Impact of disease location and laterality on hemodynamic response following pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

JHLT Open Pub Date : 2025-06-14 DOI:10.1016/j.jhlto.2025.100314

Bryan O. Pérez Martínez MD , Gabriella V. Rubick MD , Avi Toiv MD , Sidney Perkins MD , Jorge Vinales , Victor M. Moles MD , Vallerie V. McLaughlin MD , Thomas M. Cascino MD MSc , Bryan Kelly DO , Gillian Grafton DO , Rana Awdish MD , Jonathan W. Haft MD , Vikas Aggarwal MD MPH

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Abstract

Background

In patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary thromboendarterectomy (PTE), obstructive disease burden predicts positive hemodynamic responsiveness. However, the effect of disease location (upper, middle, or lower lobes) and lung laterality (right or left) has not been studied.

Objectives

Examine the effect of obstructive disease location and laterality on hemodynamic response following PTE.

Methods

This analysis is a retrospective cohort study of 56 consecutive patients diagnosed with CTEPH who underwent PTE at the University of Michigan Hospital between August 2019 and July 2022. Disease burden, location, and laterality were assessed on invasive pulmonary angiography (IPA), and lobar segments were assigned a score based on these features and correlated with an absolute change in pulmonary vascular resistance (PVR) following PTE. The relationship between disease burden and hemodynamic responsiveness was modeled using linear regressions with R² reported as a measure of correlation.

Results

Most patients were World Health Organization (WHO) class III or IV (n = 47; 83.9%) and had a history of acute pulmonary embolism (n = 51; 91.1%). A modest correlation between patients’ overall disease burden and absolute change in PVR was noted, with the strongest contributions from the right lower lobe (RLL), right middle lobe (RML), and left lower lobe (LLL) (R² = 0.16, 0.10, and 0.03, respectively).

Conclusion

Disease location in the RLL, RML, and LLL may predict hemodynamic improvement in patients with CTEPH undergoing PTE.

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慢性血栓栓塞性肺动脉高压肺血栓动脉内膜切除术后疾病位置和侧边对血流动力学反应的影响

在接受肺血栓动脉内膜切除术（PTE）的慢性血栓栓塞性肺动脉高压（CTEPH）患者中，阻塞性疾病负担预示着阳性的血流动力学反应性。然而，疾病位置（上、中、下肺叶）和肺侧边（右或左）的影响尚未研究。目的探讨阻塞性疾病的位置和侧侧性对PTE后血流动力学反应的影响。方法回顾性队列研究了2019年8月至2022年7月在密歇根大学医院接受PTE治疗的56例连续诊断为CTEPH的患者。通过有创肺血管造影（IPA）评估疾病负担、位置和侧侧性，并根据这些特征对肺叶段进行评分，并与PTE后肺血管阻力（PVR）的绝对变化相关。疾病负担与血流动力学反应性之间的关系采用线性回归模型，R2作为相关性衡量指标。结果大多数患者为世界卫生组织（WHO） III级或IV级(n = 47；83.9%)，有急性肺栓塞史(n = 51；91.1%)。患者总体疾病负担与PVR的绝对变化之间存在适度的相关性，其中右下叶（RLL）、右中叶（RML）和左下叶（LLL）的贡献最大（R2分别= 0.16、0.10和0.03）。结论病变部位在RLL、RML和LLL可预测CTEPH患者行PTE后血流动力学的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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