METHODS: A total of 76 patients with CTEPH underwent 354 BPA sessions from January 2017 to October 2022. Responders were defined as those with mean pulmonary artery pressure (mPAP) ≤ 30 mmHg or those showing ≥ 30% decrease in pulmonary vascular resistance (PVR) after the last BPA session, compared to baseline. Logistic regression analysis was performed to identify predictors of BPA efficacy.
RESULTS: BPA resulted in a significant decrease in mPAP (from 50.8 ± 10.4 mmHg to 35.5 ± 11.9 mmHg, p < 0.001), PVR (from 888.7 ± 363.5 dyn·s·cm-5 to 545.5 ± 383.8 dyn·s·cm-5, p < 0.001), and eccentricity index (from 1.3 to 1.1, p < 0.001), and a significant increase in RV free wall longitudinal strain (RVFWLS: from 15.7% to 21.0%, p < 0.001). Significant improvement was also observed in the 6-min walking distance (from 385.5 m to 454.5 m, p < 0.001). After adjusting for confounders, multivariate analysis showed that RVFWLS was the only independent predictor of BPA efficacy. The optimal RVFWLS cutoff value for predicting BPA responders was 12%.
CONCLUSIONS: BPA was found to reduce pulmonary artery pressure, reverse RV remodeling, and improve exercise capacity. RVFWLS obtained by 2D-STE was an independent predictor of BPA outcomes. Our study may provide a meaningful reference for interventional therapy of CTEPH.
方法:2017年1月至2022年10月,共有76例CTEPH患者接受了354次BPA治疗。反应者定义为平均肺动脉压(mPAP)≤30mmHg或在最后一次BPA疗程后肺血管阻力(PVR)下降≥30%的患者。与基线相比。进行Logistic回归分析以确定BPA疗效的预测因子。
结果:BPA导致mPAP显着降低(从50.8±10.4mmHg降至35.5±11.9mmHg,p<0.001),PVR(从888.7±363.5dyn·s·cm-5到545.5±383.8dyn·s·cm-5,p<0.001),和偏心指数(从1.3到1.1,p<0.001),RV自由壁纵向应变显著增加(RVFWLS:从15.7%增加到21.0%,p<0.001)。在6分钟的步行距离(从385.5m到454.5m,p<0.001)。在调整了混杂因素后,多因素分析显示RVFWLS是BPA疗效的唯一独立预测因子。预测BPA反应者的最佳RVFWLS截止值为12%。
结论:发现双酚A可降低肺动脉压,反向RV重塑,提高运动能力。通过2D-STE获得的RVFWLS是BPA结局的独立预测因子。本研究可为CTEPH的介入治疗提供有意义的参考。