Age-related differences in the effect of balloon pulmonary angioplasty on cardiac output in chronic thromboembolic pulmonary hypertension

Abstract

Abstract Background Balloon pulmonary angioplasty (BPA) has been accepted as an alternative for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). Although BPA improves most of the hemodynamic parameters, the improvement of cardiac output (CO) after BPA cannot be obtained in all the patients. Purpose This study was aimed to clarify whether BPA could improve CO or not. We also investigated the determinants for the improvement of CO after BPA. Methods We enrolled in consecutive 317 CTEPH patients treated with BPA in our hospital. All the patients were divided into three groups by generations (Younger group; age <60 years old, n=103, Middle-aged group; 60 ≤ age < 70 years old, n=100, Elderly group; 70 ≤ age, n=114). We retrospectively investigated the change of CO after BPA, including its determinants as heart rate (HR) and stroke volume (SV) among the three groups. Results Baseline mean pulmonary arterial pressure and six minutes-walk distance in the elderly group were lower than those in the younger group. Baseline CO was almost similar among the three groups. All the hemodynamic parameters, excluding CO, were improved after BPA in overall patients' analyses. The significant improvement in CO after BPA was identified only in the younger patients. Whereas HR decreased after BPA in all age groups, the improvement of CO and SV depended on each patient's generation, as shown in Figure 1. Conclusions It would be challenging to improve CO after BPA in all the populations, especially in elderly CTEPH patients. Adjuvant medical treatment in addition to BPA would be required in elderly patients. Funding Acknowledgement Type of funding sources: None.