通过压力导管和血管造影肺灌注优化目标终点，改进球囊肺血管成形术

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-10-28 DOI:10.1016/j.jcin.2024.08.045

Taijyu Satoh MD, PhD , Nobuhiro Yaoita MD, PhD , Satoshi Higuchi MD, PhD , Kotaro Nochioka MD, PhD , Saori Yamamoto MD, PhD , Haruka Sato MD, PhD , Kaito Yamada MD , Yusuke Yamada MD , Kohei Komaru MD , Naoki Chiba MD , Mitsuru Nakada MHSc , Satoshi Miyata MD, PhD , Hideki Ota MD, PhD , Kei Takase MD, PhD , Satoshi Yasuda MD, PhD

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引用次数: 0

摘要

背景球囊肺血管成形术（BPA）在治疗慢性血栓栓塞性肺动脉高压（CTEPH）方面取得了重大进展。目的作者试图研究在功能评估指导下扩张肺动脉（PA）对接受 BPA 治疗的 CTEPH 患者的临床意义。方法这项前瞻性单中心队列研究共纳入 95 例患者，他们接受了 278 次连续 BPA 治疗。通过二维灌注血管造影评估肺实质灌注情况，并通过压力导管测量确定 PA 压力比。分析肺灌注与压力比之间的相关性，以确定最佳目标压力比。将患者分为两组，即压力引导组（28 人）和血管造影组（63 人），以评估优化压力比是否能改善残余 PH 和并发症。通过片断线性回归模型确定了目标压力比为 0.7，这与肺灌注的显著增强有关。压力引导策略实现了更高的平均肺动脉压 <25 mm Hg 率（92.8% [26/28 名患者] vs 60.3% [38/63 名患者]；P = 0.001），同时减少了 BPA 相关并发症（3.9% [4/101 次治疗] vs 12.9% [23/177 次治疗]；P = 0.019）。这种方法改善了残余 PH 值并减少了并发症，凸显了其提高 CTEPH 治疗效果的潜力。

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Improving Balloon Pulmonary Angioplasty Through Target Endpoint Optimization With Pressure Catheter and Angiographic Lung Perfusion

Background

Balloon pulmonary angioplasty (BPA) has exhibited substantial progress in the management of chronic thromboembolic pulmonary hypertension (CTEPH). However, nearly one-half of the patients with CTEPH experience persistent pulmonary hypertension after undergoing BPA, emphasizing the need for enhanced therapies.

Objectives

The authors sought to investigate the clinical significance of functional assessment-guided dilation of the pulmonary artery (PA) in patients with CTEPH undergoing BPA treatment.

Methods

The prospective single-center cohort study enrolled 95 patients who underwent 278 consecutive BPA sessions. Lung parenchymal perfusion was assessed via 2-dimensional perfusion angiography, and pressure catheter measurements were taken to determine the PA pressure ratios. The correlation between lung perfusion and the pressure ratio was analyzed to establish an optimal target pressure ratio. Patients were stratified into 2 groups, a pressure-guided group (n = 28) and an angiographic group (n = 63), to evaluate whether optimizing the pressure ratio led to improvements in residual PH and complications.

Results

The pressure ratio and lung perfusion measurements of 141 PA lesions were analyzed. A piecewise linear regression model identified a target pressure ratio of 0.7, associated with significant enhancement in lung perfusion. The pressure-guided strategy achieved a higher rate of mean pulmonary artery pressure <25 mm Hg (92.8% [26/28 patients] vs 60.3% [38/63 patients]; P = 0.001) and a concurrent reduction in BPA relevant complications (3.9% [4/101 sessions] vs 12.9% [23/177 sessions]; P = 0.019).

Conclusions

Functional assessment-guided PA dilation with a target pressure ratio of 0.7 proved beneficial in BPA treatment for patients with CTEPH. This approach improved the residual PH and reduced complications, highlighting its potential to enhance CTEPH management outcomes.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.