Background: The hemodynamic results of balloon pulmonary angioplasty vary among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies revealed that microvasculopathy accounted for residual pulmonary hypertension after pulmonary endarterectomy, which could be reflected by the diffusing capacity for carbon monoxide (DLCO). We aimed to identify whether the DLCO could predict the BPA response.
Materials and Methods: We retrospectively analyzed 75 consecutive patients with inoperable CTEPH who underwent BPA from May 2018 to January 2021 at Fuwai Hospital. According to the hemodynamics at follow-up after the last BPA, patients were classified as “BPA responders” (defined as a mean pulmonary arterial pressure ≤ 30 mmHg and/or a reduction of pulmonary vascular resistance ≥ 30%) or “BPA nonresponders.”
Results: At the baseline, BPA responders had significantly higher DLCO values than nonresponders, although the other variables were comparable. In BPA responders, the DLCO decreased after the first BPA session and then returned to a level similar to the baseline at follow-up. Conversely, the DLCO increased constantly from the baseline to follow-up in nonresponders. Multivariate logistic analysis showed that a baseline DLCO of <70% and a percent change in DLCO between the baseline and the period within 7 days after the first BPA session (ΔDLCO) of > 6% were both independent predictors of an unfavorable response to BPA. Receiver operator characteristic analysis showed that the combination of a baseline DLCO < 70% and ΔDLCO > 6% demonstrated a better area under the curve than either of these two variables used alone.
Conclusions: A baseline DLCO < 70% and ΔDLCO > 6% could independently predict unfavorable responses to BPA. Measuring the DLCO dynamically facilitates the identification of patients who might have unsatisfactory hemodynamic results after BPA.
中文翻译:
一氧化碳的扩散能力可预测无法手术的慢性血栓栓塞性肺动脉高压患者对球囊肺血管成形术的反应
背景:无法手术的慢性血栓栓塞性肺动脉高压 (CTEPH) 患者的球囊肺血管成形术的血流动力学结果各不相同。先前的研究表明,微血管病变是肺动脉内膜切除术后残留肺动脉高压的原因,这可以通过一氧化碳 (DLCO) 的扩散能力来反映。我们旨在确定 DLCO 是否可以预测 BPA 反应。
材料和方法:我们回顾性分析了 2018 年 5 月至 2021 年 1 月在阜外医院接受 BPA 治疗的 75 例不能手术的 CTEPH 患者。根据最后一次 BPA 后随访时的血流动力学,患者被分类为“BPA 反应者”(定义为平均肺动脉压≤ 30 mmHg 和/或肺血管阻力降低≥ 30%)或“BPA 无反应者”。 ”
结果:在基线时,BPA 反应者的 DLCO 值显着高于无反应者,尽管其他变量具有可比性。在 BPA 应答者中,DLCO 在第一次 BPA 会话后下降,然后在随访时恢复到与基线相似的水平。相反,DLCO 从基线到无反应者的随访不断增加。多变量逻辑分析显示,基线 DLCO <70% 和基线与第一次 BPA 会话后 7 天内期间 DLCO 的百分比变化 (ΔDLCO) > 6% 都是对 BPA 不利反应的独立预测因子。接受者操作者特征分析表明,与单独使用这两个变量中的任何一个相比,基线 DLCO < 70% 和 ΔDLCO > 6% 的组合表现出更好的曲线下面积。
结论:基线 DLCO < 70% 和 ΔDLCO > 6% 可以独立预测对 BPA 的不利反应。动态测量 DLCO 有助于识别 BPA 后血流动力学结果可能不令人满意的患者。