains unclear because BPA does not directly address microvascular damage. This study investigates the influence of microvasculopathy on BPA in CTEPH according to DLco.
We retrospectively analysed data from patients with inoperable CTEPH who underwent BPA at the University of Tokyo Hospital from July 2011 to August 2023. The patients were classified into two groups based on their preprocedural DLco (normal DLco (ND) and low DLco (LD) groups), with a DLco cut-off value of 80%. We compared the patient characteristics and effectiveness of BPA between the groups.
Among the 75 patients, 36 were in the LD group. The LD group had a shorter 6-minute walking distance (324±91 vs 427±114 m) than the ND group but the mean pulmonary artery pressure (mPAP) was similar (38.9±7.3 vs 41.1±9.2 mm Hg) before BPA. BPA improved the haemodynamic status and exercise tolerance in both groups. The LD group exhibited a higher mPAP (25.1±7.4 vs 21.5±5.6 mm Hg) and required more sessions of BPA (median 6 vs 4). Based on the analysis of covariance adjusted for baseline values, low DLco significantly correlated with mPAP (sβ=-0.304, 95% CI -7.015 to -1.132, p=0.007) and pulmonary vascular resistance (sβ=-0.324, 95% CI -141.0 to -29.81, p=0.003).
BPA was associated with an improvement in the haemodynamic status and exercise tolerance in patients with CTEPH even with low DLco. However, low DLco may attenuate the effect of BPA on mPAP and pulmonary vascular resistance and require more treatment sessions.
一氧化碳弥散量（DLco）降低与慢性血栓栓塞性肺动脉高压（CTEPH）的微血管损伤有关。球囊肺动脉成形术（BPA）是 CTEPH 的有效治疗方法，但 BPA 在 DLco 较低的 CTEPH 患者中的疗效尚不清楚，因为 BPA 不能直接解决微血管损伤。本研究根据 DLco 探讨了微血管病变对 CTEPH 中 BPA 的影响。
我们回顾性分析了 2011 年 7 月至 2023 年 8 月在东京大学医院接受 BPA 治疗的不可手术 CTEPH 患者的数据。根据术前 DLco 将患者分为两组（正常 DLco（ND）组和低 DLco（LD）组），DLco 截断值为 80%。我们比较了两组患者的特征和 BPA 的疗效。
在 75 名患者中，36 名患者在 LD 组。LD 组 6 分钟步行距离较短（324±91 比 427±114m），但 BPA 前平均肺动脉压（mPAP）相似（38.9±7.3 比 41.1±9.2mmHg）。BPA 改善了两组患者的血流动力学状态和运动耐量。LD 组 mPAP 较高（25.1±7.4 比 21.5±5.6mmHg），需要更多次 BPA（中位数 6 次比 4 次）。基于调整基线值的协方差分析，低 DLco 与 mPAP 显著相关（sβ=-0.304，95%CI-7.015 至-1.132，p=0.007）和肺血管阻力（sβ=-0.324，95%CI-141.0 至-29.81，p=0.003）。
即使 DLco 较低，BPA 也与 CTEPH 患者的血流动力学状态和运动耐量改善相关。然而，低 DLco 可能会减弱 BPA 对 mPAP 和肺血管阻力的影响，并需要更多的治疗次数。
