Chronic Thromboembolic Pulmonary Hypertension: An Observational Study

Abstract

Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) has a high mortality. The treatment of CTEPH could be balloon pulmonary angioplasty (BPA), medical (MT) or pulmonary endarterectomy (PEA). This study aims to assess the clinical characteristics of CTEPH patients, surgically or medically treated, in a pulmonology referral center. Materials and Methods: A total of 124 patients with PH with suspected CTEPH (53 male subjects and 71 female subjects; mean age at diagnosis 67 ± 6) were asked to give informed consent and then were evaluated. The presence of CTEPH was ascertained by medical evaluations, radiology and laboratory tests. Results: After the evaluation of all clinical data, 65 patients met the inclusion criteria for CTEPH and they were therefore enrolled (22 males and 43 females; mean age at diagnosis was 69 ± 8). 26 CTEPH patients were treated with PEA, 32 with MT and 7 with BPA. There was a statistically significant age difference between the PEA and MT groups, at the time of diagnosis, the PEA patients were younger than the MT patients, whereas there was no statistically significant difference in other clinical characteristics (e.g., smoking habit, thrombophilia predisposition), as well as functional and hemodynamic parameters (e.g., 6-min walk test, right heart catheterization). During three years of follow-up, no patients in the PEA groups died; conversely, eleven patients in the MT group died during the same period (p < 0.05). Furthermore, a significant decrease in plasma BNP values and an increase in a meter at the six-minute walk test, 1 and 3 years after surgery, were observed in the PEA group (p < 0.05). Conclusions: This study seems to confirm that pulmonary endarterectomy (PEA) can provide an improvement in functional tests in CTEPH.

Sildenafil improves hemodynamic changes caused by acute pulmonary embolism by inhibiting Rho kinase activity

“…The most common cause of thromboembolism of the pulmonary artery and its branches in clinical practice is lower-limb venous thrombosis. 1,2 Acute right heart failure and/or circulatory shock caused by a dramatic increase in pulmonary vascular resistance are the main causes of death from APE, and drug treatment to alleviate neurohumoral factormediated pulmonary vasoconstriction might reduce APE-induced hemodynamic disturbances and improve prognosis. 3,4 Abnormal activation of the Rho/Rho kinase (ROCK) signaling pathway is involved in the formation of experimental pulmonary hypertension (PH), and ROCK inhibitors can prevent and reverse pulmonary vasoconstriction and pulmonary vascular remodeling during PH.…”

“…The most common cause of thromboembolism of the pulmonary artery and its branches in clinical practice is lower-limb venous thrombosis. 1,2 Acute right heart failure and/or circulatory shock caused by a dramatic increase in pulmonary vascular resistance are the main causes of death from APE, and drug treatment to alleviate neurohumoral factor-mediated pulmonary vasoconstriction might reduce APE-induced hemodynamic disturbances and improve prognosis. 3,4…”

Balloon Pulmonary Angioplasty for Inoperable Chronic Thromboembolic Pulmonary Hypertension: Insights from a Pilot Low-Volume Centre Study and a Comparative Analysis with Other Centres

“…However, despite it being a promising treatment option for CTEPH, the available efficacy and safety data are based on single-arm, small-sample-size studies with large variations in patient characteristics (operable CTEPH and patients after PEA), disease characteristics, treatment approaches (BPA in addition to endarterectomy), and the duration of follow-up. The results should therefore be interpreted carefully, and further research is needed to establish the impact of BPA on survival, as well as in conjunction with medical therapy [ 17 , 18 , 19 ]. In this context, we aim to assess the efficacy and safety of the BPA procedure specifically in inoperable CTEPH patients without previous PEA or BPA in a low-volume single PH referral centre setting.…”

Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study

“…In addition to accurate preoperative/pre-interventional planning, CT diagnostics are also able provide evidence for the presence of pulmonary hypertension (PH) in patients with severe AS [ 3 , 4 , 5 ]. In the 2015 European Society for Cardiology (ESC) guidelines [ 6 ], a diameter of the main pulmonary artery (PA) ≥ 29 mm is considered potentially indicative of the presence of pulmonary hypertension, which is associated with a poor prognosis in terms of increased mortality in patients with severe AS.…”