Additive effects of balloon pulmonary angioplasty and the following cardiac rehabilitation on exercise capacity and quality of life

Abstract

Background: We have recently shown that balloon pulmonary angioplasty (BPA) improves peak oxygen uptake (peak VO2) early after the procedure, along with hemodynamics, in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), without postprocedural deconditioning. However, the combined effects of BPA and the following cardiac rehabilitation (CR) on exercise capacity and quality of life (QOL) remain to be examined. Methods: We prospectively enrolled 35 consecutive patients (68±10 years) with inoperable CTEPH who underwent a series of BPA (3.7±2.0 procedures). Just after the final BPA (6.4±2.5 days), 13 out of 35 patients participated in 12-week CR program, consisting of walking, bicycle, and resistance training. Serial changes of cardiopulmonary exercise testing (CPX), hemodynamics, and QOL were assessed before the first BPA, after the final BPA (the beginning of CR), and the end of CR. Results: In 35 patients, BPA significantly improved hemodynamics (mean pulmonary arterial pressure, 35±11 to 24±6 mmHg), heart failure (HF) symptoms and signs, exercise intolerance (normalized peak VO2, 64±13 to 72±11%, P<0.001) and ventilatory efficiency, and QOL scores for physical component (all P<0.05). After 12-week CR, residual exercise intolerance (normalized peak VO2, 72±9 to 82±12%, P<0.001), quadriceps strength, and HF symptoms further improved (all P<0.05) and QOL scores tended to improve (P=0.08), without adverse events or worsening of hemodynamics or HF. Conclusions: The combination of BPA and the following CR safely and additively improved exercise capacity to normal level and QOL in patients with inoperable CTEPH.