Abstract 16122: Percutaneous Transluminal Balloon Angioplasty Ameliorates Metabolic and Renal Dysfunctions Associated With Hemodynamic Improvement in Patients With Chronic Thromboembolic Pulmonary Hypertension

Abstract

Background: Insulin resistance, dyslipidemia and renal dysfunction have been regarded as poor prognostic factors for pulmonary hypertension. We and others have recently demonstrated that percutaneous transluminal pulmonary angioplasty (PTPA) markedly improves pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). In this study, we examined whether PTPA also improves metabolic and renal impairments in CTEPH patients. Methods and Results: From April 2012 to May 2013, we examined serum levels of lipids and fatty acids fractions and plasma levels of glucose and immunoreactive insulin in 68 consecutive patients with CTEPH (64±14[SD] years, M/F 13/55) and calculated the homeostatic model assessment of insulin resistance (HOMA-IR). Renal function was assessed by estimated GFR (eGFR) and urinary albumin-to-creatinine (U-A/C) ratio. Vascular stiffness was evaluated by cardio-ankle vascular index (CAVI). The measurements were repeated after PTPA in 49 patients. Among the 68 patients, we noted NYHA functional class ≥III in 17, 6 min-walk distance <300m in 15, and cardiac index <2.0l/min/m 2 in 18, and regarding metabolic disorders, hypertension in 41, diabetes in 6 and dyslipidemia in 24. Insulin resistance (defined as HOMA-IR >2.0) was noted in 29 out of 63 (58%). Regarding renal function, eGFR was 61.6±17.8 ml/min/m 2 , U-A/C ratio 80.8±214.7mg/gCre, and chronic kidney disease in stage ≥3 was noted in 32 patients (47%). We performed PTPA in 49 patients (mean 3.3 essions/patient), which markedly improved NYHA functional class (P=0.008), 6min-walk distance (102±25 m, P<0.0001) and mean pulmonary arterial pressure (-9.9±1.3 mmHg, P<0.0001). Furthermore, PTPA significantly improved metabolic profiles such as HDL-chol (6.2 ±2.2 mg/dl, P=0.01), EPA (18.3±6.2 mg/dl, P=0.006), fasting blood sugar (-8.0±3.5 mg/dl, P=0.04), HbA1c (-0.3±0.1 %, P<0.0001) and CAVI (-0.44±0.23, P=0.02) . PTPA also significantly improved eGFR (5.2±1.2 ml/min/m 2 , P <0.001) and U-A/C ratio (-47.1±18.9 mg/gCre, P=0.004). Conclusions: These results indicate that metabolic and renal dysfunctions are commonly present in CTEPH patients and that PTPA markedly improves those disorders in addition to pulmonary hemodynamics.