N-terminal pro–B-type natriuretic peptide for monitoring after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
Graphical Abstract
Section snippets
Study population
The present study included 51 consecutive patients who were treated by BPA at the Kerckhoff Heart and Thorax Center and completed a 6-month follow-up (6-MFU) after the final BPA treatment between March 2014 and March 2017. Pre- and post-procedural management data of the patients were recently published.6, 18 In brief, clinical examination, echocardiography, 12-lead electrocardiography (ECG), laboratory tests, 6-minute walk tests, ventilation–perfusion scan, computed tomographic (CT)
Results
Clinical and procedural characteristics of all 51 patients (28 women, 23 men; age [mean ± SD] 63.1 ± 11.5 years) enrolled in the study are presented in Table 1. The indication for the BPA therapy was a technically inoperable status due to peripheral lesions in 47 (92.2%) patients and a status after PEA with insufficient effects on hemodynamics and clinical parameters in 4 patients (7.8%) (Figure 1).
At baseline, 49 (96.1%) patients were in World Health Organization functional class (WHO FC)
Discussion
Practical experience with BPA, including both beneficial improvements and negative side effects, has accumulated over the last decade.6, 8, 9, 15, 18, 20, 21 BPA is a safe procedure, with pulmonary reperfusion edema and vessel injuries being the leading complications.7, 21 Published data on the effect of BPA on pulmonary hemodynamics are quite heterogeneous, with a broad range of results concerning the reduction of PVR and mean PAP after BPA21; however, right ventricular function and reverse
Disclosure statement
C.B.W. received consultant honoraria and/or speaker fees from Actelion, Bayer AG, MSD, Pfizer and BTG; M.H. received lecture honoraria from Daiichi-Sankyo and Pfizer. T.K. received speaker fees from Abbott. S.G. received speaker fees from Actelion, Bayer, GSK and Pfizer; A.R. received lecture honoraria from Astra Zeneca, Boehringer Ingelheim and Pfizer-Bristol-Myers Squibb; C.W.H. received lecture or consulting honoraria from Astra Zeneca, Bayer, Boehringer Ingelheim, GSK, Daiichi-Sankyo and
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Riociguat and balloon pulmonary angioplasty improve prognosis in patients with inoperable chronic thromboembolic pulmonary Hypertension
2023, Journal of Heart and Lung TransplantationBalloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: Evaluation of haemodynamic effects, complication rates and radiation exposure over time
2022, Archives of Cardiovascular DiseasesCitation Excerpt :After an initial experience reported in 2001 that was associated with high morbidity and mortality [4], BPA has been refined by Japanese teams [5–7] and, thereafter, by an increasing number of teams all over the world [8]. Data have now been accumulated on the effectiveness of BPA in terms of functional and haemodynamic status, cardiac biomarkers, right ventricular function, quality of life and even survival [9–14]. However, despite a large consensus regarding effectiveness, there are still questions that are worthy of being addressed.
Effects of BPA on right ventricular mechanical dysfunction in patients with inoperable CTEPH – A cardiac magnetic resonance study
2022, European Journal of RadiologyCitation Excerpt :Finally, RV GLS revealed promising and significant correlations with RVEF, mPAP, PVR, and septal native AA-T1 before and after BPA. The improvements in pulmonary haemodynamics (mPAP and PVR) are in line with the results of previously published studies [13,35]. Furthermore, improvement of biventricular function [36], interventricular asynchrony [37], and effects on reversed myocardial remodelling assessed by native T1 mapping or extracellular volume fraction measurement (ECV) [23], with correlations to right heart function and pulmonary haemodynamics [24], were also shown previously.
Interventional Management of Chronic Thromboembolic Pulmonary Hypertension
2022, Cardiology ClinicsCitation Excerpt :There is a growing evidence base supporting the use of BPA in nonoperative candidates, with demonstrated benefits in several clinical factors. The bulk of the evidence is composed of small and single-center studies,11,28–31,33,35,39–52 which have consistently shown improved hemodynamics with reductions in mPAP and PVR and increases in cardiac index, and typically improvements in WHO functional class (most patients achieving WHO I or II status) and increase in 6MWD by 50 to 100 m. Most studies have also measured brain natriuretic peptide levels and shown improvements post-BPA, and selected studies have shown improvements in imaging parameters, with smaller right ventricular and larger left ventricular volumes and reduction in ventricular dyssynchrony post-BPA,39 improvements in pulmonary artery energetics by MRI,43 and improved echo parameters of right ventricular systolic and diastolic function.45,47 These findings have been corroborated in larger, multicenter studies as well,32,34,53–56 with the largest study to date57 being a 7-center registry including 308 patients who underwent 1408 BPA procedures in Japan.
Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT
2021, Journal of Heart and Lung TransplantationCitation Excerpt :Brenot et al demonstrated that outcome and complication rates improve with growing experience.252 In addition to hemodynamic improvements in right atrial pressure, pulmonary artery pressure, cardiac index and PVR, other parameters that have been shown to improve after BPA including 6MWD, functional class, NT-proBNP, and right heart imaging parameters including tricuspid annular plane systolic excursion.245,250,269-281 In addition, cardiopulmonary exercise testing has proven enlightening, with clear improvement in ventilatory efficiency (VE/VC02) that likely accounts for a significant component of the improvement in dyspnea and physical functioning that have become the hallmark of successful BPA treatment.272
Balloon pulmonary angioplasty protocol in a Portuguese pulmonary hypertension expert center
2021, Revista Portuguesa de Cardiologia
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These authors have contributed equally to this study.