Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

Sarasa Isobe, Yuji Itabashi, Takashi Kawakami, Masaharu Kataoka, Shun Kosaka, Toshimitsu Tsugu, Mai Kimura, Mitsuaki Sawano, Toshiomi Katsuki, Takashi Kohno, Jin Endo, Mitsushige Murata, Keiichi Fukuda

Research output: Contribution to journalArticle

Abstract

Balloon pulmonary angioplasty (BPA) has emerged as an effective treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Renal function has been identified as a prognostic marker in patients with pulmonary hypertension in previous studies. We, therefore, aimed to investigate the clinical parameters associated with improvements in renal function in patients with CTEPH. A total of 45 consecutive patients with inoperable CTEPH undergoing BPA (mean age 62.2 ± 15.1 years) were included in the study. We evaluated the patients’ clinical characteristics at baseline and at 1-year post-BPA, and investigated the association between renal function and hemodynamic parameters, including right heart function. Hemodynamics and renal function showed sustained improvements at 1 year after BPA in 64.4% of patients. Improved estimated glomerular filtration rate (eGFR) was significantly correlated with increased cardiac index (r = 0.433, p = 0.003) and mixed venous oxygen saturation (SvO2; r = 0.459, p = 0.002), and with decreased mean pulmonary arterial pressure (r = − 0.420, p = 0.004) and pulmonary vascular resistance (r = -− 0.465, p = 0.001). Multivariate analysis revealed that an increase in SvO2 immediately after the final BPA was associated with improved eGFR after the 1st year (odds ratio 1.041; 95% confidence interval 1.004–1.078; P = 0.027). The cut-off value for predicting improved eGFR was an increase in SvO2 after the final BPA of >125.4% over the baseline value (specificity 100%, sensitivity 24.1%). In conclusion, BPA improved symptoms, right heart function, hemodynamics, and renal function up to the chronic phase. Increasing SvO2 by >125.4% above baseline in the acute phase is important for improving renal function at 1 year after BPA in CTEPH patients.

Original languageEnglish
JournalHeart and Vessels
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Balloon Angioplasty
Pulmonary Hypertension
Oxygen
Kidney
Lung
Glomerular Filtration Rate
Hemodynamics
Vascular Resistance
Arterial Pressure
Multivariate Analysis
Odds Ratio
Confidence Intervals
Sensitivity and Specificity

Keywords

  • Balloon pulmonary angioplasty
  • Cardiac index
  • Chronic thromboembolic pulmonary hypertension
  • Mixed venous oxygen saturation
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{b6471b740fb544718a23510cece3bfe7,
title = "Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension",
abstract = "Balloon pulmonary angioplasty (BPA) has emerged as an effective treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Renal function has been identified as a prognostic marker in patients with pulmonary hypertension in previous studies. We, therefore, aimed to investigate the clinical parameters associated with improvements in renal function in patients with CTEPH. A total of 45 consecutive patients with inoperable CTEPH undergoing BPA (mean age 62.2 ± 15.1 years) were included in the study. We evaluated the patients’ clinical characteristics at baseline and at 1-year post-BPA, and investigated the association between renal function and hemodynamic parameters, including right heart function. Hemodynamics and renal function showed sustained improvements at 1 year after BPA in 64.4{\%} of patients. Improved estimated glomerular filtration rate (eGFR) was significantly correlated with increased cardiac index (r = 0.433, p = 0.003) and mixed venous oxygen saturation (SvO2; r = 0.459, p = 0.002), and with decreased mean pulmonary arterial pressure (r = − 0.420, p = 0.004) and pulmonary vascular resistance (r = -− 0.465, p = 0.001). Multivariate analysis revealed that an increase in SvO2 immediately after the final BPA was associated with improved eGFR after the 1st year (odds ratio 1.041; 95{\%} confidence interval 1.004–1.078; P = 0.027). The cut-off value for predicting improved eGFR was an increase in SvO2 after the final BPA of >125.4{\%} over the baseline value (specificity 100{\%}, sensitivity 24.1{\%}). In conclusion, BPA improved symptoms, right heart function, hemodynamics, and renal function up to the chronic phase. Increasing SvO2 by >125.4{\%} above baseline in the acute phase is important for improving renal function at 1 year after BPA in CTEPH patients.",
keywords = "Balloon pulmonary angioplasty, Cardiac index, Chronic thromboembolic pulmonary hypertension, Mixed venous oxygen saturation, Renal function",
author = "Sarasa Isobe and Yuji Itabashi and Takashi Kawakami and Masaharu Kataoka and Shun Kosaka and Toshimitsu Tsugu and Mai Kimura and Mitsuaki Sawano and Toshiomi Katsuki and Takashi Kohno and Jin Endo and Mitsushige Murata and Keiichi Fukuda",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00380-018-1284-4",
language = "English",
journal = "Heart and Vessels",
issn = "0910-8327",
publisher = "Springer Japan",

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TY - JOUR

T1 - Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

AU - Isobe, Sarasa

AU - Itabashi, Yuji

AU - Kawakami, Takashi

AU - Kataoka, Masaharu

AU - Kosaka, Shun

AU - Tsugu, Toshimitsu

AU - Kimura, Mai

AU - Sawano, Mitsuaki

AU - Katsuki, Toshiomi

AU - Kohno, Takashi

AU - Endo, Jin

AU - Murata, Mitsushige

AU - Fukuda, Keiichi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Balloon pulmonary angioplasty (BPA) has emerged as an effective treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Renal function has been identified as a prognostic marker in patients with pulmonary hypertension in previous studies. We, therefore, aimed to investigate the clinical parameters associated with improvements in renal function in patients with CTEPH. A total of 45 consecutive patients with inoperable CTEPH undergoing BPA (mean age 62.2 ± 15.1 years) were included in the study. We evaluated the patients’ clinical characteristics at baseline and at 1-year post-BPA, and investigated the association between renal function and hemodynamic parameters, including right heart function. Hemodynamics and renal function showed sustained improvements at 1 year after BPA in 64.4% of patients. Improved estimated glomerular filtration rate (eGFR) was significantly correlated with increased cardiac index (r = 0.433, p = 0.003) and mixed venous oxygen saturation (SvO2; r = 0.459, p = 0.002), and with decreased mean pulmonary arterial pressure (r = − 0.420, p = 0.004) and pulmonary vascular resistance (r = -− 0.465, p = 0.001). Multivariate analysis revealed that an increase in SvO2 immediately after the final BPA was associated with improved eGFR after the 1st year (odds ratio 1.041; 95% confidence interval 1.004–1.078; P = 0.027). The cut-off value for predicting improved eGFR was an increase in SvO2 after the final BPA of >125.4% over the baseline value (specificity 100%, sensitivity 24.1%). In conclusion, BPA improved symptoms, right heart function, hemodynamics, and renal function up to the chronic phase. Increasing SvO2 by >125.4% above baseline in the acute phase is important for improving renal function at 1 year after BPA in CTEPH patients.

AB - Balloon pulmonary angioplasty (BPA) has emerged as an effective treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Renal function has been identified as a prognostic marker in patients with pulmonary hypertension in previous studies. We, therefore, aimed to investigate the clinical parameters associated with improvements in renal function in patients with CTEPH. A total of 45 consecutive patients with inoperable CTEPH undergoing BPA (mean age 62.2 ± 15.1 years) were included in the study. We evaluated the patients’ clinical characteristics at baseline and at 1-year post-BPA, and investigated the association between renal function and hemodynamic parameters, including right heart function. Hemodynamics and renal function showed sustained improvements at 1 year after BPA in 64.4% of patients. Improved estimated glomerular filtration rate (eGFR) was significantly correlated with increased cardiac index (r = 0.433, p = 0.003) and mixed venous oxygen saturation (SvO2; r = 0.459, p = 0.002), and with decreased mean pulmonary arterial pressure (r = − 0.420, p = 0.004) and pulmonary vascular resistance (r = -− 0.465, p = 0.001). Multivariate analysis revealed that an increase in SvO2 immediately after the final BPA was associated with improved eGFR after the 1st year (odds ratio 1.041; 95% confidence interval 1.004–1.078; P = 0.027). The cut-off value for predicting improved eGFR was an increase in SvO2 after the final BPA of >125.4% over the baseline value (specificity 100%, sensitivity 24.1%). In conclusion, BPA improved symptoms, right heart function, hemodynamics, and renal function up to the chronic phase. Increasing SvO2 by >125.4% above baseline in the acute phase is important for improving renal function at 1 year after BPA in CTEPH patients.

KW - Balloon pulmonary angioplasty

KW - Cardiac index

KW - Chronic thromboembolic pulmonary hypertension

KW - Mixed venous oxygen saturation

KW - Renal function

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U2 - 10.1007/s00380-018-1284-4

DO - 10.1007/s00380-018-1284-4

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JO - Heart and Vessels

JF - Heart and Vessels

SN - 0910-8327

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