Efficacy and Safety of Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension and Comorbid Chronic Obstructive Pulmonary Disease

Abstract

Background Balloon pulmonary angioplasty (BPA) is a promising treatment modality for nonoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, BPA for atypical CTEPH with concurrent chronic obstructive pulmonary disease (COPD) remains controversial owing to the risk of exacerbation of ventilation‐perfusion mismatch. We aimed to evaluate the efficacy and safety of BPA for CTEPH with moderate or severe COPD. Methods and Results Data from 149 patients with CTEPH, who underwent BPA from March 2011 to June 2021, were retrospectively analyzed. Patients were divided based on COPD comorbidity: the COPD group (n=32, defined as forced expiratory volume in 1 second/forced vital capacity <70% and forced expiratory volume in 1 second <80% predicted) and the non‐COPD group (n=101); patients with mild COPD (n=16) were excluded. Hemodynamic and respiratory parameters were compared between the groups. Hemodynamics improved similarly in both groups (reduction in pulmonary vascular resistance): −55.6±29.0% (COPD group) and −58.9±21.4% (non‐COPD group); P =nonsignificant. Respiratory function and oxygenation improved in the COPD group (forced expiratory volume in 1 second/forced vital capacity [61.8±7.0% to 66.5±10.2%, P =0.02] and arterial oxygen partial pressure [60.9±10.6 mm Hg to 69.3±13.6 mm Hg, P <0.01]). Higher vital capacity ( P =0.024) and higher diffusing capacity for lung carbon monoxide ( P =0.028) at baseline were associated with greater improvement in oxygenation in the multivariable linear analysis. Lung injury per BPA session was 1.6% in the COPD group. Conclusions The efficacy and safety of BPA for nonoperable CTEPH in patients with comorbid COPD were similar to those in patients without COPD. Oxygenation and forced expiratory volume in 1 second/forced vital capacity improved in patients with COPD. BPA should be considered in patients with CTEPH with concurrent COPD.

Efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension patients with pulmonary comorbidity

“…However, the efficacy of interventional treatment for CTEPH with pulmonary comorbidity had not been well studied. In contrast with previous studies [35] , our data did not show any changes in PFT parameters in patients with a pulmonary comorbidity. These discrepancies might partly be explained by the inclusion criteria used for the study population.…”

“…In the present study, significant improvements in hemodynamics were seen in CTEPH patients both with and without concomitant pulmonary pathology after BPA treatment, which is consistent with the findings of the study by Fujii et al [35] . Additionally, we found that right heart function was improved to varying degrees in both groups, whereas exercise capacity was improved only in CTEPH patients without underlying pulmonary disease.…”

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Patients With Chronic Obstructive Pulmonary Disease: A Note of Caution

“…In this issue of the Journal of the American Heart Association ( JAHA ), Fujii et al report on 32 patients with chronic obstructive pulmonary disease (COPD) undergoing balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). 1 Patients were identified from a larger cohort of 149 patients with CTEPH who underwent BPA over a 10‐year‐period. COPD was diagnosed based on pulmonary function tests (forced expiratory volume in 1 s [FEV1]/forced vital capacity <70% and FEV1<80% predicted).…”