Search

Balloon pulmonary angioplasty (BPA) has been proven effective for addressing technically inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the effectiveness of BPA in technically operable CTEPH patients who, for various reasons, did not undergo the procedure remains an area requiring exploration. This study sought to assess the safety and efficacy of BPA in such cases. We collected and reviewed data from CTEPH patients who underwent BPA in a consecutive manner. Following multidisciplinary team (MDT) decisions, patients were classified into two groups: technically inoperable (group A) and operable (group B). Group B comprised patients deemed technically suitable for pulmonary endarterectomy (PEA) but who did not undergo the procedure for various reasons. All patients underwent a comprehensive diagnostic work‐up, including right heart categorization at baseline and the last intervention. This study compared changes in hemodynamic parameters, functional capacity, and quality of life between the two groups. In total, 161 patients underwent 414 procedures at our center, with Group A comprising 112 patients who underwent 282 BPA sessions and group B comprising 49 patients who underwent 132 BPA sessions. Significantly, both groups exhibited improvements in hemodynamics, functional capacity, and quality of life. The occurrence rate of complications, including hemoptysis and lung injury, was similar [12 (63.2%) vs. 7 (36.8%), p = 0.68]. BPA demonstrated favorable outcomes in patients with proximal CTEPH who did not undergo pulmonary endarterectomy. However, the clinical impact of BPA in technically operable CTEPH was found to be less significant than in inoperable cases. [ABSTRACT FROM AUTHOR]

Introduction: Quantification of hemodynamics and right ventricular (RV) function is crucial for pulmonary hypertension (PH). Cardiovascular magnetic resonance–based heart deformation analysis (CMR‐HDA) has been used to assess the ventricular strain. Objective: This study was to determine the correlation of right ventricular longitudinal strain (RVLS) assessed with CMR‐HDA with RV function as well as hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Thirty‐six CTEPH patients were prospectively included in this research. Each patients underwent CMR and right heart catheterization (RHC). RVLS and RV ejection fraction (RVEF) was quantified from cine images acquired with a retrospectively gated turbo FLASH gradient‐echo sequence. The late gadolinium enhancement (LGE) images were acquired using a 2D inversion recovery phase‐sensitive fast gradient‐echo sequence. Hemodynamics were determined with RHC. Results: Right ventricular longitudinal strain measured with CMR‐HDA was −13.99 ± 4.94%. Bland–Altman plots showed statistical agreement with RVLS with low intra‐ and interobserver variability. RVLS correlated with serum N‐terminal‐pro‐B‐type natriuretic peptide (r = 0.615, P <.001). RVLS inversely correlated with RVEF (r = −0.699, P <.001), and it was positively correlated with both RVESV (r = 0.664, P <.001) and myocardial the volume of LGE (r = 0.447, P =.008). Receiver‐operating characteristic (ROC) indicated that RVLS values of >−14.20% could be used to predict RVEF <40% with a 100% sensitivity and a 96.7% specificity. Hemodynamically, RVLS was positively correlated with mean pulmonary artery pressure (r = 0.598, P <.001) and pulmonary vascular resistance (r = 0.685, P <.001). Conclusion: Right ventricular longitudinal strain assessed by CMR‐HDA is a readily available and reproducible parameters of RV function. RVLS >−14.20% suggests the presence of RV dysfunction. [ABSTRACT FROM AUTHOR]