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Canadian Journal of Cardiology

De-escalation of oxygen-therapy and medication in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty

Published:January 19, 2023DOI:https://doi.org/10.1016/j.cjca.2023.01.014

      Abstract

      Introduction

      There is no consensus on the adjustment of home oxygen therapy (HOT) and pulmonary hypertension (PH)-specific medications after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to examine the status of de-escalation/discontinuation of HOT and PH-specific medications post-BPA and clarify its effect on hemodynamics, biomarkers, and long-term outcomes.

      Methods and Results

      From November 2012 to May 2018, 135 consecutive CTEPH patients who underwent BPA at a single university hospital were enrolled (age, 63.5 ± 13.5 years; World Health Organization functional class [WHO-FC] II/III/IV, 34/92/9). The mean pulmonary arterial pressure decreased from 37.7 ± 11.3 to 20.4 ± 5.1 mmHg 1-year post-BPA (p<0.01). The proportion of patients who required HOT and combination medical therapy (≥2 PH-specific medications) decreased 1-year post-BPA (from 58.5% to 7.4% and from 40.0% to 10.4%, respectively). Baseline factors influencing the requirement of HOT and combination medical therapy post-BPA were almost identical (i.e., lower exercise capacity and pulmonary diffusion capacity, and worse hemodynamics). Regardless of their discontinuation, the improved hemodynamics, functional capacity (WHO-FC), and biomarkers (B-type natriuretic peptide and high-sensitivity troponin T) were almost maintained, and no adverse 1-year clinical outcomes (all-cause death and PH-related hospitalization) were observed.

      Conclusions

      Most CTEPH patients discontinued HOT and PH-specific combination medical therapy post-BPA, which was not associated with the deterioration of hemodynamics, functional capacity, or biomarkers. No long-term adverse outcomes were observed.

      Graphical abstract

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      References

        • Feinstein J.A.
        • Goldhaber S.Z.
        • Lock J.E.
        • Ferndandes S.M.
        • Landzberg M.J.
        Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension.
        Circulation. 2001; 103: 10-13
        • Kataoka M.
        • Inami T.
        • Hayashida K.
        • et al.
        Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension.
        Circ Cardiovasc Interv. 2012; 5: 756-762
        • Mizoguchi H.
        • Ogawa A.
        • Munemasa M.
        • Mikouchi H.
        • Ito H.
        • Matsubara H.
        Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension.
        Circ Cardiovasc Interv. 2012; 5: 748-755
        • Kimura M.
        • Kohno T.
        • Kawakami T.
        • et al.
        Midterm Effect of Balloon Pulmonary Angioplasty on Hemodynamics and Subclinical Myocardial Damage in Chronic Thromboembolic Pulmonary Hypertension.
        Can J Cardiol. 2017; 33: 463-470
        • Kimura M.
        • Kohno T.
        • Kawakami T.
        • et al.
        Shortening Hospital Stay Is Feasible and Safe in Patients With Chronic Thromboembolic Pulmonary Hypertension Treated With Balloon Pulmonary Angioplasty.
        Can J Cardiol. 2019; 35: 193-198
        • Aoki T.
        • Sugimura K.
        • Nochioka K.
        • et al.
        Effects of Balloon Pulmonary Angioplasty on Oxygenation in Patients With Chronic Thromboembolic Pulmonary Hypertension - Importance of Intrapulmonary Shunt.
        Circ J. 2016; 80: 2227-2234
        • Shimokawahara H.
        • Nagayoshi S.
        • Ogawa A.
        • Matsubara H.
        Continual Improvement in Pressure Gradient at the Lesion After Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension.
        Can J Cardiol. 2021; 37: 1232-1239
        • Kataoka M.
        • Inami T.
        • Kawakami T.
        • Fukuda K.
        • Satoh T.
        Balloon Pulmonary Angioplasty (Percutaneous Transluminal Pulmonary Angioplasty) for Chronic Thromboembolic Pulmonary Hypertension: A Japanese Perspective.
        JACC Cardiovasc Interv. 2019; 12: 1382-1388
      1. Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015;46:903-975.

        • Ghofrani H.A.
        • D'Armini A.M.
        • Grimminger F.
        • et al.
        Riociguat for the treatment of chronic thromboembolic pulmonary hypertension.
        N Engl J Med. 2013; 369: 319-329
        • Delcroix M.
        • Torbicki A.
        • Gopalan D.
        • et al.
        ERS statement on chronic thromboembolic pulmonary hypertension.
        Eur Respir J. 2021; 572002828
        • Suntharalingam J.
        • Treacy C.M.
        • Doughty N.J.
        • et al.
        Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension.
        Chest. 2008; 134: 229-236
        • Ghofrani H.A.
        • Simonneau G.
        • D'Armini A.M.
        • et al.
        Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study.
        Lancet Respir Med. 2017; 5: 785-794
        • Sadushi-Kolici R.
        • Jansa P.
        • Kopec G.
        • et al.
        Subcutaneous treprostinil for the treatment of severe non-operable chronic thromboembolic pulmonary hypertension (CTREPH): a double-blind, phase 3, randomised controlled trial.
        Lancet Respir Med. 2019; 7: 239-248
        • Ogo T.
        • Shimokawahara H.
        • Kinoshita H.
        • et al.
        Selexipag for the treatment of chronic thromboembolic pulmonary hypertension.
        Eur Respir J. 2021; 2101694
        • Tsugu T.
        • Murata M.
        • Kawakami T.
        • et al.
        Significance of echocardiographic assessment for right ventricular function after balloon pulmonary angioplasty in patients with chronic thromboembolic induced pulmonary hypertension.
        Am J Cardiol. 2015; 115: 256-261
      2. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group.
        Ann Intern Med. 1980; 93: 391-398
      3. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party.
        Lancet. 1981; 1: 681-686
        • Ulrich S.
        • Saxer S.
        • Hasler E.D.
        • et al.
        Effect of domiciliary oxygen therapy on exercise capacity and quality of life in patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension: a randomised, placebo-controlled trial.
        Eur Respir J. 2019; 541900276
        • Matsuoka Y.
        • Taniguchi Y.
        • Miwa K.
        • et al.
        Assessment of oxygenation after balloon pulmonary angioplasty for patients with inoperable chronic thromboembolic pulmonary hypertension.
        Int J Cardiol. 2021; 333: 188-194
        • Kikuchi H.
        • Goda A.
        • Takeuchi K.
        • et al.
        Exercise intolerance in chronic thromboembolic pulmonary hypertension after pulmonary angioplasty.
        Eur Respir J. 2020; 561901982
        • Ogawa A.
        • Satoh T.
        • Fukuda T.
        • et al.
        Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of a Multicenter Registry.
        Circ Cardiovasc Qual Outcomes. 2017; 10e004029
        • Brenot P.
        • Jaïs X.
        • Taniguchi Y.
        • et al.
        French experience of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.
        Eur Respir J. 2019; 531802095
        • Halliday B.P.
        • Wassall R.
        • Lota A.S.
        • et al.
        Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial.
        Lancet. 2019; 393: 61-73
        • Nijst P.
        • Martens P.
        • Dauw J.
        • et al.
        Withdrawal of Neurohumoral Blockade After Cardiac Resynchronization Therapy.
        J Am Coll Cardiol. 2020; 75: 1426-1438
        • Simonneau G.
        • Montani D.
        • Celermajer D.S.
        • et al.
        Haemodynamic definitions and updated clinical classification of pulmonary hypertension.
        Eur Respir J. 2019; 531801913
        • Riedel M.
        • Stanek V.
        • Widimsky J.
        • Prerovsky I.
        Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data.
        Chest. 1982; 81: 151-158
        • Lewczuk J.
        • Piszko P.
        • Jagas J.
        • et al.
        Prognostic factors in medically treated patients with chronic pulmonary embolism.
        Chest. 2001; 119: 818-823
        • Taboada D.
        • Pepke-Zaba J.
        • Jenkins D.P.
        • et al.
        Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease.
        Eur Respir J. 2014; 44: 1635-1645