Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic disease

Wiedenroth, Christoph B.; Olsson, Karen M.; Guth, Stefan; Breithecker, Andreas; Haas, Moritz; Kamp, Jan C.; Fuge, Jan; Hinrichs, Jan B.; Roller, Fritz; Hamm, Christian W.; Mayer, Eckhard; Ghofrani, Hossein Ardeschir; Meyer, Bernhard; Liebetrau, Christoph

doi:10.1177/2045893217753122

Cited by 67 publications

(54 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The performed pre- and post-procedural diagnostic and therapeutic work up of patients suffering from CTEPH was published by our group. [ 3 , 14 , 15 ] The routinely performed diagnostic work up of all patients includes clinical examination, 12-lead ECG, laboratory tests, 6-minute walk tests (6-MWD), echocardiography, CT angiography, right-heart catheterization, and pulmonary angiography. [ 3 , 8 ] The findings of all patients were assessed in an interdisciplinary CTEPH conference to proof the final diagnosis of CTEPH in accordance with the current guidelines and to define the individual therapeutic concept.…”

Section: Methodsmentioning

confidence: 99%

Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

et al. 2018

Self Cite

View full text Add to dashboard Cite

AimsBalloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress.Methods and resultsThis study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU.In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8±219.2dyn×sec×cm-5) decreased significantly within the 6-MFU (meanPAP: 32.6±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm-5, P<0.001). At BL, the median hs-cTnT level was 11 (IQR 6–16) ng/L and the median NT-proBNP level was 820 (IQR 153–1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5–12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84–464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (rrs = 0.42; p = 0.005), the meanPAP (rrs = 0.32; p = 0.029) and the NT-proBNP (rrs = 0.51; p<0.001) levels at BL.ConclusionNon-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.

show abstract

Section: Methodsmentioning

confidence: 99%

Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition, with early treatment, potential long-term complications like the development of secondary small-vessel vasculopathy and right heart failure can be avoided [1,7,11]. Recently, a report of a multicentre registry of inoperable CTED patients was published that showed improvements in physical capacity and PVR after balloon pulmonary angioplasty, but no exercise data were reported [12].…”

Section: Introductionmentioning

confidence: 99%

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

et al. 2018

Self Cite

View full text Add to dashboard Cite

Symptomatic patients with chronic thromboembolic disease (CTED) without pulmonary hypertension often show an excessive increase in mean pulmonary arterial pressure (MPAP) during exercise.We report on the impact of pulmonary endarterectomy (PEA) on pulmonary haemodynamics in a prospective series of 32 consecutive CTED patients who underwent PEA. All patients had a comprehensive diagnostic work-up including right heart catheterisation at baseline and 12 months after PEA. Furthermore, in 12 patients exercise right heart catheterisation was performed before and after PEA.After PEA, MPAP was lower at rest (20±3 17±3 mmHg; p=0.008) and during maximal exercise (39±8 31±6 mmHg; p=0.016). The mean total pulmonary resistance (TPR) decreased from 3.6±0.8 Wood Units (WU) pre-operatively to 2.7±0.7 WU 1 year after PEA (p=0.004) and the mean slope of the MPAP/cardiac output (CO) relationship decreased from 3.6±1.0 to 2.3±0.8 WU (p=0.002). Peak oxygen uptake increased from 1.2±0.4 to 1.5±0.3 L·min (p=0.014) and ventilatory equivalents of carbon dioxide decreased from 39±2 to 30±2 (p=0.002). There was a significant improvement in quality of life assessed by the Cambridge Pulmonary Hypertension Outcome Review questionnaire.In CTED patients, PEA resulted in haemodynamic and clinical improvements. The means of TPR and MPAP/CO slopes decreased to <3.0 WU.

show abstract

“…Similar findings appeared in subsequent publications from Europe 110, 114, 115, 121–124 . In Germany, significant improvements could be also shown in CTED patients 123 , but this observation needs to be further confirmed by subsequent studies on BPA in CTED. The latest experiences from Germany 121,123 and France 124 are remarkable, as these centers have introduced BPA along with a well-established PEA program.…”

Section: Treatment Strategiesmentioning

confidence: 93%

Chronic thromboembolic pulmonary hypertension – still evolving

Gerges¹,

Yacoub²

2020

gcsp

View full text Add to dashboard Cite

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the leading causes of severe pulmonary hypertension (PH). The disease is still underdiagnosed, and the true prevalence is unknown. CTEPH is characterized by intraluminal non-resolving thrombus organization and fibrous stenosis, or complete obliteration of pulmonary arteries, promoted by progressive remodeling of the pulmonary vasculature. One consequence of this is an increase in pulmonary vascular resistance and pressure, resulting in PH and progressive right heart failure, leading to death if left untreated.Endovascular disobliteration by pulmonary endarterectomy (PEA) is the preferred treatment for CTEPH patients. PEA surgery is the only technique that can potentially cure CTEPH disease, especially in patients with fresh or organized thrombi of the proximal branches of pulmonary arteries. However, not all patients are eligible for PEA surgery. Recent research has provided evidence suggesting balloon pulmonary angioplasty (BPA) and targeted medical therapy as additional promising available treatments options for inoperable CTEPH and recurrent/persistent PH after PEA surgery.Studies on BPA have shown it to improve pulmonary hemodynamics, symptoms, exercise capacity and RV function in inoperable CTEPH. Subsequently, BPA has developed into an essential component of the modern era of CTEPH treatment. Large randomized controlled trials have demonstrated varying significant improvements with targeted medical therapy in technically inoperable CTEPH patients. Thus, treatment of CTEPH requires a comprehensive multidisciplinary assessment, including an experienced PEA surgeon, PH specialist, BPA interventionist and CTEPH-trained radiologist at expert centers. In this comprehensive review, we address the latest developments in the fast-evolving field of CTEPH. These include advancements in imaging modalities and developments in operative and interventional techniques, which have widened the range of patients who may benefit from these procedures. The efficacy and safety of targeted medical therapies in CTEPH patients are also discussed. As the treatment options for CTEPH improve, hybrid management involving multiple treatments in the same patient may become a viable option in the near future.

show abstract

Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic disease

Cited by 67 publications

References 21 publications

Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

Chronic thromboembolic pulmonary hypertension – still evolving

Contact Info

Product

Resources

About