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
Graphical Abstract
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension.Circulation. 2001; 103: 10-13
- Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension.Circ Cardiovasc Interv. 2012; 5: 756-762
- Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension.Circ Cardiovasc Interv. 2012; 5: 748-755
- Midterm Effect of Balloon Pulmonary Angioplasty on Hemodynamics and Subclinical Myocardial Damage in Chronic Thromboembolic Pulmonary Hypertension.Can J Cardiol. 2017; 33: 463-470
- 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
- Effects of Balloon Pulmonary Angioplasty on Oxygenation in Patients With Chronic Thromboembolic Pulmonary Hypertension - Importance of Intrapulmonary Shunt.Circ J. 2016; 80: 2227-2234
- Continual Improvement in Pressure Gradient at the Lesion After Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension.Can J Cardiol. 2021; 37: 1232-1239
- Balloon Pulmonary Angioplasty (Percutaneous Transluminal Pulmonary Angioplasty) for Chronic Thromboembolic Pulmonary Hypertension: A Japanese Perspective.JACC Cardiovasc Interv. 2019; 12: 1382-1388
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.
- Riociguat for the treatment of chronic thromboembolic pulmonary hypertension.N Engl J Med. 2013; 369: 319-329
- ERS statement on chronic thromboembolic pulmonary hypertension.Eur Respir J. 2021; 572002828
- Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension.Chest. 2008; 134: 229-236
- 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
- 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
- Selexipag for the treatment of chronic thromboembolic pulmonary hypertension.Eur Respir J. 2021; 2101694
- 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
- 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
- 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
- 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
- Assessment of oxygenation after balloon pulmonary angioplasty for patients with inoperable chronic thromboembolic pulmonary hypertension.Int J Cardiol. 2021; 333: 188-194
- Exercise intolerance in chronic thromboembolic pulmonary hypertension after pulmonary angioplasty.Eur Respir J. 2020; 561901982
- Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of a Multicenter Registry.Circ Cardiovasc Qual Outcomes. 2017; 10e004029
- French experience of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.Eur Respir J. 2019; 531802095
- 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
- Withdrawal of Neurohumoral Blockade After Cardiac Resynchronization Therapy.J Am Coll Cardiol. 2020; 75: 1426-1438
- Haemodynamic definitions and updated clinical classification of pulmonary hypertension.Eur Respir J. 2019; 531801913
- Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data.Chest. 1982; 81: 151-158
- Prognostic factors in medically treated patients with chronic pulmonary embolism.Chest. 2001; 119: 818-823
- Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease.Eur Respir J. 2014; 44: 1635-1645
Article info
Publication history
Accepted:
January 16,
2023
Received in revised form:
January 13,
2023
Received:
July 2,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: The authors have no conflicts of interest to declare.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
