肺动脉内膜切除术和球囊肺动脉成形术对老年慢性血栓栓塞性肺动脉高压的影响：CTEPH AC登记的亚分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-12 DOI:10.1016/j.ijcha.2025.101751

Jun Yamashita , Hitoshi Ogino , Kohei Masaki , Yu Taniguchi , Shiro Adachi , Takumi Inami , Kazuya Hosokawa , Ichizo Tsujino , Nobuhiro Yaoita , Masaru Hatano , Nobutaka Ikeda , Nobuhiro Tanabe , Hiroto Shimokawahara , Kayoko Kubota , Ayako Shigeta , Koshin Horimoto , Yoshito Ogihara , Yoshihiro Dohi , Takahiro Hiraide , Takashi Kawakami , Kohtaro Abe

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引用次数: 0

摘要

背景：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切除术（PEA）和球囊肺血管成形术（BPA）。PEA和BPA在症状缓解、血流动力学改善和患者总体预后方面均表现出显著的益处。然而，它们对老年人有效的证据仍然有限。本研究旨在评估年龄≥70岁接受PEA或BPA治疗的CTEPH患者的治疗效果，包括运动耐量、血流动力学、功能状态和临床结果。方法在CTEPH抗凝登记的1527例患者中，我们选择了年龄在70岁或以上的患者，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等级（WHO FC），一种主观症状的测量方法，以及运动能力、血流动力学参数和临床结果。结果基线时，BPA患者比PEA患者年龄更大（P = 0.003），体重更轻（P = 0.069）。在中位随访~ 2年时，BPA显著改善了6分钟步行距离和心脏指数，降低了平均肺动脉压和肺血管阻力，在调整了年龄、性别和体重指数后，其效果与PEA相当(均调整了P >；0.10)。然而，BPA对WHO FC的改善更为频繁，并在协变量调整后变得显著（校正P = 0.035）。两组的不良事件发生率很少且相似(P >；0.10)。结论：在年龄≥70岁的CTEPH患者中，BPA改善了血液动力学、运动能力和与PEA相当的结果，但对WHO FC的改善更大。在老年人中进一步的随机试验是有必要的。临床试验注册编号UMIN临床试验注册中心（标识符UMIN 000033784）。

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Effects of pulmonary endarterectomy and balloon pulmonary angioplasty in older adults with chronic thromboembolic pulmonary hypertension: A sub-analysis of the CTEPH AC registry

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Clinical trial registration number

UMIN Clinical Trials Registry (identifier UMIN 000033784).

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.