Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Li, Wen; Yang, Tao; Quan, Ruilin; Chen, Xiaoxi; An, Jing; Zhao, Zhihui; Liu, Zhihong; Xiong, Changming; He, Jian‐Guo; Gu, Qing

doi:10.1007/s00330-020-07481-6

Cited by 17 publications

(13 citation statements)

References 43 publications

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“…The first was achieving the low-risk criteria of the original/hybrid COMPERA 2.0 risk score after the first BPA session or during subsequent BPA sessions. The other secondary outcome was positive hemodynamic response during subsequent BPA sessions, which was defined as mean pulmonary arterial pressure (mPAP) < 30 mmHg (alternative threshold used in many centers) [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

The original and two new derivative versions of the COMPERA 2.0 risk assessment model: useful tools for guiding balloon pulmonary angioplasty

Zhang

Jin

et al. 2022

Respir Res

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Background The COMPERA 2.0 4-stratum (4-S) risk score has been demonstrated superior over the 3-stratum (3-S) one in patients with pulmonary arterial hypertension and medically managed patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to determine the prognostic value of the original 4-S and 3-S COMPERA 2.0 risk score and two new derivative versions in CTEPH patients who underwent balloon pulmonary angioplasty (BPA). Methods We retrospectively enrolled 175 BPA-treated patients with CTEPH. We assessed the risk stratification before and after each BPA session of CTEPH patients by the original 4-S and 3-S COMPERA 2.0 risk score (by rounding decimal to the nearest integer) and two new proposed derivative versions: the modified version (by rounding decimal to the next integer) and a hybrid version that fuses the original and modified versions. The primary endpoint was clinical worsening events. The secondary outcomes were achieving low-risk profile and mean pulmonary arterial pressure (mPAP) < 30 mmHg at follow-up. We used the Kaplan–Meier curve analysis to assess the survival differences between stratified patients. The comparative model’s performance was evaluated in terms of discrimination by Harrell’s C-index. Results All versions of COMPERA 2.0 4-S model outperformed the 3-S one in discriminating the differences in echocardiographic and hemodynamic parameters and clinical worsening-free survival rates. The original and hybrid 4-S model could independently predict the primary and secondary endpoints, and the hybrid version seemed to perform better. The first BPA session could significantly improve risk profiles, and these changes were associated with the likelihood of experiencing clinical worsening events, achieving a low-risk profile and mPAP < 30 mmHg at follow-up. The number of BPA sessions required to achieve low risk/mPAP < 30 mmHg increased as the baseline risk score escalated. Conclusions The COMPERA 2.0 4-S model outperformed the 3-S one in BPA-treated patients with CTEPH. The 4-S model, especially its hybrid version, could be used to predict clinical outcome before the initiation of BPA and monitor treatment response.

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Section: Methodsmentioning

confidence: 99%

The original and two new derivative versions of the COMPERA 2.0 risk assessment model: useful tools for guiding balloon pulmonary angioplasty

Zhang

Jin

et al. 2022

Respir Res

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“…In parallel to haemodynamics at rest, right ventricular functional improvements are documented by echocardiography and cardiac magnetic resonance, echocardiographic speckle tracking analysis and phase-contrast MRI. [43][44][45][46][47][48] However, for cardiopulmonary disease, dynamic improvement in exercise capacity is of particular interest. Studies after PEA have shown that despite normalised resting haemodynamics, exercise limitations persist.…”

Section: Functional Improvement After Balloon Pulmonary Angioplastymentioning

confidence: 99%

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Clinical Outcomes

Lang

2023

Eur Cardiol

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare major vessel pulmonary vascular disease that is characterised by fibrotic obstructions deriving from an organised clot. Recent advances in treatments for CTEPH have significantly improved outcomes. Apart from classical surgical pulmonary endarterectomy, balloon pulmonary angioplasty (BPA) and vasodilator drugs that were tested in randomised controlled trials of non-operable patients are now available. In Europe, CTEPH affects males and females equally. In the first European CTEPH Registry, women with CTEPH underwent pulmonary endarterectomy less frequently than men, especially at low-volume centres. In Japan, CTEPH is more common in females and is predominantly treated by BPA. More data on gender-specific outcomes are expected from the results of the International BPA Registry (NCT03245268).

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“…[55,56] A metaanalysis of five echocardiographic studies shows that BPA can significantly reduce the RV basal diameter and increase the RV fractional area change, but the beneficial effects on TAPSE and tricuspid lateral annular systolic velocity (S') are not significant. [57] CMR is also useful for evaluating the RV function in CTEPH patients after BPA. BPA significantly reduces the EDV and ESV of the RV, while improving RVEF.…”

Section: Improvement In the Cardiac Function After Bpamentioning

confidence: 99%

Right ventricle remodeling in chronic thromboembolic pulmonary hypertension

Liu

Yang

Tian

et al. 2022

Journal of Translational Internal Medicine

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Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed, but potentially curable pulmonary vascular disease. The increased pulmonary vascular resistance in CTEPH is caused by unresolved proximal thrombus and secondary microvasculopathy in the pulmonary vasculature, leading to adaptive and maladaptive remodeling of the right ventricle (RV), eventual right heart failure, and death. Knowledge on the RV remodeling process in CTEPH is limited. The progression to RV failure in CTEPH is a markedly slower process. A detailed understanding of the pathophysiology and underlying mechanisms of RV remodeling may facilitate early diagnosis and the development of targeted therapy. While ultrasound, magnetic resonance imaging, right heart catheterization, and serum biomarkers have been used to assess cardiac function, the current treatment strategies reduce the afterload of the right heart, but are less effective in improving the maladaptive remodeling of the right heart. This review systematically summarizes the current knowledge on adaptive and maladaptive remodeling of the right heart in CTEPH from molecular mechanisms to clinical practice.

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Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Cited by 17 publications

References 43 publications

The original and two new derivative versions of the COMPERA 2.0 risk assessment model: useful tools for guiding balloon pulmonary angioplasty

The original and two new derivative versions of the COMPERA 2.0 risk assessment model: useful tools for guiding balloon pulmonary angioplasty

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Clinical Outcomes

Right ventricle remodeling in chronic thromboembolic pulmonary hypertension

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