PDF(Pubmed)
Abstract：
UNASSIGNED: Balloon pulmonary angioplasty (BPA)-related complications are not uncommon and could contribute to perioperative mortality. However, there is a lack of a prediction model for BPA-related complications.
UNASSIGNED: Data from consecutive patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent BPA were retrospectively analyzed. The primary outcome was BPA-related complications. The secondary outcomes were mortality and hemodynamics after BPA.
UNASSIGNED: A total of 207 patients with 614 BPA sessions were included. Complications occurred during 63 sessions (10.26%) in 49 patients. Hemoptysis or hemosputum (6.51%) was the most common complication, whereas pulmonary reperfusion edema was rare (0.49%). Multivariable logistic regression identified that disease duration, mean pulmonary arterial pressure (mPAP) and the proportion of occlusion lesions were correlated with BPA complications. A nomogram was constructed accordingly, which had the highest area under curve (0.703) and was superior to previously reported predictors [nomogram vs. mPAP, net reclassification index (95% confidence interval (CI)), 0.215 (0.002, 0.427), p = 0.047; integrated discrimination index (95% CI), 0.059 (0.010, 0.109), p = 0.018]. The nomogram was found to be accurate based on validation and calibration (slope 0.978, Bier score 0.163). After adjusting for the number of BPA sessions in multivariable linear regression, the occurrence of complications was not associated with hemodynamic improvement after BPA. The 3-year survival was also comparable between patients with and without complications (98.0% vs. 94.8%, log-rank p = 0.503).
UNASSIGNED: The nomogram, comprising mPAP, the proportion of occlusion lesions and disease duration, could better predict BPA-related complications than previously reported single parameters. Distinctively, the occurrence of complications did not impair the beneficial impact of BPA on hemodynamics and survival. The occurrence of complications should not discourage patients from continuing BPA sessions.
UNASSIGNED: Data from consecutive patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent BPA were retrospectively analyzed. The primary outcome was BPA-related complications. The secondary outcomes were mortality and hemodynamics after BPA.
UNASSIGNED: A total of 207 patients with 614 BPA sessions were included. Complications occurred during 63 sessions (10.26%) in 49 patients. Hemoptysis or hemosputum (6.51%) was the most common complication, whereas pulmonary reperfusion edema was rare (0.49%). Multivariable logistic regression identified that disease duration, mean pulmonary arterial pressure (mPAP) and the proportion of occlusion lesions were correlated with BPA complications. A nomogram was constructed accordingly, which had the highest area under curve (0.703) and was superior to previously reported predictors [nomogram vs. mPAP, net reclassification index (95% confidence interval (CI)), 0.215 (0.002, 0.427), p = 0.047; integrated discrimination index (95% CI), 0.059 (0.010, 0.109), p = 0.018]. The nomogram was found to be accurate based on validation and calibration (slope 0.978, Bier score 0.163). After adjusting for the number of BPA sessions in multivariable linear regression, the occurrence of complications was not associated with hemodynamic improvement after BPA. The 3-year survival was also comparable between patients with and without complications (98.0% vs. 94.8%, log-rank p = 0.503).
UNASSIGNED: The nomogram, comprising mPAP, the proportion of occlusion lesions and disease duration, could better predict BPA-related complications than previously reported single parameters. Distinctively, the occurrence of complications did not impair the beneficial impact of BPA on hemodynamics and survival. The occurrence of complications should not discourage patients from continuing BPA sessions.
摘要：
■球囊肺血管成形术（BPA）相关并发症并不少见，并可能导致围手术期死亡率。然而,缺乏BPA相关并发症的预测模型.
■回顾性分析连续诊断为慢性血栓栓塞性肺动脉高压（CTEPH）并接受BPA治疗的患者的数据。主要结果是BPA相关并发症。次要结果是BPA后的死亡率和血流动力学。
■共纳入207例614次BPA患者。49例患者在63个疗程中发生了并发症（10.26％）。最常见的并发症是咯血或咳痰（6.51％），而肺再灌注水肿很少见(0.49%)。多变量逻辑回归确定疾病持续时间，平均肺动脉压（mPAP）和闭塞病变比例与BPA并发症相关。相应地构造了一个列线图，曲线下面积最高(0.703)，优于以前报道的预测因子[列线图与mPAP,净重分类指数(95%置信区间(CI))，0.215(0.002,0.427),p=0.047；综合判别指数（95%CI），0.059(0.010,0.109),p=0.018]。基于验证和校准,发现列线图是准确的(斜率0.978,Bier评分0.163)。在调整了多变量线性回归中的BPA会话数量后，BPA术后并发症的发生与血流动力学改善无关。有并发症和无并发症患者的3年生存率也相当(98.0%vs.94.8%,对数秩p=0.503)。
■列线图，包括mPAP，闭塞病变的比例和疾病持续时间，与以前报道的单一参数相比，可以更好地预测BPA相关并发症。特别是,并发症的发生并未损害BPA对血流动力学和生存率的有益影响.并发症的发生不应阻止患者继续服用BPA。
■回顾性分析连续诊断为慢性血栓栓塞性肺动脉高压（CTEPH）并接受BPA治疗的患者的数据。主要结果是BPA相关并发症。次要结果是BPA后的死亡率和血流动力学。
■共纳入207例614次BPA患者。49例患者在63个疗程中发生了并发症（10.26％）。最常见的并发症是咯血或咳痰（6.51％），而肺再灌注水肿很少见(0.49%)。多变量逻辑回归确定疾病持续时间，平均肺动脉压（mPAP）和闭塞病变比例与BPA并发症相关。相应地构造了一个列线图，曲线下面积最高(0.703)，优于以前报道的预测因子[列线图与mPAP,净重分类指数(95%置信区间(CI))，0.215(0.002,0.427),p=0.047；综合判别指数（95%CI），0.059(0.010,0.109),p=0.018]。基于验证和校准,发现列线图是准确的(斜率0.978,Bier评分0.163)。在调整了多变量线性回归中的BPA会话数量后，BPA术后并发症的发生与血流动力学改善无关。有并发症和无并发症患者的3年生存率也相当(98.0%vs.94.8%,对数秩p=0.503)。
■列线图，包括mPAP，闭塞病变的比例和疾病持续时间，与以前报道的单一参数相比，可以更好地预测BPA相关并发症。特别是,并发症的发生并未损害BPA对血流动力学和生存率的有益影响.并发症的发生不应阻止患者继续服用BPA。
