Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension

  • Background: Balloon pulmonary angioplasty is an evolving, interventional treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary hypertension at rest as well as exercise capacity is considered to be relevant outcome parameters. The aim of the present study was to determine whether measurement of pulmonary hemodynamics during exercise before and six months after balloon pulmonary angioplasty have an added value. Methods: From March 2014 to July 2018, 172 consecutive patients underwent balloon pulmonary angioplasty. Of these, 64 consecutive patients with inoperable CTEPH underwent a comprehensive diagnostic workup that included right heart catheterization at rest and during exercise before balloon pulmonary angioplasty treatments and six months after the last intervention. Results: Improvements in pulmonary hemodynamics at rest and during exercise, in quality of life, and in exercise capacity were observed six months after balloon pulmonary angioplasty: WHO functional class improved in 78% of patients. The mean pulmonary arterial pressure (mPAP) at rest was reduced from 41 ± 9 to 31 ± 9 mmHg (p < 0.0001). The mPAP/cardiac output slope decreased after balloon pulmonary angioplasty (11.2 ± 25.6 WU to 7.7 ± 4.1 WU; p < 0.0001), and correlated with N-terminal fragment of pro-brain natriuretic peptide (p = 0.035) and 6-minute walking distance (p = 0.01). Conclusions: Exercise right heart catheterization provides valuable information on the changes of pulmonary hemodynamics after balloon pulmonary angioplasty in inoperable CTEPH patients that are not obtainable by measuring resting hemodynamics.

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Author:Christoph B. Wiedenroth, Andreas J. Rieth, Steffen Kriechbaum, H.- Ardeschir Ghofrani, Andreas Breithecker, Moritz Haas, Fritz Roller, Manuel J. Richter, Mareike Lankeit, Lisa Mielzarek, Andreas Rolf, Christian HammORCiDGND, Eckhard Mayer, Stefan Guth, Christoph LiebetrauGND
Parent Title (English):Pulmonary circulation
Publisher:SAGE Publications
Place of publication:Thousand Oaks, CA
Document Type:Article
Date of Publication (online):2020/08/18
Date of first Publication:2020/08/18
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/10/15
Tag:balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension; exercise; right heart catheter
Page Number:9
First Page:1
Last Page:9
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (English):License LogoCreative Commons - Namensnennung-Nicht kommerziell 4.0