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Abstract：
BACKGROUND: Balloon pulmonary angioplasty (BPA) improves the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricle (RV) is an important predictor of prognosis in CTEPH patients. 2D-speckle tracking echocardiography (2D-STE) can evaluate RV function. This study aimed to evaluate the effectiveness of BPA in CTEPH patients and to assess the value of 2D-STE in predicting outcomes of BPA.
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.
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.
摘要：
背景：球囊肺血管成形术（BPA）可改善慢性血栓栓塞性肺动脉高压（CTEPH）的预后。右心室(RV)是CTEPH患者预后的重要预测因子。2D斑点追踪超声心动图（2D-STE）可以评估RV功能。本研究旨在评估BPA在CTEPH患者中的有效性，并评估2D-STE在预测BPA预后中的价值。
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。
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。
