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Poor subpleural perfusion as a predictor of failure after balloon pulmonary angioplasty for non-operable chronic thromboembolic pulmonary hypertension

Session CTEPH: Catheter-directed and surgical therapy

Speaker Assistant Professor Yu Taniguchi

Event : ESC Congress 2017

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure, Other
  • Session type : Moderated Posters

Authors : Y Taniguchi (Le Kremlin-Bicetre,FR), P Brenot (Le Plessis Robinson,FR), X Jais (Le Kremlin-Bicetre,FR), C Garcia (Le Plessis Robinson,FR), O Planche (Le Kremlin-Bicetre,FR), E Fadel (Le Plessis Robinson,FR), M Humbert (Le Kremlin-Bicetre,FR), G Simonneau (Le Kremlin-Bicetre,FR)

Authors:
Y. Taniguchi1 , P. Brenot2 , X. Jais1 , C. Garcia2 , O. Planche1 , E. Fadel2 , M. Humbert1 , G. Simonneau1 , 1Hopital Bicetre - Le Kremlin-Bicetre - France , 2Surgical Centre Marie Lannelongue - Le Plessis Robinson - France ,

Topic(s):
Pulmonary circulation, other

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 835

Background: It has been shown that “poor subpleural perfusion” (PSP) in the capillary phase of pulmonary angiography (PA), which is related to microvasculopathy in chronic thromboembolic pulmonary hypertension (CTEPH), predicts poor outcome after surgical pulmonary endarterectomy (Tanabe, Chest 2012). We assessed the association between PSP and failure of Balloon Pulmonary Angioplasty (BPA) in 101 non-operable CTEPH.

Method: Subpleural perfusion in the capillary phase of PA was classified as normal or poorly perfused as previously described. Patients were divided according to hemodynamic results after the last BPA session: a failure group (defined as mean PAP >30mmHg and PVR decrease <20% after BPA [n=11]) or a success group [n=90].

Results: Baseline clinical characteristics and hemodynamics were similar in the two groups (table). In contrast, PSP was observed in 45.5% of patients in the failure group versus 15.6% in the success group (p=0.016). Multivariate analysis revealed that PSP was the only predictor of BPA failure (Odds Ratio 4.524, 95% confidence interval 1.213–16.877, p=0.025).

Conclusion: Poor subpleural perfusion in the capillary phase of pulmonary angiography, suggesting the presence of diffuse microvasculopathy, is associated with significant residual pulmonary hypertension after BPA. In our experience, it affected approximately 10% of non-operable CTEPH patients who underwent BPA.

Characteristics of baseline/after BPA
VariablesSuccess group (n=90)Failure group (n=11)p value
Baseline
  NYHA Fc (I, II/III, IV) (%)26.5/73.527.3/72.70.369
  Mean PAP (mmHg)45.6±10.245.6±11.40.988
  Cardiac Index (L/min/m2)2.51±0.482.66±0.800.393
  PVR (Wood unit)8.39±3.257.58±2.280.422
  Poor subpleural perfusion14 (15.6%)5 (45.5%)0.016
After last BPA session
  NYHA Fc (I, II/III, IV) (%)91.7/8.344.4/55.60.002
  Mean PAP (mmHg)29.6±7.542.8±8.7<0.0001
  Cardiac Index (L/min/m2)3.04±0.702.59±0.620.047
  PVR (Wood unit)3.64±1.616.77±2.39<0.0001
  % decrease of PVR (%)-53.3±19.1-10.8±9.6<0.0001
  % decrease of mean PAP (%)-33.2±17.4-4.5±9.4<0.0001
  No. of patients (mean PAP ≤30mmHg)530

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