Improvements in Hemodynamics and Right Heart Remodeling Following Balloon Pulmonary Angioplasty Treatment in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Study

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2024-11-13 DOI:10.1002/hsr2.70159

Qi-Le Shen, Qin-Hua Zhao, Hui-Ting Li, Jie Deng, Jing He, Lan Wang, Su-Gang Gong, Jin-Ming Liu

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Abstract

Background and Aims

This study aimed to evaluate the hemodynamic alterations and right heart remodeling dynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) undergoing treatment with balloon pulmonary angioplasty (BPA).

Methods

This retrospective cohort study involved a cohort of 31 patients with a confirmed diagnosis of CTEPH. Comprehensive clinical evaluations were systematically performed before BPA, and at 3 and 6 months following the procedure.

Results

Significant clinical progress was evidenced by the uplift in the percentage of patients achieving WHO-FC II, escalating from 19.35% at baseline to 51.61% at 6 months after BPA (p = 0.003). NT-proBNP levels significantly dropped from a median of 614.6 to 69.9 pg/mL (p < 0.001). Hemodynamic assessments showed significant decreases in mean PAP from 45.53 ± 11.19 to 22.56 ± 5.81 mmHg (p < 0.001) and PVR from 8.33 to 2.86 WU (p < 0.001). Echocardiographic analysis revealed substantial reductions in the right atrial area (RAA, from 20.29 ± 7.55 to 16.79 ± 4.82 cm², p < 0.001) and right ventricular internal diameter (RVID, from 4.13 ± 0.79 to 3.68 ± 0.59 cm, p = 0.001) at the 3-month interval post-BPA. These improvements were sustained or even enhanced by the 6-month mark, with RAA and RVID further diminishing (to 14.46 ± 3.78 cm² and 3.29 ± 0.54 cm, respectively; both p < 0.01). The TAPSE/PASP ratios showed progressive improvement from baseline (0.32 ± 0.13) to 3 months (0.42 ± 0.13) and continued to improve at 6 months following BPA (0.50 ± 0.11, p = 0.04 compared to 3 months post-BPA).

Conclusion

BPA has significantly ameliorated clinical conditions, hemodynamic profiles, and initiated a continued reversal in right heart remodeling in patients with CTEPH.

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慢性血栓栓塞性肺动脉高压患者接受球囊肺血管成形术治疗后血流动力学和右心重塑的改善：一项回顾性研究。

背景和目的：本研究旨在评估接受球囊肺血管成形术（BPA）治疗的无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的血流动力学改变和右心重塑动态：这项回顾性队列研究涉及 31 例确诊为 CTEPH 的患者。在 BPA 术前、术后 3 个月和 6 个月系统地进行了全面的临床评估：达到WHO-FC II的患者比例从基线时的19.35%上升到BPA术后6个月时的51.61%（p = 0.003），这证明临床治疗取得了重大进展。在 BPA 后的 3 个月间隔期内，NT-proBNP 水平从中位数 614.6 pg/mL 显著降至 69.9 pg/mL（p p p 2，p p = 0.001）。这些改善在 6 个月后得以持续甚至加强，RAA 和 RVID 进一步缩小（分别为 14.46 ± 3.78 平方厘米和 3.29 ± 0.54 厘米；与 BPA 后 3 个月相比，两者的 p p = 0.04）：结论：BPA 能明显改善 CTEPH 患者的临床状况和血液动力学特征，并能持续逆转右心重塑。

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