Midterm Effect of Balloon Pulmonary Angioplasty on Hemodynamics and Subclinical Myocardial Damage in Chronic Thromboembolic Pulmonary Hypertension

Mai Kimura, Takashi Kohno, Takashi Kawakami, Masaharu Kataoka, Toshimitsu Tsugu, Keitaro Akita, Sarasa Isobe, Yuji Itabashi, Yuichiro Maekawa, Mitsushige Murata, Keiichi Fukuda

Research output: Contribution to journalArticle

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Abstract

Background The acute favourable effect of balloon pulmonary angioplasty (BPA) has been proven in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, data on its effect 6 months after therapy (from now on referred to as mid-term) and influence on the right ventricle and myocardial damage are sparse. To evaluate factors that influence improvement in cardiac output (CO) and subclinical myocardial damage, we examined hemodynamics and serum high-sensitivity troponin T (hs-TnT) levels before, 1 week after, and 6 months after BPA. Methods In a retrospective study, we reviewed 67 consecutive patients from November 2012 to January 2016 with CTEPH who had undergone BPA at Keio University Hospital. Results Six months after BPA, the mean right atrium pressure, mean pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), B-type natriuretic peptide (BNP), and hs-TnT levels decreased; CO and 6-minute walking distance increased. Changes in CO and hs-TnT levels varied compared with other hemodynamic parameters and BNP levels. The CO-increase group (n = 42) had higher mean PAP and PVR, and lower CO at baseline than the CO-decrease/stable group (n = 25). The hs-TnT-decrease group (n = 36) had higher mean right atrium pressure, PAP, PVR, and BNP levels, and lower CO at baseline than the hs-TnT-increase/stable group (n = 31). Conclusions Six months after BPA, hemodynamics and exercise capacity improved and hs-TnT levels decreased. Improvements in CO and hs-TnT levels were more prominent in CTEPH patients with impaired baseline hemodynamics, suggesting that BPA has a favourable mid-term effect on hemodynamics and subclinical myocardial damage in patients with CTEPH, especially in those with impaired hemodynamics.

Original languageEnglish
Pages (from-to)463-470
Number of pages8
JournalCanadian Journal of Cardiology
Volume33
Issue number4
DOIs
Publication statusPublished - 2017 Apr 1

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Troponin T
Balloon Angioplasty
Pulmonary Hypertension
Cardiac Output
Hemodynamics
Lung
Brain Natriuretic Peptide
Pressure
High Cardiac Output
Vascular Resistance
Pulmonary Artery
Heart Atria
Walking
Heart Ventricles
Retrospective Studies
Exercise
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Midterm Effect of Balloon Pulmonary Angioplasty on Hemodynamics and Subclinical Myocardial Damage in Chronic Thromboembolic Pulmonary Hypertension. / Kimura, Mai; Kohno, Takashi; Kawakami, Takashi; Kataoka, Masaharu; Tsugu, Toshimitsu; Akita, Keitaro; Isobe, Sarasa; Itabashi, Yuji; Maekawa, Yuichiro; Murata, Mitsushige; Fukuda, Keiichi.

In: Canadian Journal of Cardiology, Vol. 33, No. 4, 01.04.2017, p. 463-470.

Research output: Contribution to journalArticle

Kimura, Mai ; Kohno, Takashi ; Kawakami, Takashi ; Kataoka, Masaharu ; Tsugu, Toshimitsu ; Akita, Keitaro ; Isobe, Sarasa ; Itabashi, Yuji ; Maekawa, Yuichiro ; Murata, Mitsushige ; Fukuda, Keiichi. / Midterm Effect of Balloon Pulmonary Angioplasty on Hemodynamics and Subclinical Myocardial Damage in Chronic Thromboembolic Pulmonary Hypertension. In: Canadian Journal of Cardiology. 2017 ; Vol. 33, No. 4. pp. 463-470.
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AU - Kawakami, Takashi

AU - Kataoka, Masaharu

AU - Tsugu, Toshimitsu

AU - Akita, Keitaro

AU - Isobe, Sarasa

AU - Itabashi, Yuji

AU - Maekawa, Yuichiro

AU - Murata, Mitsushige

AU - Fukuda, Keiichi

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AB - Background The acute favourable effect of balloon pulmonary angioplasty (BPA) has been proven in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, data on its effect 6 months after therapy (from now on referred to as mid-term) and influence on the right ventricle and myocardial damage are sparse. To evaluate factors that influence improvement in cardiac output (CO) and subclinical myocardial damage, we examined hemodynamics and serum high-sensitivity troponin T (hs-TnT) levels before, 1 week after, and 6 months after BPA. Methods In a retrospective study, we reviewed 67 consecutive patients from November 2012 to January 2016 with CTEPH who had undergone BPA at Keio University Hospital. Results Six months after BPA, the mean right atrium pressure, mean pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), B-type natriuretic peptide (BNP), and hs-TnT levels decreased; CO and 6-minute walking distance increased. Changes in CO and hs-TnT levels varied compared with other hemodynamic parameters and BNP levels. The CO-increase group (n = 42) had higher mean PAP and PVR, and lower CO at baseline than the CO-decrease/stable group (n = 25). The hs-TnT-decrease group (n = 36) had higher mean right atrium pressure, PAP, PVR, and BNP levels, and lower CO at baseline than the hs-TnT-increase/stable group (n = 31). Conclusions Six months after BPA, hemodynamics and exercise capacity improved and hs-TnT levels decreased. Improvements in CO and hs-TnT levels were more prominent in CTEPH patients with impaired baseline hemodynamics, suggesting that BPA has a favourable mid-term effect on hemodynamics and subclinical myocardial damage in patients with CTEPH, especially in those with impaired hemodynamics.

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