Poor Subpleural Perfusion as a predictor of Failure after Balloon Pulmonary Angioplasty for non-operable Chronic Thromboembolic Pulmonary Hypertension

Abstract

Background: It has been shown that ‘poor subpleural perfusion’ (PSP) in the capillary phase of pulmonary angiography (PA), which is related to microvasculopathy in chronic thromboembolic pulmonary hypertension (CTEPH), predicts poor outcome after pulmonary endarterectomy (Tanabe, Chest 2012). We assessed the association between PSP and failure of Balloon Pulmonary Angioplasty (BPA) in 101 non-operable CTEPH. Method: Subpleural perfusion in the capillary phase of PA was classified as normal or poorly perfused as previously described. Patients were divided according to hemodynamic results after the last BPA: a failure group (defined as mean PAP >30mmHg and PVR decrease Results: Baseline characteristics and hemodynamics were similar in the two groups (table). In contrast, PSP was observed in 45.5% of patients in the failure group versus 15.6% in the success group (p=0.016). Multivariate analysis revealed that PSP was the only predictor of BPA failure (Odds Ratio 4.524, 95% confidence interval 1.213-16.877, p=0.025). Conclusion: Poor subpleural perfusion in the capillary phase of pulmonary angiography, suggesting the presence of diffuse microvasculopathy, is associated with significant residual pulmonary hypertension after BPA. In our experience, it affected approximately 10% of non-operable CTEPH who underwent BPA.