Improving Balloon Pulmonary Angioplasty Through Target Endpoint Optimization With Pressure Catheter and Angiographic Lung Perfusion.
Humans
Female
Male
Pulmonary Artery
/ physiopathology
Prospective Studies
Angioplasty, Balloon
/ adverse effects
Middle Aged
Aged
Treatment Outcome
Hypertension, Pulmonary
/ physiopathology
Arterial Pressure
Pulmonary Circulation
Predictive Value of Tests
Pulmonary Embolism
/ physiopathology
Chronic Disease
Perfusion Imaging
/ methods
Transducers, Pressure
Time Factors
Vascular Access Devices
chronic thromboembolic pulmonary hypertension
distal subtract angiography
lung perfusion
pressure catheter
target pressure ratio
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
28 Oct 2024
28 Oct 2024
Historique:
received:
14
12
2023
revised:
25
08
2024
accepted:
27
08
2024
medline:
31
10
2024
pubmed:
31
10
2024
entrez:
30
10
2024
Statut:
ppublish
Résumé
Balloon pulmonary angioplasty (BPA) has exhibited substantial progress in the management of chronic thromboembolic pulmonary hypertension (CTEPH). However, nearly one-half of the patients with CTEPH experience persistent pulmonary hypertension after undergoing BPA, emphasizing the need for enhanced therapies. The authors sought to investigate the clinical significance of functional assessment-guided dilation of the pulmonary artery (PA) in patients with CTEPH undergoing BPA treatment. The prospective single-center cohort study enrolled 95 patients who underwent 278 consecutive BPA sessions. Lung parenchymal perfusion was assessed via 2-dimensional perfusion angiography, and pressure catheter measurements were taken to determine the PA pressure ratios. The correlation between lung perfusion and the pressure ratio was analyzed to establish an optimal target pressure ratio. Patients were stratified into 2 groups, a pressure-guided group (n = 28) and an angiographic group (n = 63), to evaluate whether optimizing the pressure ratio led to improvements in residual PH and complications. The pressure ratio and lung perfusion measurements of 141 PA lesions were analyzed. A piecewise linear regression model identified a target pressure ratio of 0.7, associated with significant enhancement in lung perfusion. The pressure-guided strategy achieved a higher rate of mean pulmonary artery pressure <25 mm Hg (92.8% [26/28 patients] vs 60.3% [38/63 patients]; P = 0.001) and a concurrent reduction in BPA relevant complications (3.9% [4/101 sessions] vs 12.9% [23/177 sessions]; P = 0.019). Functional assessment-guided PA dilation with a target pressure ratio of 0.7 proved beneficial in BPA treatment for patients with CTEPH. This approach improved the residual PH and reduced complications, highlighting its potential to enhance CTEPH management outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Balloon pulmonary angioplasty (BPA) has exhibited substantial progress in the management of chronic thromboembolic pulmonary hypertension (CTEPH). However, nearly one-half of the patients with CTEPH experience persistent pulmonary hypertension after undergoing BPA, emphasizing the need for enhanced therapies.
OBJECTIVES
OBJECTIVE
The authors sought to investigate the clinical significance of functional assessment-guided dilation of the pulmonary artery (PA) in patients with CTEPH undergoing BPA treatment.
METHODS
METHODS
The prospective single-center cohort study enrolled 95 patients who underwent 278 consecutive BPA sessions. Lung parenchymal perfusion was assessed via 2-dimensional perfusion angiography, and pressure catheter measurements were taken to determine the PA pressure ratios. The correlation between lung perfusion and the pressure ratio was analyzed to establish an optimal target pressure ratio. Patients were stratified into 2 groups, a pressure-guided group (n = 28) and an angiographic group (n = 63), to evaluate whether optimizing the pressure ratio led to improvements in residual PH and complications.
RESULTS
RESULTS
The pressure ratio and lung perfusion measurements of 141 PA lesions were analyzed. A piecewise linear regression model identified a target pressure ratio of 0.7, associated with significant enhancement in lung perfusion. The pressure-guided strategy achieved a higher rate of mean pulmonary artery pressure <25 mm Hg (92.8% [26/28 patients] vs 60.3% [38/63 patients]; P = 0.001) and a concurrent reduction in BPA relevant complications (3.9% [4/101 sessions] vs 12.9% [23/177 sessions]; P = 0.019).
CONCLUSIONS
CONCLUSIONS
Functional assessment-guided PA dilation with a target pressure ratio of 0.7 proved beneficial in BPA treatment for patients with CTEPH. This approach improved the residual PH and reduced complications, highlighting its potential to enhance CTEPH management outcomes.
Identifiants
pubmed: 39477643
pii: S1936-8798(24)01165-8
doi: 10.1016/j.jcin.2024.08.045
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2394-2407Informations de copyright
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures The present study was supported by Japan Agency for Medical Research and Development under grant number 22ek0210149h0003. Dr S.Y. has received grants support from Takeda Pharmaceutical, Abbott, and Boston Scientific and lecture fees from Daiichi-Sankyo and Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.