Wang Wei, Wang Jianfeng, Yang Suqiao, Kuang Tuguang, Li Yidan, Gong Juanni, Yang Yuanhua
Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital Capital Medical University Beijing PR China.
Beijing Institute of Respiratory Medicine Beijing PR China.
Pulm Circ. 2024 Aug 25;14(3):e12429. doi: 10.1002/pul2.12429. eCollection 2024 Jul.
The present study aimed to evaluate the efficacy of long-term riociguat sequentially combined with balloon pulmonary angioplasty (BPA) for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Eight inoperable CTEPH patients were enrolled in this study, who have been administrated riociguat 2.5 mg three times daily for about 8 years, then underwent several sessions of BPA procedures. Data are prospectively collected to evaluate clinical outcomes, hemodynamics, exercise capacity, and right heart size and function by echocardiography at baseline, 8 years after riociguat, and 3 months after the final BPA. Eight patients (mean age 54.9 ± 11.4 years) were treated with riociguat 2.5 mg three times daily for 95.0 ± 10.7 months. Cardiac index (CI) (1.5 ± 0.5 L/min/m to 2.4 ± 0.6 L/min/m, = 0.005), 6 min walking distance (6MWD) (329.6 ± 87.5 m to 418.1 ± 75.8 m, = 0.016), and pulmonary vascular resistance (PVR) (1336.9 ± 320.2 dyn·s·cm to 815.4 ± 195.6 dyn·s·cm, = 0.008) were significant improvement after riociguat treatment. Mean 4.1 ± 1.6 additional combinational BPA sessions and mean 18.8 ± 8.1 balloon dilations were performed. Mean pulmonary artery pressure (54.1 ± 11.1 mmHg to 33.6 ± 7.7 mmHg, = 0.002) and PVR (815.4 ± 195.6 dyn·s·cm to 428.3 ± 151.2 dyn·s·cm, ＜0.001) were further decreased. CI (2.4 ± 0.6 L/min/m to 2.7 ± 0.7 L/min/m, = 0.028) and 6MWD (418.1 ± 75.8 m to 455.7 ± 100.0 m, = 0.038) were increased significantly. After long-term riociguat treatment, sequential combination with BPA delivered considerably incremental benefits on exercise capacity and pulmonary hemodynamics, as well as right heart size and function of technically inoperable CTEPH patients.
本研究旨在评估长期使用利奥西呱序贯联合球囊肺血管成形术（BPA）治疗无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的疗效。本研究纳入了8例无法手术的CTEPH患者，他们每日3次服用2.5mg利奥西呱约8年，随后接受了多次BPA治疗。前瞻性收集数据，以评估基线、利奥西呱治疗8年后和最后一次BPA治疗3个月后的临床结局、血流动力学、运动能力以及通过超声心动图评估的右心大小和功能。8例患者（平均年龄54.9±11.4岁）每日3次服用2.5mg利奥西呱，治疗95.0±10.7个月。利奥西呱治疗后，心脏指数（CI）（从1.5±0.5L/min/m²增至2.4±0.6L/min/m²，P = 0.005）、6分钟步行距离（6MWD）（从329.6±87.5m增至418.1±75.8m，P = 0.016）和肺血管阻力（PVR）（从1336.9±320.2dyn·s·cm⁻⁵降至815.4±195.6dyn·s·cm⁻⁵，P = 0.008）均有显著改善。平均额外进行了4.1±1.6次联合BPA治疗，平均进行了18.8±8.1次球囊扩张。平均肺动脉压（从54.1±11.1mmHg降至33.6±7.7mmHg，P = 0.002）和PVR（从815.4±195.6dyn·s·cm⁻⁵降至428.3±151.2dyn·s·cm⁻⁵，P＜0.001）进一步降低。CI（从2.4±0.6L/min/m²增至2.7±0.7L/min/m²，P = 0.028）和6MWD（从418.1±75.8m增至455.7±100.0m，P = 0.038）显著增加。长期使用利奥西呱治疗后，序贯联合BPA在运动能力、肺血流动力学以及无法手术的CTEPH患者的右心大小和功能方面带来了显著的额外益处。
