Abstract
BackgroundThe efficacy of balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension would be promising. However, some patients showed residual dyspnea or symptoms, despite normalized hemodynamics. We aimed to clarify the clinical impact of oxygenation parameters on BPA outcome. MethodNinety-nine consecutive patients who underwent BPA from September 2011 to December 2019 were enrolled. We evaluated hemodynamics with right heart catheterization, arterial blood gas examination, New York Heart Association functional class (NYHA-FC), respiratory function tests, nocturnal oximetry, and exercise capacity (6-min walk test and cardiopulmonary exercise testing) at baseline and after BPA. ResultNearly normal hemodynamics was achieved after BPA (mean pulmonary artery pressure (PAP): 37.5 ± 10.0 to 20.6 ± 4.9 mmHg, p < 0.01). Oxygenation slightly improved (partial pressure of arterial oxygen; 61.5 ± 12.3 to 67.7 ± 12.7 mmHg, p < 0.01). Exertional desaturation remained unchanged (−8.1 ± 4.8 to −7.8 ± 5.1, p = 0.59), and this was associated with residual symptom (NYHA-FC ≥ 2) after BPA (OR 0.591, 95% CI 0.416–0.840, p = 0.003) in multivariate regression analyses. Lower vital capacity (r2 = 0.03, p = 0.01), higher mean PAP (r2 = 0.08, p = 0.02), and higher minute ventilation/carbon dioxide production (VE/VCO2) slope (r2 = 0.18, p < 0.01), the marker of ventilatory inefficiency, were correlated with exertional desaturation after BPA in multivariate linear analyses. ConclusionAlthough hemodynamics nearly normalized, oxygenation did not. Moreover, exertional desaturation remained unchanged. This might cause residual symptom after BPA. Residual pulmonary hypertension suggesting incurable arteriopathy, and higher VE/VCO2 slope suggesting ventilation-perfusion mismatch might be related to exertional desaturation. Domiciliary oxygen therapy should be continued, if necessary.
Highlights
Routine medical assessment included hemodynamic characteristics assessed by right heart catheterization (RHC); lung functional tests; functional status with the New York Heart Association functional class (NYHA-FC); exercise capacity using the 6-min walk test (6-MWT) and cardiopulmonary exercise test (CPET); and nocturnal oximetry tests
Reevaluation was done with RHC, CPET, and the lung function test after the last balloon pulmonary angioplasty (BPA) had not been performed in 33 patients by the cut-off date; the efficacy analysis was evaluated in 99 patients
Larger desaturation during 6MWT (Odds Ratio [OR] 0.591, 95% CI 0.416–0.840, p = 0.003), lower 6-MWT distance, and lower peak Oxygen uptake (VO2) in CPET after BPA were independently correlated with residual symptoms (NYHA-FC ≥ 2)
Summary
Some patients showed residual dyspnea or desaturation in exercise despite normalized hemodynamics with unresolved oxygenation problems. The correlation between oxygenation and hemodynamic improvement in patients treated with BPA remains unclear. We aimed to clarify the clinical impact of oxygenation parameters on BPA outcome in patients with CTEPH. Some patients showed residual dyspnea or symptoms, despite normalized hemodynamics. Result: Nearly normal hemodynamics was achieved after BPA (mean pulmonary artery pressure (PAP): 37.5 ± 10.0 to 20.6 ± 4.9 mmHg, p < 0.01). Exertional desaturation remained unchanged (−8.1 ± 4.8 to −7.8 ± 5.1, p = 0.59), and this was associated with residual symptom (NYHA-FC ≥ 2) after BPA (OR 0.591, 95% CI 0.416–0.840, p = 0.003) in multivariate regression analyses. This might cause residual symptom after BPA.
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