Heart-Rate Recovery at 1 Min After Exercise Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension

Abstract

BackgroundDysfunction of autonomic nervous system plays an important role in the development of pulmonary hypertension. The present study aimed to investigate the interaction between balloon pulmonary angioplasty (BPA) and cardiac autonomic function by using heart-rate recovery at 1 min (HRR1) after exercise as a surrogate marker.Methods and ResultsWe retrospectively enrolled 89 consecutive patients with inoperable chronic thromboembolic pulmonary hypertension who underwent BPA from May, 2018 to Jan, 2021. According to hemodynamics at follow-up, patients were categorized as BPA responders if they met one or both of the following criteria: (1) mean pulmonary arterial pressure ≤ 30 mmHg and (2) a reduction of pulmonary vascular resistance ≥ 30%. Compared with baseline, HRR1 tended to increase within 7 days after the first BPA session, and this improvement persisted at follow-up. HRR1 at baseline and at follow-up were associated with well-validated markers of CTEPH severity, including N-terminal pro-brain natriuretic peptide, mean pulmonary arterial pressure and pulmonary vascular resistance. Furthermore, the change of HRR1 from baseline to follow-up was also associated with the change of those variables. After adjustment for confounders, baseline HRR1 was still a strong independent predictor of BPA outcome. Receiver operator characteristic curve analysis showed that the cutoff value for HRR1 in predicting BPA outcome was 19 beats.ConclusionsBPA could significantly improve HRR1, suggesting the alleviation of sympathovagal imbalance. Easily available and non-invasive HRR1 seems to be a useful tool in predicting outcome of BPA and dynamically monitoring the efficacy of BPA.

Effects of right ventricular remodeling in chronic thromboembolic pulmonary hypertension on the outcomes of balloon pulmonary angioplasty: a 2D-speckle tracking echocardiography study

“…In the present study, patients with mPAP ≤ 30 mmHg or those showing PVR decrease by ≥ 30% were considered as responders. At present, there is no widely accepted method to predict the efficacy of BPA [ 30 ]. Most experts accept that RV function is a major determinant of prognosis in patients with CTEPH [ 1 ].…”

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

“…At present, there continues to be no consensus on the definition of BPA efficacy. In line with previous studies [21] , [22] , we used two hemodynamic parameters, mean PAP (mPAP) and PVR, determined according to the results of reevaluation RHC (more than 3 months after the last BPA session) to classify the study participants into two groups: ‘BPA success’ and ‘BPA failure’. Successful BPA was defined as meeting at least one of the following criteria: (1) mPAP ≤ 30 mmHg; and (2) PVR decrease ≥ 30 %.…”