Yamashita Jun, Ogino Hitoshi, Masaki Kohei, Taniguchi Yu, Adachi Shiro, Inami Takumi, Hosokawa Kazuya, Tsujino Ichizo, Yaoita Nobuhiro, Hatano Masaru, Ikeda Nobutaka, Tanabe Nobuhiro, Shimokawahara Hiroto, Kubota Kayoko, Shigeta Ayako, Horimoto Koshin, Ogihara Yoshito, Dohi Yoshihiro, Hiraide Takahiro, Kawakami Takashi, Ikemiyagi Hidekazu, Tamura Yuichi, Fukumoto Yoshihiro, Abe Kohtaro
Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
Int J Cardiol Heart Vasc. 2025 Jul 12;60:101751. doi: 10.1016/j.ijcha.2025.101751. eCollection 2025 Oct.
Invasive treatments for chronic thromboembolic pulmonary hypertension (CTEPH) include pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). Both PEA and BPA demonstrate significant benefits for symptom relief, hemodynamic improvement, and overall patient outcomes. However, evidence of their efficacy in older adults remains limited. This study aimed to evaluate treatment efficacy-including exercise tolerance, hemodynamics, functional status-and clinical outcomes in CTEPH patients aged ≥70 years who underwent PEA or BPA.
Among 1,527 patients in the CTEPH AntiCoagulants Registry, we selected those aged 70 years or older, including 25 who underwent PEA during follow-up and 210 who received BPA. We evaluated the World Health Organization functional class (WHO FC), a measure of subjective symptoms, along with exercise capacity, hemodynamic parameters, and clinical outcomes.
At baseline, BPA patients were older (P = 0.003) and tended to have lower body weight (P = 0.069) than those undergoing PEA. At a median follow-up of ∼2 years, BPA significantly improved six-minute walk distance and cardiac index, and reduced mean pulmonary artery pressure and pulmonary vascular resistance, with effects comparable to PEA after adjusting for age, sex, and body mass index (all adjusted P > 0.10). However, improvement in WHO FC was more frequent with BPA and became significant after covariate adjustment (adjusted P = 0.035). Adverse event rates were infrequent and similar between the two groups (all P > 0.10).
In adults aged ≥ 70 years with CTEPH, BPA improved hemodynamics, exercise capacity, and outcomes comparable to PEA, but with greater WHO FC improvement. Further randomized trials in older adults are warranted.
UMIN Clinical Trials Registry (identifier UMIN 000033784).
慢性血栓栓塞性肺动脉高压（CTEPH）的侵入性治疗包括肺动脉内膜剥脱术（PEA）和球囊肺动脉成形术（BPA）。PEA和BPA在缓解症状、改善血流动力学及患者总体预后方面均显示出显著益处。然而，它们在老年人中的疗效证据仍然有限。本研究旨在评估接受PEA或BPA治疗的≥70岁CTEPH患者的治疗效果，包括运动耐量、血流动力学、功能状态及临床结局。
在CTEPH抗凝登记研究的1527例患者中，我们选取了70岁及以上的患者，其中25例在随访期间接受了PEA，210例接受了BPA。我们评估了世界卫生组织功能分级（WHO FC），这是一种主观症状的衡量指标，同时还评估了运动能力、血流动力学参数和临床结局。
基线时，BPA组患者比接受PEA组的患者年龄更大（P = 0.003），且体重有降低趋势（P = 0.069）。在中位随访约2年时，BPA显著改善了6分钟步行距离和心脏指数，并降低了平均肺动脉压和肺血管阻力，在调整年龄、性别和体重指数后，其效果与PEA相当（所有调整后P>0.10）。然而，BPA组WHO FC的改善更为常见，在进行协变量调整后具有显著性（调整后P = 0.035）。两组不良事件发生率均较低且相似（所有P>0.10）。
在≥70岁的CTEPH成人患者中，BPA改善血流动力学、运动能力和结局的效果与PEA相当，但在WHO FC改善方面更显著。有必要在老年人中进行进一步的随机试验。
UMIN临床试验注册库（标识符UMIN 000033784）。
