1
|
Loosen G, Taboada D, Ortmann E, Martinez G. How Would I Treat My Own Chronic Thromboembolic Pulmonary Hypertension in the Perioperative Period? J Cardiothorac Vasc Anesth 2024; 38:884-894. [PMID: 37716891 DOI: 10.1053/j.jvca.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 09/18/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) results from an incomplete resolution of acute pulmonary embolism, leading to occlusive organized thrombi, vascular remodeling, and associated microvasculopathy with pulmonary hypertension (PH). A definitive CTEPH diagnosis requires PH confirmation by right-heart catheterization and evidence of chronic thromboembolic pulmonary disease on imaging studies. Surgical removal of the organized fibrotic material by pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest represents the treatment of choice. One-third of patients with CTEPH are not deemed suitable for surgical treatment, and medical therapy or interventional balloon pulmonary angioplasty presents alternative treatment options. Pulmonary endarterectomy in patients with technically operable disease significantly improves symptoms, functional capacity, hemodynamics, and quality of life. Perioperative mortality is <2.5% in expert centers where a CTEPH multidisciplinary team optimizes patient selection and ensures the best preoperative optimization according to individualized risk assessment. Despite adequate pulmonary artery clearance, patients might be prone to perioperative complications, such as right ventricular maladaptation, airway bleeding, or pulmonary reperfusion injury. These complications can be treated conventionally, but extracorporeal membrane oxygenation has been included in their management recently. Patients with residual PH post-PEA should be considered for medical or percutaneous interventional therapy.
Collapse
Affiliation(s)
- Gregor Loosen
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Dolores Taboada
- Pulmonary Vascular Diseases Unit, Cambridge National Pulmonary Hypertension Service, Royal Papworth Hospital NHS, Department of Cardiothoracic Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Erik Ortmann
- Department of Anesthesiology, Schuechtermann-Heart-Centre, Bad Rothenfelde, Germany
| | - Guillermo Martinez
- Pulmonary Vascular Diseases Unit, Cambridge National Pulmonary Hypertension Service, Royal Papworth Hospital NHS, Department of Cardiothoracic Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
| |
Collapse
|
2
|
Ghofrani HA, Simonneau G, D'Armini AM, Fedullo P, Howard LS, Jaïs X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH. Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study. THE LANCET. RESPIRATORY MEDICINE 2024; 12:e21-e30. [PMID: 38548406 DOI: 10.1016/s2213-2600(24)00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Macitentan is beneficial for long-term treatment of pulmonary arterial hypertension. The microvasculopathy of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension are similar. METHODS The phase 2, double-blind, randomised, placebo-controlled MERIT-1 trial assessed macitentan in 80 patients with CTEPH adjudicated as inoperable. Patients identified as WHO functional class II-IV with a pulmonary vascular resistance (PVR) of at least 400 dyn·s/cm5 and a walk distance of 150-450 m in 6 min were randomly assigned (1:1), via an interactive voice/web response system, to receive oral macitentan (10 mg once a day) or placebo. Treatment with phosphodiesterase type-5 inhibitors and oral or inhaled prostanoids was permitted for WHO functional class III/IV patients. The primary endpoint was resting PVR at week 16, expressed as percentage of PVR measured at baseline. Analyses were done in all patients who were randomly assigned to treatment; safety analyses were done in all patients who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT02021292. FINDINGS Between April 3, 2014, and March 17, 2016, we screened 186 patients for eligibility at 48 hospitals across 20 countries. Of these, 80 patients in 36 hospitals were randomly assigned to treatment (40 patients to macitentan, 40 patients to placebo). At week 16, geometric mean PVR decreased to 71·5% of baseline in the macitentan group and to 87·6% in the placebo group (geometric means ratio 0·81, 95% CI 0·70-0·95, p=0·0098). The most common adverse events in the macitentan group were peripheral oedema (9 [23%] of 40 patients) and decreased haemoglobin (6 [15%]). INTERPRETATION In MERIT-1, macitentan significantly improved PVR in patients with inoperable CTEPH and was well tolerated. FUNDING Actelion Pharmaceuticals Ltd.
Collapse
Affiliation(s)
- Hossein-Ardeschir Ghofrani
- German Center for Lung Research (DZL), Giessen, Germany; University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany; Department of Medicine, Imperial College London, London, UK.
| | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Le Kremlin-Bicêtre, France; INSERM U-999, Le Kremlin-Bicêtre, France
| | - Andrea M D'Armini
- Department of Cardio-Thoracic and Vascular Surgery, Heart and Lung Transplantation and Pulmonary Hypertension Unit, Foundation IRCCS Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy
| | - Peter Fedullo
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, CA, USA
| | - Luke S Howard
- National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK; National Heart & Lung Institute, Imperial College London, London, UK
| | - Xavier Jaïs
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Le Kremlin-Bicêtre, France; INSERM U-999, Le Kremlin-Bicêtre, France
| | - David P Jenkins
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Zhi-Cheng Jing
- State Key Lab of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Michael M Madani
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego Medical Center, San Diego, CA, USA
| | | | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff-Clinic, Bad Nauheim, Germany
| | | | | | - Nick H Kim
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
3
|
Chen T, Ding L, Zhao M, Song S, Hou J, Li X, Li M, Yin K, Li X, Wang Z. Recent advances in the potential effects of natural products from traditional Chinese medicine against respiratory diseases targeting ferroptosis. Chin Med 2024; 19:49. [PMID: 38519984 PMCID: PMC10958864 DOI: 10.1186/s13020-024-00918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
Respiratory diseases, marked by structural changes in the airways and lung tissues, can lead to reduced respiratory function and, in severe cases, respiratory failure. The side effects of current treatments, such as hormone therapy, drugs, and radiotherapy, highlight the need for new therapeutic strategies. Traditional Chinese Medicine (TCM) offers a promising alternative, leveraging its ability to target multiple pathways and mechanisms. Active compounds from Chinese herbs and other natural sources exhibit anti-inflammatory, antioxidant, antitumor, and immunomodulatory effects, making them valuable in preventing and treating respiratory conditions. Ferroptosis, a unique form of programmed cell death (PCD) distinct from apoptosis, necrosis, and others, has emerged as a key area of interest. However, comprehensive reviews on how natural products influence ferroptosis in respiratory diseases are lacking. This review will explore the therapeutic potential and mechanisms of natural products from TCM in modulating ferroptosis for respiratory diseases like acute lung injury (ALI), asthma, pulmonary fibrosis (PF), chronic obstructive pulmonary disease (COPD), lung ischemia-reperfusion injury (LIRI), pulmonary hypertension (PH), and lung cancer, aiming to provide new insights for research and clinical application in TCM for respiratory health.
Collapse
Affiliation(s)
- Tian Chen
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Lu Ding
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China
- Research Center of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130021, China
| | - Meiru Zhao
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Siyu Song
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China
| | - Juan Hou
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xueyan Li
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Min Li
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Kai Yin
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xiangyan Li
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China.
| | - Zeyu Wang
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China.
| |
Collapse
|
4
|
Khezerlouy‐Aghdam N, Toufan Tabrizi M, Seyed Toutounchi K, Jabbaripour Sarmadian A, Masoumi S. Challenging in pulmonary thromboembolism diagnosis in patients with disproportionate pulmonary hypertension and severe mitral stenosis: Report of two cases. Clin Case Rep 2024; 12:e8597. [PMID: 38464564 PMCID: PMC10920307 DOI: 10.1002/ccr3.8597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
Key Clinical Message Before valvular interventions, echocardiography, especially the TEE or the ventilation/perfusion scan, should be performed to detect silent PTE and set a more accurate treatment and surgical plan. Abstract Pulmonary hypertension (PH) is a progressive and critical disease that can be caused by mitral stenosis (MS). Some of these patients present with disproportionate PH, which is an uncommon phenomenon and is considered a challenging diagnostic and treatment process. In these patients, other causes may also play a role in developing PH. This report presented two cases with disproportionate PH and severe MS who were scheduled for percutaneous mitral valvuloplasty (PMV). The pre-procedural echocardiography revealed systolic pulmonary artery pressure (sPAP) of 90 and 120 mmHg, mitral valve area of 0.80 and 0.55 cm2 by three-dimensional (3D) planimetry, and diastolic pressure gradient (DPG) of 13 and 18.8 mmHg, respectively. Furthermore, in the first patient, 3D transesophageal echocardiography (TEE) revealed multiple saddle-type organized thrombi in the proximal parts of the right and left pulmonary arteries, extending to the distal branches. In the second patient, 3D TEE revealed a large, relatively fresh, flow-limiting thrombosis in the proximal part of the right pulmonary artery. The diagnosis of pulmonary thromboembolism (PTE) in both patients was confirmed by CT angiography. In both patients, the valves were surgically repaired, while all thrombi were removed from the cardiac chambers and pulmonary vessels during surgery. In addition, patients underwent warfarin therapy orally. They were followed up 6 months after the intervention, and their clinical symptoms had improved significantly.
Collapse
Affiliation(s)
| | | | | | | | - Shahab Masoumi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| |
Collapse
|
5
|
Kenneweg F, Hobohm L, Bang C, Gupta SK, Xiao K, Thum S, Ten Cate V, Rapp S, Hasenfuß G, Wild P, Konstantinides S, Wachter R, Lankeit M, Thum T. Circulating miR-let7a levels predict future diagnosis of chronic thromboembolic pulmonary hypertension. Sci Rep 2024; 14:4514. [PMID: 38402278 PMCID: PMC10894210 DOI: 10.1038/s41598-024-55223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
Distinct patterns of circulating microRNAs (miRNAs) were found to be involved in misguided thrombus resolution. Thus, we aimed to investigate dysregulated miRNA signatures during the acute phase of pulmonary embolism (PE) and test their diagnostic and predictive value for future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Microarray screening and subsequent validation in a large patient cohort (n = 177) identified three dysregulated miRNAs as potential biomarkers: circulating miR-29a and miR-720 were significantly upregulated and miR-let7a was significantly downregulated in plasma of patients with PE. In a second validation study equal expression patterns for miR-29a and miR-let7a regarding an acute event of recurrent venous thromboembolism (VTE) or deaths were found. MiR-let7a concentrations significantly correlated with echocardiographic and laboratory parameters indicating right ventricular (RV) dysfunction. Additionally, circulating miR-let7a levels were associated with diagnosis of CTEPH during follow-up. Regarding CTEPH diagnosis, ROC analysis illustrated an AUC of 0.767 (95% CI 0.54-0.99) for miR-let7a. Using logistic regression analysis, a calculated patient-cohort optimized miR-let7a cut-off value derived from ROC analysis of ≥ 11.92 was associated with a 12.8-fold increased risk for CTEPH. Therefore, miR-let7a might serve as a novel biomarker to identify patients with haemodynamic impairment and as a novel predictor for patients at risk for CTEPH.
Collapse
Affiliation(s)
- Franziska Kenneweg
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Claudia Bang
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Shashi K Gupta
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Ke Xiao
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Sabrina Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Vincent Ten Cate
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - Steffen Rapp
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Cardiovascular Research Centre (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Gerd Hasenfuß
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Philipp Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
- German Cardiovascular Research Centre (DZHK), Partner Site Rhine Main, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Rolf Wachter
- Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité-University Medicine Berlin, Berlin, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.
- REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany.
| |
Collapse
|
6
|
Chia AXF, Valchanov K, Ng C, Tsui S, Taghavi J, Vuylsteke A, Fowles JA, Jenkins DP. Perioperative extracorporeal membrane oxygenation support for pulmonary endarterectomy: A 17-year experience from the UK national cohort. J Heart Lung Transplant 2024; 43:241-250. [PMID: 37730188 DOI: 10.1016/j.healun.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) is the guideline-recommended treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients develop severe cardiopulmonary compromise before surgery, intraoperatively, or early postoperatively. This may result from advanced CTEPH, reperfusion pulmonary edema, massive endobronchial bleeding, or right ventricular (RV) failure secondary to residual pulmonary hypertension. Conventional cardiorespiratory support is ineffective when these complications are severe. Since 2005, we used extracorporeal membrane oxygenation (ECMO) as a rescue therapy for this group. We review our experience with ECMO support in these patients. METHODS This study was a retrospective analysis of patients who received perioperative ECMO for PEA from a single national center from August 2005 to July 2022. Data were prospectively collected. RESULTS One hundred and ten patients (4.7%) had extreme cardiorespiratory compromise requiring perioperative ECMO. Nine were established on ECMO before PEA. Of those who received ECMO postoperatively, 39 were for refractory reperfusion lung injury, 20 for RV failure, 31 for endobronchial bleeding, and the remaining 11 were for "other" reasons, such as cardiopulmonary resuscitation following late tamponade and aspiration pneumonitis. Sixty-two (56.4%) were successfully weaned from ECMO. Fifty-seven patients left the hospital alive, giving a salvage rate of 51.8%. Distal disease (Jamieson Type III) and significant residual pulmonary hypertension were also predictors of mortality on ECMO support. Overall, 5- and 10-year survival in patients who were discharged alive following ECMO support was 73.9% (SE: 6.1%) and 58.2% (SE: 9.5%), respectively. CONCLUSIONS Perioperative ECMO support has an appropriate role as rescue therapy for this group. Over 50% survived to hospital discharge. These patients had satisfactory longer-term survival.
Collapse
Affiliation(s)
- Alicia X F Chia
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Kamen Valchanov
- Department of Anaesthesia, Singapore General Hospital, Singapore, Singapore
| | - Choo Ng
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Steven Tsui
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - John Taghavi
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Alain Vuylsteke
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Jo-Anne Fowles
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - David P Jenkins
- Department of Cardiothoracic Surgery, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom.
| |
Collapse
|
7
|
Yamasaki Y, Kamitani T, Sagiyama K, Hino T, Kisanuki M, Tabata K, Isoda T, Kitamura Y, Abe K, Hosokawa K, Toyomura D, Moriyama S, Kawakubo M, Yabuuchi H, Ishigami K. Dynamic chest radiography for pulmonary vascular diseases: clinical applications and correlation with other imaging modalities. Jpn J Radiol 2024; 42:126-144. [PMID: 37626168 PMCID: PMC10811043 DOI: 10.1007/s11604-023-01483-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Dynamic chest radiography (DCR) is a novel functional radiographic imaging technique that can be used to visualize pulmonary perfusion without using contrast media. Although it has many advantages and clinical utility, most radiologists are unfamiliar with this technique because of its novelty. This review aims to (1) explain the basic principles of lung perfusion assessment using DCR, (2) discuss the advantages of DCR over other imaging modalities, and (3) review multiple specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities.
Collapse
Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Megumi Kisanuki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Hematology, Oncology and Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Tabata
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuro Isoda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Toyomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Moriyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
8
|
Hayashi H, Ning Y, Kurlansky P, Vaynrub A, Bacchetta M, Rosenzweig EB, Takeda K. Characteristics and prognostic significance of right heart remodeling and tricuspid regurgitation after pulmonary endarterectomy. J Thorac Cardiovasc Surg 2024; 167:658-667.e7. [PMID: 35534282 DOI: 10.1016/j.jtcvs.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/05/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Right heart remodeling and tricuspid regurgitation (TR) are common in patients with chronic thromboembolic pulmonary hypertension. This study aimed to investigate the significance of right heart remodeling and TR after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension. METHODS Patients who underwent PEA with preoperative and postoperative transthoracic echocardiograms at our center between June 2010 and July 2019 were retrospectively reviewed. The composite end point was defined as death or hospitalization due to worsening heart failure, bleeding, or recurrent pulmonary embolism. RESULTS In total, 158 patients were included for analysis. Right ventricular basal (48 [45-52] vs 43 [39-47] mm, P < .001), midcavitary (46 [42-50] vs 38 [34-42] mm, P < .001), and longitudinal dimensions (87 [83-93] vs 80 [75-84] mm, P < .001), along with the right atrial volume index (37 [25-51] vs 24 [18-34] mL/m2, P < .001), significantly decreased, whereas left ventricular and atrial sizes and left ventricular ejection fraction increased after PEA. Overall, 78 patients (49%) showed significant TR on preoperative transthoracic echocardiograms, and 33 (21%) had significant residual TR after PEA. Fourteen patients died, and 24 patients met the composite end point. Residual TR after PEA was independently associated with mortality (P = .005) and the composite end point (P = .003). Patients with residual TR had significantly worse survival (log-rank P < .001) and greater event rates (log-rank P = .003) than those without residual TR. CONCLUSIONS Significant improvements in right heart remodeling were seen following PEA. However, residual TR was a poor prognostic marker.
Collapse
Affiliation(s)
- Hideyuki Hayashi
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY
| | - Paul Kurlansky
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Anna Vaynrub
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Matthew Bacchetta
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Erika B Rosenzweig
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
| |
Collapse
|
9
|
González-Hermosillo LM, Cueto-Robledo G, Navarro-Vergara DI, Roldan-Valadez E, Porres-Aguilar M, Garcia-Cesar M, Torres-Rojas MB, Hernández-Villa L, Tapia-Leon IA, Mendoza-Pineda JC. Prevalence and Prognosis of Hypothyroidism in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Updated Review With Description of Case Series. Curr Probl Cardiol 2024; 49:102069. [PMID: 37689379 DOI: 10.1016/j.cpcardiol.2023.102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Hypothyroidism has been shown to have several effects on organs, including derangements in the coagulation system, impairing endothelial function, but data on the importance of hypothyroidism in the pathogenesis and development of chronic thromboembolic pulmonary hypertension (CTEPH) are limited. This report presents an updated review of the prevalence and prognosis of hypothyroidism in patients diagnosed with CTEPH, including a detailed retrospective description of the series. The descriptive case series included 34 adult patients diagnosed with CTEPH, of whom 11 patients were diagnosed with hypothyroidism. The prevalence of hypothyroidism in CTEPH was found to be 32.35%. All patients with hypothyroidism had NYHA functional Class II-III. Hemodynamic values obtained through right heart catheterization (RHC) showed that patients with hypothyroidism had significantly higher mean pulmonary arterial pressures (mPAP), with a mean of 56.91 mm Hg vs 43.93 mm Hg (p = 0.026), and the PVR in dynes/sec/cm5 was 932 vs 541 (p = 0.027). Significant differences in PVR were found in wood units (WU) 11.91 vs 7.11 (p = 0.042). The mean level of brain natriuretic peptide (BNP) between both groups was 797.3 pg/mL for patients with hypothyroidism vs 262.02 pg/mL in patients with euthyroidism (p = .032). Hypothyroidism may significantly affect patients' clinical and hemodynamic outcomes in patients with CTEPH. Hypothyroidism as a risk factor in the evaluation and treatment of these patients is vital to optimize outcomes in CTEPH; further research is warranted whether hypothyroidism therapies could alter such outcomes.
Collapse
Affiliation(s)
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Dulce-Iliana Navarro-Vergara
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mateo Porres-Aguilar
- Department of Internal Medicine, Divisions of Adult Thrombosis and Hospital Medicine, Texas Tech University Health Sciences Center; El Paso, TX
| | - Marisol Garcia-Cesar
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Maria-Berenice Torres-Rojas
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Lizbeth Hernández-Villa
- Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Ivan-Arturo Tapia-Leon
- Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | | |
Collapse
|
10
|
Saveeta F, Payal F, Bai Bansari R. Comment on "Riociguat and Balloon Pulmonary Angioplasty Improve Prognosis in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension". Curr Probl Cardiol 2023; 48:101967. [PMID: 37479007 DOI: 10.1016/j.cpcardiol.2023.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Fnu Saveeta
- Peoples University of Medical and Health Sciences for Women, Pakistan, Nawabshah, Sindh, Pakistan.
| | - Fnu Payal
- Ghulam Muhammad Mahar Medical College Sukkur, Sukkur, Sindh, Pakistan
| | - Raveena Bai Bansari
- Peoples University of Medical and Health Sciences for Women, Pakistan, Nawabshah, Sindh, Pakistan
| |
Collapse
|
11
|
Luijten D, de Jong CMM, Ninaber MK, Spruit MA, Huisman MV, Klok FA. Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism. Semin Thromb Hemost 2023; 49:848-860. [PMID: 35820428 DOI: 10.1055/s-0042-1749659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Survivors of acute pulmonary embolism (PE) are at risk of developing persistent, sometimes disabling symptoms of dyspnea and/or functional limitations despite adequate anticoagulant treatment, fulfilling the criteria of the post-PE syndrome (PPES). PPES includes chronic thromboembolic pulmonary hypertension (CTEPH), chronic thromboembolic pulmonary disease, post-PE cardiac impairment (characterized as persistent right ventricle impairment after PE), and post-PE functional impairment. To improve the overall health outcomes of patients with acute PE, adequate measures to diagnose PPES and strategies to prevent and treat PPES are essential. Patient-reported outcome measures are very helpful to identify patients with persistent symptoms and functional impairment. The primary concern is to identify and adequately treat patients with CTEPH as early as possible. After CTEPH is ruled out, additional diagnostic tests including cardiopulmonary exercise tests, echocardiography, and imaging of the pulmonary vasculature may be helpful to rule out non-PE-related comorbidities and confirm the ultimate diagnosis. Most PPES patients will show signs of physical deconditioning as main explanation for their clinical presentation. Therefore, cardiopulmonary rehabilitation provides a good potential treatment option for this patient category, which warrants testing in adequately designed and executed randomized trials. In this review, we describe the definition and characteristics of PPES and its diagnosis and management.
Collapse
Affiliation(s)
- Dieuwke Luijten
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Cindy M M de Jong
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn A Spruit
- Department of Research & Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Menno V Huisman
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
12
|
Ishisaka Y, Watanabe A, Takagi H, Steiger D, Kuno T. Anticoagulation in chronic thromboembolic pulmonary hypertension: A systematic review and meta-analysis. Thromb Res 2023; 231:91-98. [PMID: 37839150 DOI: 10.1016/j.thromres.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Life-long anticoagulation is the recommended management for chronic thromboembolic pulmonary hypertension (CTEPH). Evidence regarding the use of direct oral anticoagulants (DOAC) for CTEPH is yet to be established. We performed a systematic review and meta-analysis to clarify the outcomes of CTEPH in patients who used DOAC or vitamin K antagonists (VKA). METHODS We reviewed literature in PubMed and EMBASE through March 2023. We included studies involving patients with CTEPH where DOAC and VKA were compared. We collected data including intervention history for CTEPH, bleeding events, recurrence of VTE (venous thromboembolism), and mortality. We performed a meta-analysis using the Mantel-Haenszel method with a fixed-effects model. RESULTS We included one randomized clinical trial and six observational studies, with a total of 2969 patients. Six studies investigated major bleeding outcomes, and seven investigated all bleeding outcomes. There were no differences in major bleeding (RR 0.59, 95 % CI [0.34-1.02], I2 = 0 %) and all-bleeding (RR 0.87, 95 % CI [0.67-1.13], I2 = 0 %). Based on the five studies we included, DOAC was associated with a lower risk of mortality (RR 0.54, 95 % CI: 0.37-0.79, I2 = 5 %). However, a higher risk of recurrent pulmonary embolism (PE) was seen in three studies (RR 3.80, 95 % CI: [1.93-7.50], I2 = 11 %). No significant differences were noted in terms of VTE. CONCLUSION DOAC compared to VKA was associated with a significantly lower mortality and higher risk of recurrent PE. Since most of the included studies are observational, we must consider the existence of multiple biases and confounding factors.
Collapse
Affiliation(s)
- Yoshiko Ishisaka
- Department of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | | | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - David Steiger
- Department of Pulmonary and Critical Care, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
| |
Collapse
|
13
|
Ishisaka Y, Watanabe A, Takagi H, Takayama H, Wiley J, Kuno T. Use of Perioperative Extracorporeal Membranous Oxygenation in Pulmonary Endarterectomy Cases: A Systematic Review and Meta-Analysis. J Intensive Care Med 2023; 38:785-796. [PMID: 37226426 DOI: 10.1177/08850666231178262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Introduction: Pulmonary endarterectomy (PEA) is known to be a curative intervention for chronic thromboembolic pulmonary hypertension (CTEPH). Its complications include endobronchial bleeding, persistent pulmonary arterial hypertension, right ventricular failure, and reperfusion lung injury. Extracorporeal membranous oxygenation (ECMO) is a perioperative salvage method for PEA. Although risk factors and outcomes have been reported in several studies, overall trends remain unknown. We performed a systematic review and study-level meta-analysis to understand the outcomes of ECMO utilization in the perioperative period of PEA. Methods: We performed a literature search with PubMed and EMBASE on 11/18/2022. We included studies including patients who underwent perioperative ECMO in PEA. We collected data including baseline demographics, hemodynamic measurements, and outcomes such as mortality and weaning of ECMO and performed a study-level meta-analysis. Results: Eleven studies with 2632 patients were included in our review. ECMO insertion rate was 8.7% (225/2,625, 95% CI 5.9-12.5) in total, VV-ECMO was performed as the initial intervention in 1.1% (41/2,625, 95% CI 0.4-1.7) (Figure 3), and VA-ECMO was performed as an initial intervention in 7.1% (184/2,625, 95% CI 4.7-9.9). Preoperative hemodynamic measurements showed higher pulmonary vascular resistance, mean pulmonary arterial pressure, and lower cardiac output in the ECMO group. Mortality rates were 2.8% (32/1238, 95% CI: 1.7-4.5) in the non-ECMO group and 43.5% (115/225, 95% CI: 30.8-56.2) in the ECMO group. The proportion of patients with successful weaning of ECMO was 72.6% (111/188, 95% CI: 53.4-91.7). Regarding complications of ECMO, the incidence of bleeding and multi-organ failure were 12.2% (16/79, 95% CI: 13.0-34.8) and 16.5% (15/99, 95% CI: 9.1-28.1), respectively. Conclusion: Our systematic review showed a higher baseline cardiopulmonary risk in patients with perioperative ECMO in PEA, and its insertion rate was 8.7%. Further studies that compare the use of ECMO in high-risk patients who undergo PEA are anticipated.
Collapse
Affiliation(s)
- Yoshiko Ishisaka
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth, Israel
| | - Atsuyuki Watanabe
- Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Hiroo Takayama
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| |
Collapse
|
14
|
Nafees B, de Freitas HM, Beaudet A, Todd E, Gin-Sing W. A Health State Utility Study to Elicit Societal Values Associated with Pulmonary Hypertension. Patient Prefer Adherence 2023; 17:2119-2130. [PMID: 37650045 PMCID: PMC10464901 DOI: 10.2147/ppa.s400061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/22/2023] [Indexed: 09/01/2023] Open
Abstract
Aim Pulmonary hypertension (PH) is a rare, severe, and progressive pulmonary vascular disease, which includes five subgroups with similar presentation. Symptoms include dyspnea, and fatigue, and can significantly impact one's health-related quality of life (HRQL). Although treatments are mainly medical, PH group 4, chronic thromboembolic pulmonary hypertension (CTEPH), can be managed with procedures, ie pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). Currently, drugs in Europe are only approved for pulmonary arterial hypertension (PAH), and CTEPH therefore the aim of this study was to elicit novel societal health state utilities in the UK for PAH and CTEPH based on disease severity, functional class (FC), clinical events, and treatment procedures specifically for CTEPH. Material and Methods Six health states were defined: World Health Organization (WHO)-FC II, WHO-FC III, and WHO-FC IV [defined by the New York Heart Association (NYHA)]; PH-related hospitalization; and "BPA procedure and recovery" and "PEA surgery and recovery". Health states were based on a targeted literature review and two rounds of interviews with clinical experts (N = 4) and patients (N = 6). Draft health states were validated in cognitive debriefing interviews with clinical experts (N = 3). Health states were valued by the UK general public (n = 200), using a visual analogue scale (VAS) and time trade-off (TTO) assessment with the lead time method. Results The mean TTO values/utilities were 0.81 (FC II), 0.80 (BPA), 0.78 (PEA), 0.59 (FC III), 0.28 (FC IV), and 0.25 (PH-related hospitalization). Each progression in FC was associated with worse TTO scores. Conclusion This study reports societal utility values for PAH and CTEPH in the UK. It provides first utility estimates for states such as BPA procedure and recovery, PEA surgery and recovery and PH-related hospitalization for this population. The results show important distinctions between FC, treatment procedures, and hospitalization, and the significant burden of disease on HRQL.
Collapse
Affiliation(s)
- Beenish Nafees
- Patient-Reported Outcomes, Nafees Consulting Limited, London, UK
| | | | - Amélie Beaudet
- Global Market Access and Pricing, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Eunju Todd
- Janssen Global Commercial Strategy Organization, High Wycombe, UK
| | - Wendy Gin-Sing
- Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| |
Collapse
|
15
|
Parvizi R, Bilehjani E, Mahmoudian B, Koohi A, Shojaan H, Ansarin K, Rashidi F. Single-Center Experience of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: The Results from the Tabriz University Medical Sciences (TUMS) CTEPH Program. Thorac Cardiovasc Surg 2023; 71:407-412. [PMID: 36657456 DOI: 10.1055/s-0042-1760204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Pulmonary endarterectomy (PEA) remains the preferred and potentially curative option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to report the results of PEA for CTEPH in a tertiary center in Tabriz, Iran. METHODS We analyzed the results of 42 CTEPH patients undergoing PEA, who were enrolled in the Tabriz University of Medical Sciences (TUMS-CTEPH) from January 2016 to October 2020. The main outcome measures included the New York Heart Association (NYHA) functional classification, the 6-Minute Walk Distance, hemodynamic measures in right heart catheterization, morbidity, and mortality. RESULTS There was a significant improvement in the NYHA function class (2.6 ± 0.5 vs 1.1 ± 0.34), mean pulmonary arterial pressure (47.1 ± 13 vs 27.9 ± 8 mm Hg), cardiac output (4.3 ± 1.06 vs 5.9 ± 1.2 L/min), and pulmonary vascular resistance (709.4 ± 297.5 vs 214 ± 77 dyn s/cm5). Fifteen patients (35%) developed complications. The most common complication (10 [23%]) was reperfusion injury. Also, postsurgical mortality was 4% during hospital admission and 1-year follow-up. CONCLUSION This is the first single-center report of PEA from Iran. Post-PEA and 1-year survival were acceptable as a referral center. PEA can be performed safe with low mortality. Greater awareness of PEA and patients' access to experienced CTEPH centers are important issues.
Collapse
Affiliation(s)
- Rezayat Parvizi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Eisa Bilehjani
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Mahmoudian
- Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Koohi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hooriah Shojaan
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khalil Ansarin
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Rashidi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
16
|
Ermerak NO, Yildizeli SO, Kocakaya D, Mutlu B, Ak K, Tas S, Yildizeli B. Surgical Treatment of Another Sequalae of COVID-19: Post-COVID CTEPH. Thorac Cardiovasc Surg 2023; 71:413-417. [PMID: 36944361 DOI: 10.1055/a-2059-4513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is still an ongoing entity and every day we face new sequalae of the disease. We hereby present surgical results of patients who are treated for post-COVID chronic thromboembolic pulmonary hypertension. METHODS Data were collected among patients who underwent pulmonary endarterectomy and had a diagnosis of post-COVID chronic thromboembolic pulmonary hypertension. All data were retrospectively reviewed from a prospectively conducted database. Operative mortality was described as death in hospital or within 30 days of surgery. RESULTS Eleven patients (seven males, four females; median age, 52 [22-63] years) were identified. Pulmonary vascular resistance improved significantly from 572 dyn/s/cm-5 (240-1,192) to 240 (195-377) dyn/s/cm-5 (p < 0.005). Significant difference was also detected in median mPAP, as it decreased from 40 mm Hg (24-54) to 24 mm Hg (15-36) following surgery (p < 0.005). Mortality was observed in one patient due to sepsis on the fifth postoperative day. Median time from COVID-19 disease to surgery was 12 months (6-24). Median length of hospital stay of the survivors was 10 days (8-14). CONCLUSION In the new era of chronic thromboembolic pulmonary hypertension, hybrid approach including surgery, balloon pulmonary angioplasty, and medical treatment has been recommended. pulmonary endarterectomy is still the only curative treatment when the disease is surgically accessible. We hereby report the first publication of post-COVID chronic thromboembolic pulmonary hypertension patients who were surgically treated. As we see a lot of long-term symptoms and clinical manifestations in patients who had COVID-19, we should always remember chronic thromboembolic pulmonary hypertension in the differential diagnosis.
Collapse
Affiliation(s)
- Nezih Onur Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Derya Kocakaya
- Department of Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bulent Mutlu
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Koray Ak
- Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Serpil Tas
- Department of Cardiovascular Surgery, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Bedrettin Yildizeli
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
17
|
Bird E, Hasenstab K, Kim N, Madani M, Malhotra A, Hahn L, Kligerman S, Hsiao A, Contijoch F. Mapping the Spatial Extent of Hypoperfusion in Chronic Thromboembolic Pulmonary Hypertension Using Multienergy CT. Radiol Cardiothorac Imaging 2023; 5:e220221. [PMID: 37693197 PMCID: PMC10483250 DOI: 10.1148/ryct.220221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/05/2023] [Accepted: 07/03/2023] [Indexed: 09/12/2023]
Abstract
Purpose To assess if a novel automated method to spatially delineate and quantify the extent of hypoperfusion on multienergy CT angiograms can aid the evaluation of chronic thromboembolic pulmonary hypertension (CTEPH) disease severity. Materials and Methods Multienergy CT angiograms obtained between January 2018 and December 2020 in 51 patients with CTEPH (mean age, 47 years ± 17 [SD]; 27 women) were retrospectively compared with those in 110 controls with no imaging findings suggestive of pulmonary vascular abnormalities (mean age, 51 years ± 16; 81 women). Parenchymal iodine values were automatically isolated using deep learning lobar lung segmentations. Low iodine concentration was used to delineate areas of hypoperfusion and calculate hypoperfused lung volume (HLV). Receiver operating characteristic curves, correlations with preoperative and postoperative changes in invasive hemodynamics, and comparison with visual assessment of lobar hypoperfusion by two expert readers were evaluated. Results Global HLV correctly separated patients with CTEPH from controls (area under the receiver operating characteristic curve = 0.84; 10% HLV cutoff: 90% sensitivity, 72% accuracy, and 64% specificity) and correlated moderately with hemodynamic severity at time of imaging (pulmonary vascular resistance [PVR], ρ = 0.67; P < .001) and change after surgical treatment (∆PVR, ρ = -0.61; P < .001). In patients surgically classified as having segmental disease, global HLV correlated with preoperative PVR (ρ = 0.81) and postoperative ∆PVR (ρ = -0.70). Lobar HLV correlated moderately with expert reader lobar assessment (ρHLV = 0.71 for reader 1; ρHLV = 0.67 for reader 2). Conclusion Automated quantification of hypoperfused areas in patients with CTEPH can be performed from clinical multienergy CT examinations and may aid clinical evaluation, particularly in patients with segmental-level disease.Keywords: CT-Spectral Imaging (Multienergy), Pulmonary, Pulmonary Arteries, Embolism/Thrombosis, Chronic Thromboembolic Pulmonary Hypertension, Multienergy CT, Hypoperfusion© RSNA, 2023.
Collapse
Affiliation(s)
- Elizabeth Bird
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Kyle Hasenstab
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Nick Kim
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Michael Madani
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Atul Malhotra
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Lewis Hahn
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Seth Kligerman
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Albert Hsiao
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Francisco Contijoch
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| |
Collapse
|
18
|
Otero R, Lobo JL, López R, Fernández C, Jiménez D, Muriel A, Alfonso M, Ballaz A, Núñez-Ares A, Rodríguez-Matute C, de Miguel-Díez J, Rodríguez-Chiaradía DA, Alcalde M, Elías T, Jara-Palomares L, Rivas A, Alonso Á, García-Ortega A, Sancho T, Morillo R, García-Bragado F, Hernández-Blasco L, Uresandi F, Madridano O, Agüero R, Monreal M. Feasibility of a screening algorithm for chronic thromboembolic pulmonary hypertension: The OSIRIS study. Thromb Res 2023; 228:1-9. [PMID: 37263121 DOI: 10.1016/j.thromres.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term sequel to pulmonary embolism (PE) whose incidence varies according to different published studies. We have carried out this study to determine its incidence within 2 years after index pulmonary embolism and to study limitations to an early diagnosis. MATERIAL AND METHODS OSIRIS is a multicentre, longitudinal cohort study. Patients were followed for 3, 6, 12, and 24 months after pulmonary embolism using a structured three-step algorithm. A physician-centered questionnaire at least one positive response in a screening proceeded to the second step, transthoracic echocardiography. The third step consisted of ventilation/perfusion lung scintigraphy and right heart catheterisation. A transthoracic echocardiography was performed in patients without positive response in the screening questionnaire after 2 years. CTEPH diagnosis required haemodynamic confirmation by right heart catheterisation and mismatched perfusion defects on lung scintigraphy. RESULTS A total of 1191 patients were enrolled in 18 Spanish hospitals. Cumulative CTEPH incidence after 2-years PE was: 2.49 % (95 % CI: 1.68-3.56) and the incidence rate of CTEPH was 1.1 cases per 1000 person-months (95 % CI: 0.725; 1.60). The CTEPH algorithm presented a lack of adherence of 29 %; patient and physician preferences posed barriers to the triage algorithm The screening questionnaire, in patients who completed the follow-up, shows a specificity of 91.3 % (89.0-93.2 %) and negative predictive value of 99.4 % (98.4-99.8 %).. CONCLUSIONS OSIRIS provides practiced clinical based data on the chronic thromboembolic pulmonary hypertension incidence and identified barriers to the implementation of a 3-step triage algorithm for its detection. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: NCT03134898.
Collapse
Affiliation(s)
- Remedios Otero
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - José Luis Lobo
- Hospital de Araba, Vitoria-Gasteiz, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Raquel López
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - David Jiménez
- Hospital Universitario Ramón y Cajal y Universidad de Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Alfonso Muriel
- Hospital Universitario Ramón y Cajal y Universidad de Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | | | | | | | | | - Teresa Elías
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS), Sevilla, Spain
| | - Luis Jara-Palomares
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | | | | | - Raquel Morillo
- Hospital Universitario Ramón y Cajal y Universidad de Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | | | - Olga Madridano
- Hospital Infanta Sofía, San Sebastían de los Reyes, Madrid, Spain
| | - Ramón Agüero
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Monreal
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|
19
|
Yang J, Madani MM, Mahmud E, Kim NH. Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension. Chest 2023; 164:490-502. [PMID: 36990148 PMCID: PMC10410247 DOI: 10.1016/j.chest.2023.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of pulmonary hypertension and right heart failure. CTEPH (group 4 pulmonary hypertension) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved acute pulmonary embolism. CTEPH also may present without prior VTE history, which can contribute to its underrecognition. The true incidence of CTEPH is unclear, but is estimated to be approximately 3% after acute pulmonary embolism. V˙/Q˙ scintigraphy is the best screening test for CTEPH, with CT scan imaging and other advanced imaging methods now playing a larger role in disease detection and confirmation. Perfusion defects on V˙/Q˙ scintigraphy in the setting of pulmonary hypertension are suggestive of CTEPH, but pulmonary angiography and right heart catheterization are required for confirmation and treatment planning. CTEPH potentially is curative with pulmonary thromboendarterectomy surgery, with mortality rates of approximately 2% at expert centers. Advances in operative techniques are allowing more distal endarterectomies to be performed successfully with favorable outcomes. However, more than one-third of patients may be considered inoperable. Although these patients previously had minimal therapeutic options, effective treatments now are available with pharmacotherapy and balloon pulmonary angioplasty. Diagnosis of CTEPH should be considered in all patients with suspicion of pulmonary hypertension. Treatments for CTEPH have advanced with improvements in outcomes for both operable and inoperable patients. Therapy should be tailored based on multidisciplinary team evaluation to ensure optimal treatment response.
Collapse
Affiliation(s)
- Jenny Yang
- Division of Pulmonary, Critical Care, Sleep Medicine, University of California, San Diego, La Jolla, CA
| | - Michael M Madani
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, La Jolla, CA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Nick H Kim
- Division of Pulmonary, Critical Care, Sleep Medicine, University of California, San Diego, La Jolla, CA.
| |
Collapse
|
20
|
Jansa P, Kopeć G, Torbicki A, Sadushi‐Kolici R, Campean I, Halank M, Simkova I, Steringer‐Mascherbauer R, Salobir B, Klepetko W, Lindner J, Lang IM. The risk profile change in patients with severe chronic thromboembolic pulmonary hypertension treated with subcutaneous treprostinil. Pulm Circ 2023; 13:e12274. [PMID: 37609358 PMCID: PMC10440840 DOI: 10.1002/pul2.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is successfully treatable with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, and medical therapy. Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management risk score (RRS) is able to predict long-term outcome in inoperable patients or in patients with residual PH after surgery. We performed a post hoc analysis of RRS in patients who were enrolled in the CTREPH study (NCT01416636), a randomized, double-blind clinical trial comparing high-dose and low-dose subcutaneous (SC) treprostinil in patients with severe CTEPH that was classified by an interdisciplinary CTEPH team as nonoperable, or as persistent or recurrent pulmonary hypertension after PEA. Baseline mean RRS was similar in both treatment groups (8.7 in high-dose arm vs. 8.6 in low-dose arm), but mean RRS change from baseline to Week 24 was greater in the high-dose treprostinil group than in the low-dose treprostinil group (-0.88 vs. -0.17). The difference in RRS change from baseline to Week 24 between high dose versus low dose was statistically significant with mean difference of -0.70 (95% confidence interval: -1.36 to -0.05, p = 0.0352), and was driven mainly by improvement of World Health Organization functional class and N-terminal pro-brain natriuretic peptide concentration. SC treprostinil therapy administered in standard dose had positive effect on the risk profile measured by RRS in patients with inoperable or persistent/recurrent severe CTEPH. Although our study was limited by the small sample size and post hoc nature, assessment of risk profile is of great importance to this particular patient population with very poor prognosis.
Collapse
Affiliation(s)
- Pavel Jansa
- Clinical Department of Cardiology and Angiology of the 2nd Department of MedicineGeneral University HospitalPragueCzech Republic
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Pulmonary Circulation CentreJagiellonian University Medical College and John Paul II Hospital in KrakowKrakowPoland
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic DiseasesEuropean Health CenterOtwockPoland
| | - Roela Sadushi‐Kolici
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Ioana‐Alexandra Campean
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Michael Halank
- Department of Internal Medicine I, University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Iveta Simkova
- Department of Cardiology and Angiology of Medical FacultySlovak Medical University and National Institute of Cardiovascular DiseasesBratislavaSlovakia
| | | | - Barbara Salobir
- Department of Pulmonary Diseases and AllergyLjubljana University Medical CentreLjubljanaSlovenia
| | - Walter Klepetko
- Department of Cardiothoracic SurgeryMedical University of ViennaViennaAustria
| | - Jaroslav Lindner
- 2nd Department of Surgery—Department of Cardiovascular SurgeryGeneral University HospitalPragueCzech Republic
| | - Irene M. Lang
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| |
Collapse
|
21
|
Sheikh MA, VanAken G, Hyder SN, Giri J. Outpatient Follow-up of Pulmonary Embolism: Putting It all Together. Interv Cardiol Clin 2023; 12:429-441. [PMID: 37290845 DOI: 10.1016/j.iccl.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many patients discharged after an acute pulmonary embolism (PE) admission have inconsistent outpatient follow-up and insufficient workup for chronic complications of PE. A structured outpatient care program is lacking for the different phenotypes of chronic PE, such as chronic thromboembolic disease, chronic thromboembolic pulmonary hypertension, and post-PE syndrome. A dedicated PE follow-up clinic extends the organized, systematic care provided to patients with PE via the PERT (Pulmonary Embolism Response Team) model in the outpatient setting. Such an initiative can standardize follow-up protocols after PE, limit unnecessary testing, and ensure adequate management of chronic complications.
Collapse
Affiliation(s)
- Muhammad Adil Sheikh
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University, PO Box 19636, Springfield, IL 62794-9636, USA.
| | - Gabriella VanAken
- University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Syed Nabeel Hyder
- Division of Cardiology, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jay Giri
- Cardiovascular Medicine Division, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
22
|
Tsuchiya N, Xu YY, Ito J, Yamashiro T, Ikemiyagi H, Mummy D, Schiebler ML, Yonemoto K, Murayama S, Nishie A. Chronic thromboembolic pulmonary hypertension is associated with a loss of total lung volume on computed tomography. World J Radiol 2023; 15:146-156. [PMID: 37275304 PMCID: PMC10236971 DOI: 10.4329/wjr.v15.i5.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension (CTEPH), approximately 20%-29% of patients exhibit a restrictive pattern on pulmonary function testing.
AIM To quantify longitudinal changes in lung volume and cardiac cross-sectional area (CSA) in patients with CTEPH.
METHODS In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019, we evaluated 15 patients with CTEPH who had chest computed tomography (CT) performed at baseline and after at least 6 mo of therapy. We matched the CTEPH cohort with 45 control patients by age, sex, and observation period. CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.
RESULTS Total, right lung, and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline (total, P = 0.004; right lung, P = 0.003; right lower lobe; P = 0.01). In the CTEPH group, the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group (total, P = 0.01; right lung, P = 0.007; right lower lobe, P = 0.01; CSA, P = 0.0002). There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.
CONCLUSION After at least 6 mo of treatment, CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.
Collapse
Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| | - Yan-Yan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Junji Ito
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Yokohama City University, Yokohama 2360027, Japan
| | - Hidekazu Ikemiyagi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara 9030125, Okinawa, Japan
| | - David Mummy
- Center for In Vivo Microscopy and Department of Radiology, Duke University, Durham, NC 27710, United States
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Koji Yonemoto
- Department of Biostatistics, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara 903-0215, Okinawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| | - Akihiro Nishie
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| |
Collapse
|
23
|
Inhibition of heterogeneous nuclear ribonucleoproteins A1 and oxidative stress reduces glycolysis via pyruvate kinase M2 in chronic thromboembolic pulmonary hypertension. J Transl Int Med 2023. [DOI: 10.2478/jtim-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Abstract
Background and Objective
Chronic thromboembolic pulmonary hypertension (CTEPH) is a lethal complication of pulmonary embolism involving pulmonary artery occlusion and microvascular disease. The glucose metabolism and reactive oxygen species (ROS) production may be perturbed in CTEPH, but the precise mechanisms are unclear. This study investigated glucose metabolism in CTEPH employing pulmonary endarterectomy (PEA)-derived pulmonary artery smooth muscle cells (PASMCs) and characterized the roles of pyruvate kinase M2 (PKM2) and its regulation by heterogeneous nuclear ribonucleoproteins A1 (hnRNPA1) and ROS in CTEPH.
Methods
PEA tissues and blood samples of CTEPH patients were collected to study the levels of PKM2. Primary PASMCs were isolated from PEA tissues. We used small interfering RNAs to knock down PKM2 and hnRNPA1, and applied antioxidant N-acetylcysteine (NAC) and mito-TEMPO to reduce ROS production. The expression of glucometabolic genes, ROS production, glycolysis rate and proliferative and migratory activities were analyzed in PEA-derived PASMCs.
Results
PKM2 levels in serum and PEA tissues of CTEPH patients were higher than that of the healthy controls. Compared to the control PASMCs, PEA-derived PASMCs showed increased PKM2 expression and ROS production. The rates of glycolysis, proliferation and migration were increased in PEA-PASMCs and could be mitigated by PKM2 downregulation through hnRNPA1 or ROS inhibition.
Conclusions
Increased glycolysis and PKM2 expression were found in PEA-PASMCs. Inhibition of hnRNPA1 or ROS corrected the aberrant glycolysis, cell proliferation and migration by downregulating PKM2. Regulation of the hnRNPA1/PKM2 axis represents a potential therapeutic target for the treatment of CTEPH.
Collapse
|
24
|
Huang YS, Chen ZW, Lee WJ, Wu CK, Kuo PH, Hsu HH, Tang SY, Tsai CH, Su MY, Ko CL, Hwang JJ, Lin YH, Chang YC. Treatment Response Evaluation by Computed Tomography Pulmonary Vasculature Analysis in Patients With Chronic Thromboembolic Pulmonary Hypertension. Korean J Radiol 2023; 24:349-361. [PMID: 36907594 PMCID: PMC10067691 DOI: 10.3348/kjr.2022.0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 01/28/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To quantitatively assess the pulmonary vasculature using non-contrast computed tomography (CT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) pre- and post-treatment and correlate CT-based parameters with right heart catheterization (RHC) hemodynamic and clinical parameters. MATERIALS AND METHODS A total of 30 patients with CTEPH (mean age, 57.9 years; 53% female) who received multimodal treatment, including riociguat for ≥ 16 weeks with or without balloon pulmonary angioplasty and underwent both non-contrast CT for pulmonary vasculature analysis and RHC pre- and post-treatment were included. The radiographic analysis included subpleural perfusion parameters, including blood volume in small vessels with a cross-sectional area ≤ 5 mm² (BV5) and total blood vessel volume (TBV) in the lungs. The RHC parameters included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index (CI). Clinical parameters included the World Health Organization (WHO) functional class and 6-minute walking distance (6MWD). RESULTS The number, area, and density of the subpleural small vessels increased after treatment by 35.7% (P < 0.001), 13.3% (P = 0.028), and 39.3% (P < 0.001), respectively. The blood volume shifted from larger to smaller vessels, as indicated by an 11.3% increase in the BV5/TBV ratio (P = 0.042). The BV5/TBV ratio was negatively correlated with PVR (r = -0.26; P = 0.035) and positively correlated with CI (r = 0.33; P = 0.009). The percent change across treatment in the BV5/TBV ratio correlated with the percent change in mPAP (r = -0.56; P = 0.001), PVR (r = -0.64; P < 0.001), and CI (r = 0.28; P = 0.049). Furthermore, the BV5/TBV ratio was inversely associated with the WHO functional classes I-IV (P = 0.004) and positively associated with 6MWD (P = 0.013). CONCLUSION Non-contrast CT measures could quantitatively assess changes in the pulmonary vasculature in response to treatment and were correlated with hemodynamic and clinical parameters.
Collapse
Affiliation(s)
- Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Wen-Jeng Lee
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cho-Kai Wu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Yu Tang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Lun Ko
- Departments of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
25
|
Surgical and Device Interventions in the Treatment of Chronic Thromboembolic Disease. Pulm Ther 2023; 9:207-221. [PMID: 36800165 DOI: 10.1007/s41030-023-00217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
Chronic thromboembolic pulmonary disease (CTEPD) is characterized by unresolved clot burden in large pulmonary arteries, obstructive disease in smaller arteries, and increased downstream clot burden. This occurs in the setting of abnormal fibrinolysis or hematological disorders. Up to 50% of patients in some studies are unaware of a self-history of a deep venous thrombosis or pulmonary embolism. Ultimately, they present with symptoms of pulmonary hypertension (PH), which can result in right heart failure (RHF). Pulmonary endarterectomy (PEA) is curative, though many patients have prohibitive surgical risk or surgically inaccessible disease, warranting other interventions such as balloon pulmonary angioplasty (BPA) and medical therapy. Rarely, other treatment options may be implemented. We focus this review on PEA and BPA, with an overview of the history of CTEPD and the evolution of these procedures. We will briefly discuss other treatment modalities.
Collapse
|
26
|
Pathophysiology and Treatment of Chronic Thromboembolic Pulmonary Hypertension. Int J Mol Sci 2023; 24:ijms24043979. [PMID: 36835383 PMCID: PMC9968103 DOI: 10.3390/ijms24043979] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition in which an organic thrombus remains in the pulmonary artery (PA) even after receiving anticoagulation therapy for more than 3 months and is complicated by pulmonary hypertension (PH), leading to right-sided heart failure and death. CTEPH is a progressive pulmonary vascular disease with a poor prognosis if left untreated. The standard treatment for CTEPH is pulmonary endarterectomy (PEA), which is usually performed only in specialized centers. In recent years, balloon pulmonary angioplasty (BPA) and drug therapy for CTEPH have also shown good results. This review discusses the complex pathogenesis of CTEPH and presents the standard of care, PEA, as well as a new device called BPA, which is showing remarkable progress in efficacy and safety. Additionally, several drugs are now demonstrating established evidence of efficacy in treating CTEPH.
Collapse
|
27
|
Zhu R, Cheng GY, Denas G, Pengo V. Antiphospholipid antibodies in chronic thromboembolic pulmonary hypertension. Eur J Intern Med 2023; 111:1-4. [PMID: 36642578 DOI: 10.1016/j.ejim.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Acquired thrombophilia and in particular the presence of antiphospholipid antibodies (aPL) may play an important role in the development of chronic thromboembolic pulmonary hypertension (CTEPH). Young patients suffering from an episode of unprovoked pulmonary embolism (PE), or PE provoked by mild risk factors, should be tested for aPL. In case of a positive result, they should be closely followed up and lifelong anticoagulant treatment should be considered. Indeed, aPL-induced thrombophilia may favor PE recurrence with the consequence of possible CTEPH development. The aPL profiles play an important role in this pathway. Patients with PE and triple positivity (lupus anticoagulant, LAC, anti-cardiolipin, aCL, and anti-β2-glycoprotein I, aβ2GPI) are at the highest risk of recurrence and deserve maximum protection by anticoagulant treatment with warfarin.
Collapse
Affiliation(s)
- Rui Zhu
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Gang-Yi Cheng
- Department of Cardiac Surgery, The First Affiliated Hospital of XiaMen University, XiaMen, China
| | - Gentian Denas
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, Thrombosis Research Laboratory, University of Padua, Padua, Italy
| | - Vittorio Pengo
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, Thrombosis Research Laboratory, University of Padua, Padua, Italy; Arianna Foundation on Anticoagulation, Bologna, Italy.
| |
Collapse
|
28
|
Alamri AK, Shelburne NJ, Mayeux JD, Brittain E. Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview. Pulm Circ 2023; 13:e12182. [PMID: 36644322 PMCID: PMC9832865 DOI: 10.1002/pul2.12182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The considerable progress made in recent years in the diagnosis, risk stratification, and treatment of pulmonary hypertension was highlighted during the most recent edition of the Pulmonary Hypertension Association Scientific Sessions, which was held in Atlanta, Georgia from June 9 to 11, 2022, with the theme: Vision for the PHuture: The Evolving Science and Management of PH. Content presented over the 3-day conference focused on scientific and management updates since the last sessions were held in 2018 and included didactic talks, debates, and roundtable discussions across a broad spectrum of topics related to pulmonary hypertension. This article aims to summarize the key messages from each of the session talks.
Collapse
Affiliation(s)
- Ayedh K. Alamri
- Department of MedicineUniversity of UtahSalt Lake CityUtahUSA,Department of Medicine, College of MedicineNorthern Border UniversityArarSaudi Arabia
| | - Nicholas J. Shelburne
- Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jennalyn D. Mayeux
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Evan Brittain
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| |
Collapse
|
29
|
Zhang X, Guo X, Zhang B, Yang Q, Gong J, Yang S, Li J, Kuang T, Miao R, Yang Y. The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension. Clin Appl Thromb Hemost 2023; 29:10760296231176253. [PMID: 37700697 PMCID: PMC10501068 DOI: 10.1177/10760296231176253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 09/14/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thrombotic obstruction of the pulmonary arteries, and right ventricular (RV) dysfunction is a major cause of death. Cardiac magnetic resonance (CMR) is the gold standard for assessing heart wall deformation; therefore, we aimed to determine the prognostic value of CMR strain in patients with CTEPH. Strain derived by CMR was measured at the time of diagnosis in 45 patients with CTEPH, and the relationship between RV strain and prognosis was determined through follow-up. The value of RV strain in the prognostic model was compared with that of pulmonary arterial hypertension (PAH) risk stratification. The RV global peak longitudinal strain (GLS) and global peak circumferential strain (GCS) in CTEPH patients were lower than the normal references of RV strain in the control group. GLS and longitudinal strain in the basal segment were independent risk factors for adverse events (P < .050). Adding CMR parameters to PAH risk stratification improved its predictive power in patients with CTEPH. GLS and GCS scores were impaired in patients with chronic RV overload. RV strain derived by CMR imaging is a promising noninvasive tool for the follow-up of patients with CTEPH.
Collapse
Affiliation(s)
- Xuefei Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Bowen Zhang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Qi Yang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Juanni Gong
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Suqiao Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Jifeng Li
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Tuguang Kuang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Ran Miao
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| | - Yuanhua Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
- Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Institute of Respiratory Medicine, Beijing, China
| |
Collapse
|
30
|
Hashimoto H, Oka T, Nakanishi R, Mizumura S, Dobashi S, Hashimoto Y, Okamura Y, Ota K, Ikeda T. Evaluation of balloon pulmonary angioplasty using lung perfusion SPECT in patients with chronic thromboembolic pulmonary hypertension. J Nucl Cardiol 2022; 29:3392-3400. [PMID: 35474442 PMCID: PMC9834092 DOI: 10.1007/s12350-022-02971-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/15/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of balloon pulmonary angioplasty (BPA) using lung perfusion single-photon emission computed tomography (SPECT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS AND RESULTS 20 consecutive patients (64 ± 15 years) who were diagnosed with CTEPH and underwent BPA were included in this study. All patients underwent lung perfusion SPECT before and after BPA. The relationship between functional %volume of the lung calculated from the lung perfusion SPECT (FVL-LPSPECT), and other clinical parameters before and after BPA was assessed using the Wilcoxon signed-rank test. The correlation between each parameter and mean pulmonary artery pressure (mPAP) using the Spearman's correlation was performed. To determine predictors of mPAP for evaluating treatment effectiveness, significant parameters were included in multiple regression analysis. After BPA, world health organization functional classification, six-minute walk distance (6MWD), mPAP, and FVL-LPSPECT significantly improved. FVL-LPSPECT (r = - 0.728, P < 0.001) and 6MWD (r = - 0.571, P = 0.009) were significant correlation of mPAP. In the multiple regression analysis, FVL-LPSPECT was the most significant predictor of improvement in mPAP after BPA (P < 0.001). CONCLUSIONS This study demonstrated that the lung perfusion SPECT could be a potential measurement of the effectiveness of BPA in patients with CTEPH.
Collapse
Affiliation(s)
- Hidenobu Hashimoto
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan.
| | - Takashi Oka
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Sunao Mizumura
- Department of Radiology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Shintaro Dobashi
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Yukiko Hashimoto
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Yuriko Okamura
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Kyoko Ota
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| |
Collapse
|
31
|
Wiedenroth CB, Bandorski D, Ariobi K, Ghofrani HA, Lankeit M, Liebetrau C, Pruefer D, Mayer E, Kriechbaum SD, Guth S. Does Age Matter? Pulmonary Endarterectomy in the Elderly Patient with CTEPH. Thorac Cardiovasc Surg 2022; 70:663-670. [PMID: 35038757 DOI: 10.1055/s-0041-1740559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The gold standard treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Little is known about the influence of advanced age on surgical outcome. Therefore, the aim of this study was to investigate the impact of patient's age on postoperative morbidity, mortality, and quality of life in a German referral center. METHODS Prospectively collected data from 386 consecutive patients undergoing PEA between 01/2014 and 12/2016 were analyzed. Patients were divided into three groups according to their age: group 1: ≤ 50 years, group 2: > 50 ≤ 70 years, group 3: > 70 years. RESULTS After PEA, distinct improvements in pulmonary hemodynamics, physical capacity (World Health Organization [WHO] functional class and 6-minute walking distance) and quality of life were found in all groups. There were more complications in elderly patients with longer time of invasive ventilation, intensive care, and in-hospital stay. However, the in-hospital mortality was comparable (0% in group 1, 2.6% in group 2, and 2.1% in group 3 [p = 0.326]). Furthermore, the all-cause mortality at 1 year was 1.1% in group 1, 3.2% in group 2, and 6.3% in group 3 (p = 0.122). CONCLUSIONS PEA is an effective treatment for CTEPH patients of all ages accompanied by low perioperative and 1-year mortality. CTEPH patients in advanced age carefully selected by thorough preoperative evaluation should be offered PEA in expert centers to improve quality of life, symptoms, and pulmonary hemodynamics.
Collapse
Affiliation(s)
| | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Kanischka Ariobi
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - H-Ardeschir Ghofrani
- Department of Pulmonology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany.,Department of Medicine, Imperial College, London, United Kingdom
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.,Germany Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt am Main, Germany.,Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Diethard Pruefer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Steffen D Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| |
Collapse
|
32
|
Ejiri K, Ogawa A, Shimokawahara H, Matsubara H. Treatment of Vascular Injury During Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension. JACC. ASIA 2022; 2:831-842. [PMID: 36713759 PMCID: PMC9877217 DOI: 10.1016/j.jacasi.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 12/03/2022]
Abstract
Background Treatment strategy for vascular injury during balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) was uncertain. Objectives This study aimed to identify an optimal therapeutic strategy for vascular injury during BPA in patients with CTEPH. Methods This study reviewed 207 patients with CTEPH and 956 BPA procedures between November 1, 2012 and November 30, 2015. Patients who were diagnosed with vascular injury during BPA, which was defined as angiographic signs or sudden respiratory and hemodynamic defects were included in this study. The study investigated the safety and efficacy of the hierarchically systematic treatment strategy including gelatin sponge embolization (GSE). Results More than one-half of the 79 patients and 133 procedures with vascular injury were improved by general treatment with reversal of heparin and high-flow oxygen administration. The investigators performed conventional treatment of proximal vessel occlusion using a guiding or balloon catheter in 47 procedures (35%) in which the culprit vessels could be detected under patients' stable conditions. In 32 procedures (24%) without detected culprit lesions or improvement by conventional treatment, GSE could significantly improve patient condition. The treatment strategy obtained successful bailout in 98% of procedures with vascular injury. No patients who underwent GSE died within 30 days after the treatment. There was no significant difference in cumulative mortality rate (median follow-up: 6.6 years) between groups with or without GSE (15.6% vs 8.2%; adjusted HR: 1.47; 95% CI: 0.25-8.69; P = 0.67). Conclusions Treatment strategy including GSE would be promising for vascular injury during BPA in patients with CTEPH.
Collapse
Affiliation(s)
- Kentaro Ejiri
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan,Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiroto Shimokawahara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan,Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan,Address for correspondence: Dr Hiromi Matsubara, Departments of Cardiology and Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama, Japan, 7011192.
| |
Collapse
|
33
|
Mahmud E, Ang L. Percutaneous Interventional Therapy for Chronic Thromboembolic Pulmonary Hypertension. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
34
|
Nishiyama A, Kawata N, Yokota H, Hayano K, Matsuoka S, Shigeta A, Sugiura T, Tanabe N, Ishida K, Tatsumi K, Suzuki T, Uno T. Heterogeneity of Lung Density in Patients With Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Acad Radiol 2022; 29:e229-e239. [PMID: 35466051 DOI: 10.1016/j.acra.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Pulmonary endarterectomy (PEA) is one of the most effective treatments for chronic thromboembolic pulmonary hypertension (CTEPH). Right heart catheterization (RHC) is the gold standard assessment for pulmonary circulatory dynamics. However, computed tomography (CT) is less invasive than RHC and can elucidate some of the morphological changes caused by thromboembolism. We hypothesized that CT could facilitate the evaluation of heterogeneous pulmonary perfusion. This study investigated whether CT imaging features reflect the disease severity and changes in pulmonary circulatory dynamics in patients with CTEPH before and after PEA. MATERIALS AND METHODS This retrospective study included 58 patients with CTEPH who underwent PEA. Pre-PEA and post-PEA CT images were assessed for heterogeneity using CT texture analysis (CTTA). The CT parameters were compared with the results of the RHC and other clinical indices and analyzed with receiver operating characteristic curves analysis for patients with and without residual pulmonary hypertension (PH) (post-PEA mean pulmonary artery pressure ≥ 25 mmHg). RESULTS CT measurements reflecting heterogeneity were significantly correlated with mean pulmonary artery pressure. Kurtosis, skewness, and uniformity were significantly lower, and entropy was significantly higher in patients with residual PH than patients without residual PH. Area under the curve values of pre-PEA and post-PEA entropy between patients with and without residual PH were 0.71 (95% confidence interval 0.57-0.84) and 0.75 (0.63-0.88), respectively. CONCLUSION Heterogeneity of lung density might reflect pulmonary circulatory dynamics, and CTTA for heterogeneity could be a less invasive technique for evaluation of changes in pulmonary circulatory dynamics in patients with CTEPH undergoing PEA.
Collapse
Affiliation(s)
- Akira Nishiyama
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan.
| | - Naoko Kawata
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Hajime Yokota
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Koichi Hayano
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Shin Matsuoka
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Ayako Shigeta
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Toshihiko Sugiura
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Nobuhiko Tanabe
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Keiichi Ishida
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Koichiro Tatsumi
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Takuji Suzuki
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| | - Takashi Uno
- Department of Radiology (A.N.), Chiba University Hospital, Chiba, Japan; Department of Respirology (N.K., A.S., T.S., K.T., T.S.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Diagnostic Radiology and Radiation Oncology (H.Y., T.U.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Frontier Surgery (K.H.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Radiology (S.M.), St. Marianna University School of Medicine, Kanagawa, Japan; Department of Respirology (N.T.), Chibaken Saiseikai Narashino Hospital, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Surgery (K.I.), Eastern Chiba Medical Center, Togane, Japan
| |
Collapse
|
35
|
Traitement chirurgical de l’hypertension pulmonaire thromboembolique. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Higuchi S, Horinouchi H, Aoki T, Nishii T, Ota Y, Ueda J, Tsuji A, Ota H, Ogo T, Fukuda T. Balloon Pulmonary Angioplasty in the Management of Chronic Thromboembolic Pulmonary Hypertension. Radiographics 2022; 42:1881-1896. [DOI: 10.1148/rg.210102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Satoshi Higuchi
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Hiroki Horinouchi
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Tatsuo Aoki
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Tatsuya Nishii
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Yasutoshi Ota
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Jin Ueda
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Akihiro Tsuji
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Hideki Ota
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Takeshi Ogo
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| | - Tetsuya Fukuda
- From the Departments of Radiology (S.H., H.H., T.N., Y.O., T.F.) and Cardiovascular Medicine (T.A., J.U., A.T., T.O.), National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; and Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan (S.H., H.O.)
| |
Collapse
|
37
|
Chronic Thromboembolic Pulmonary Hypertension in Females: Clinical Features and Survival. J Cardiovasc Dev Dis 2022; 9:jcdd9090308. [PMID: 36135453 PMCID: PMC9506206 DOI: 10.3390/jcdd9090308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/19/2022] [Accepted: 09/06/2022] [Indexed: 12/04/2022] Open
Abstract
Sparse data are available on the female-specific features of chronic thromboembolic pulmonary hypertension (CTEPH). We prospectively enrolled 160 consecutive female patients who were firstly diagnosed with CTEPH between 2013 and 2019 to explore their clinical phenotypes, treatment patterns, and long-term survival. The patients’ mean age was 54.7 ± 13.8 years, 70.6% provided a confirmed history of venous thromboembolism, 46 (28.8%) patients underwent pulmonary endarterectomy (PEA), 65 (40.6%) received balloon pulmonary angioplasty (BPA), and 49 (30.6%) were treated with medical therapy alone. The patients were followed for a median of 51 (34–70) months; three patients were lost to follow-up, and twenty-two patients died. The estimated survival rates at 1, 3, 5, and 7 years were 98.1% (95% CI 96.0–100), 96.9% (95% CI 94.2–99.6), 85.1% (95% CI 78.1–92.2), and 76.2% (95% CI 65.2–87.2), respectively. After adjusting for the confounders, the results of the multivariate Cox analysis showed that the presence of anemia (5.56, 95% CI 1.6–19.22) was associated with an increased risk of all-cause death, and compared with medical treatment, receiving PEA and BPA decreased the risk of death by 74% (0.26, 95% CI 0.07–0.97) and 86% (0.14, 95% CI 0.04–0.57), respectively. In conclusion, in the modern era of CTEPH treatment, invasive revascularization combined with targeted therapy display good clinical outcomes for females; anemia should be actively modified, which may lead to clinical improvements. (ClinicalTrials.gov Identifier: NCT05360992).
Collapse
|
38
|
Opitz I, Patella M, Lauk O, Inci I, Bettex D, Horisberger T, Schüpbach R, Keller DI, Frauenfelder T, Kucher N, Granton J, Pfammatter T, de Perrot M, Ulrich S. Acute on Chronic Thromboembolic Pulmonary Hypertension: Case Series and Review of Management. J Clin Med 2022; 11:jcm11144224. [PMID: 35887991 PMCID: PMC9317831 DOI: 10.3390/jcm11144224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct form of precapillary pulmonary hypertension classified as group 4 by the World Symposium on Pulmonary Hypertension (WSPH) and should be excluded during an episode of acute pulmonary embolism (PE). Patients presenting to emergency departments with sudden onset of signs and symptoms of acute PE may already have a pre-existing CTEPH condition decompensated by the new PE episode. Identifying an underlying and undiagnosed CTEPH during acute PE, while challenging, is an important consideration as it will alter the patients’ acute and long-term management. Differential diagnosis and evaluation require an interdisciplinary expert team. Analysis of the clinical condition, the CT angiogram, and the hemodynamic situation are important considerations; patients with CTEPH usually have significantly higher sPAP at the time of index PE, which is unusual and unattainable in the context of acute PE and a naïve right ventricle. The imaging may reveal signs of chronic disease such as right ventricle hypertrophy bronchial collaterals and atypical morphology of the thrombus. There is no standard for the management of acute on chronic CTEPH. Herein, we provide a diagnostic and management algorithm informed by several case descriptions and a review of the literature.
Collapse
Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
- Correspondence: ; Tel.: +41-44-255-88-01
| | - Miriam Patella
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
| | - Dominique Bettex
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (T.H.)
| | - Thomas Horisberger
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (T.H.)
| | - Reto Schüpbach
- Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Dagmar I. Keller
- Emergency Department, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (T.F.); (T.P.)
| | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - John Granton
- Division of Respirology, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (T.F.); (T.P.)
| | - Marc de Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, Toronto, ON M5G 2C4, Canada;
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland;
| |
Collapse
|
39
|
McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
|
40
|
Liu Z, Liu X, Lin F, Zheng X, Yang Y, Zhang Y, Fang Y, Ye Z, Liu P, Sun G, Zhen Y. Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study. J Card Surg 2022; 37:2610-2617. [PMID: 35599016 DOI: 10.1111/jocs.16615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Zhan Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Fan Lin
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xia Zheng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yuguang Yang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yajun Zhang
- Department of Surgical Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Yinghui Fang
- Department of Surgical Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Guang Sun
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| |
Collapse
|
41
|
Vrigkou E, Tsantes A, Konstantonis D, Rapti E, Maratou E, Pappas A, Halvatsiotis P, Tsangaris I. Platelet, Fibrinolytic and Other Coagulation Abnormalities in Newly-Diagnosed Patients with Chronic Thromboembolic Pulmonary Hypertension. Diagnostics (Basel) 2022; 12:diagnostics12051238. [PMID: 35626393 PMCID: PMC9141147 DOI: 10.3390/diagnostics12051238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 12/31/2022] Open
Abstract
The pathophysiological background of chronic thromboembolic pulmonary hypertension (CTEPH) has not been fully elucidated. Evidence suggests that abnormal platelet function and ineffective fibrinolysis may play a key role in the development of the disease. The purpose of this study was to evaluate platelet and coagulation function in CTEPH, using non-conventional global coagulation assays, and platelet activation and endothelial dysfunction laboratory markers. A total of 40 newly-diagnosed CTEPH patients were studied, along with 35 healthy controls. Blood samples from CTEPH patients were taken directly from the pulmonary artery. All subjects were assessed with platelet function analyzer-100, light transmission aggregometry, thromboelastometry, endogenous thrombin potential. von Willebrand antigen and activity, p-selectin, thromboxane A2 and serotonin levels were also assessed. The results showed that CTEPH patients present diminished platelet aggregation, presence of disaggregation, decreased rate of fibrinolysis, defective thrombin generation and increased levels of thromboxane A2, p-selectin, von Willebrand antigen and activity. Serotonin levels did not present any differences between the two groups. The results of this study suggest that CTEPH patients present platelet function, fibrinolytic, thrombin generation and other clot formation abnormalities. Well-designed clinical studies are needed to further evaluate the complex hemostatic abnormalities in the CTEPH setting and assess their potential clinical applications.
Collapse
Affiliation(s)
- Eleni Vrigkou
- Second Department of Critical Care Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.V.); (D.K.); (A.P.)
| | - Argirios Tsantes
- Laboratory of Hematology and Blood Bank Unit, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (E.R.)
| | - Dimitrios Konstantonis
- Second Department of Critical Care Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.V.); (D.K.); (A.P.)
| | - Evdoxia Rapti
- Laboratory of Hematology and Blood Bank Unit, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (E.R.)
| | - Eirini Maratou
- Laboratory of Clinical Biochemistry, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Athanasios Pappas
- Second Department of Critical Care Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.V.); (D.K.); (A.P.)
| | - Panagiotis Halvatsiotis
- Second Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Iraklis Tsangaris
- Second Department of Critical Care Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.V.); (D.K.); (A.P.)
- Correspondence:
| |
Collapse
|
42
|
Jenkins DP, Tsui SS, Taghavi J, Kaul P, Ali J, Ng C. Pulmonary thromboendarterectomy-the Royal Papworth experience. Ann Cardiothorac Surg 2022; 11:128-132. [PMID: 35433361 PMCID: PMC9012196 DOI: 10.21037/acs-2021-pte-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/14/2021] [Indexed: 09/18/2023]
Abstract
BACKGROUND Pulmonary thromboendarterectomy (PTE) was first introduced to the UK 25 years ago, and the UK national service is provided by a single hospital. The aim of this work is to summarize our experience and review activity and outcomes by era at a high-volume PTE center. During this period the understanding of chronic thromboembolic pulmonary hypertension (CTEPH) increased and drug treatments and balloon angioplasty were developed. We also review our contribution to the better understanding of this surgery and CTEPH. METHODS We retrospectively reviewed all patients undergoing PTE for CTEPH at our center between Jan 1997 and Sept 2019, dividing them into four equal cohorts. Pre-operative characteristics and post-operative outcomes are described by era. A MEDLINE search was performed and original scientific clinical publications from this unit were reviewed. Their contemporary relevance and influence to the evolution of the clinical service are discussed. RESULTS Over this 23-year period from the commencement of our program, 2,116 consecutive PTE were performed. The mean patient age was 57.8 years (range, 11-89 years). The first 25% of our PTE were performed over 12 years whilst the most recent 25% were performed in less than three years. Over time, the average pre-operative mean pulmonary artery pressure has not changed significantly. The 30-day mortality by era quartile has progressively fallen from 12.3% to 1.9% most recently (P<0.001). Overall, one year survival exceeded 90%. 17 publications influenced our practice development during this period. CONCLUSIONS There was a consistent increase in activity and significant improvement in outcomes between the first and last quartiles of activity studied.
Collapse
Affiliation(s)
- David P Jenkins
- Department of Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Steven S Tsui
- Department of Surgery, Royal Papworth Hospital, Cambridge, UK
| | - John Taghavi
- Department of Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Pradeep Kaul
- Department of Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Jason Ali
- Department of Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Choo Ng
- Department of Surgery, Royal Papworth Hospital, Cambridge, UK
| |
Collapse
|
43
|
López-Gude MJ, Blanco I, Benito-Arnáiz V, Castellà M, Escribano-Subías P, Martin C, Barberà JA, Cortina-Romero JM. Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: the Spanish experience. Ann Cardiothorac Surg 2022; 11:151-160. [PMID: 35433371 PMCID: PMC9012199 DOI: 10.21037/acs-2021-pte-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/10/2022] [Indexed: 09/18/2023]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) can be cured by pulmonary endarterectomy (PEA). It is considered the best and only curable treatment option for patients with accessible lesions evaluated as optimal candidates. We describe the experience of the two reference centers in Spain, in order to reinforce the need for referring CTEPH patients to a specialized center to be assessed by a Multidisciplinary Expert Team. METHODS We included a population of 338 patients who met the definition for CTEPH and underwent PEA between January 2007 and December 2019. The surgery was indicated in almost 60% of patients assessed. Demographic, anthropometric, hemodynamic and echocardiographic features are listed for PEA patients. Immediate and one-year postoperative outcomes as well as overall mortality were analyzed. RESULTS Mean age was 53.5±15.0 years, 53.8% were men; a total of 68.5% were in WHO functional class III-IV; and most of them were in a preoperative hemodynamic condition: mean pulmonary arterial pressure (mPAP) was 46.5±13.1 mmHg and mean pulmonary vascular resistance (PVR) was 764.5±392.8 dyn·s·cm-5. PEA surgery was performed with cardiopulmonary bypass (CBP) and circulatory arrest, with very few complications [including neurological, postoperative reperfusion edema, extracorporeal membrane oxygenation (ECMO) implant and cardiac failure] and optimal postoperative results, where exercise capacity increased and mPAP and PVR values decreased significantly. Presence of persistent pulmonary hypertension (PH) at the six-month right heart catheterization was evaluated. A 3.3% perioperative mortality was achieved. Overall, one-, three- and five-year survival rates were analyzed by Kaplan-Meier's method (94.8%, 93.3% and 90.5% respectively), as well as for residual PH patients. Mortality risk factors were assessed. CONCLUSIONS Outstanding PEA results were seen in the immediate, one-year and long-term outcomes. The incidence of complications, including in-hospital mortality and long-term mortality were also below European rates.
Collapse
Affiliation(s)
- María Jesús López-Gude
- Department of Cardiac Surgery, Unidad Multidisciplinar de Hipertensión Pulmonar, European Reference Network for Respiratory Diseases (ERN-lung), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona; Barcelona, Spain
- Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Victoria Benito-Arnáiz
- Department of Cardiac Surgery, Unidad Multidisciplinar de Hipertensión Pulmonar, European Reference Network for Respiratory Diseases (ERN-lung), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manel Castellà
- Department of Cardiovascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pilar Escribano-Subías
- Department of Cardiology, Unidad Multidisciplinar de Hipertensión Pulmonar, European Reference Network for Respiratory Diseases (ERN-lung), Hospital Universitario 12 de Octubre, Madrid, Spain
- Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Clara Martin
- Department of Pulmonary Medicine, Hospital Clínic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona; Barcelona, Spain
| | - Joan Albert Barberà
- Department of Pulmonary Medicine, Hospital Clínic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona; Barcelona, Spain
- Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Madrid, Spain
| | - José María Cortina-Romero
- Department of Cardiac Surgery, Unidad Multidisciplinar de Hipertensión Pulmonar, European Reference Network for Respiratory Diseases (ERN-lung), Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
44
|
Martin-Suarez S, Loforte A, Cavalli GG, Gliozzi G, Botta L, Mariani C, Orioli V, Votano D, Costantino A, Santamaria V, Tassi S, Fiaschini C, Campanini F, Palazzini M, Rossi B, Barbera NA, Niro F, Manes A, Saia F, Dardi F, Galiè N, Pacini D. Therapeutic alternatives in chronic thromboembolic pulmonary hypertension: from pulmonary endarterectomy to balloon pulmonary angioplasty to medical therapy. State of the art from a multidisciplinary team. Ann Cardiothorac Surg 2022; 11:120-127. [PMID: 35433353 PMCID: PMC9012190 DOI: 10.21037/acs-2021-pte-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/02/2022] [Indexed: 08/26/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease with a very complex pathophysiology differing from other causes of pulmonary hypertension (PH). It is an infrequent consequence of acute pulmonary embolism that is frequently misdiagnosed. Pathogenesis has been related to coagulation abnormalities, infection or inflammation, although these disturbances can be absent in many cases. The hallmarks of CTEPH are thrombotic occlusion of pulmonary vessels, variable degree of ventricular dysfunction and secondary microvascular arteriopathy. The definition of CTEPH also includes an increase in mean pulmonary arterial pressure of more than 25 mmHg with a normal pulmonary capillary wedge of less than 15 mmHg. It is classified as World Health Organization group 4 PH, and is the only type that can be surgically cured by pulmonary endarterectomy (PEA). This operation needs to be carried out by a team with strong expertise, from the diagnostic and decisional pathway to the operation itself. However, because the disease has a very heterogeneous phenotype in terms of anatomy, degree of PH and the lack of a standard patient profile, not all cases of CTEPH can be treated by PEA. As a result, PH-directed medical therapy traditionally used for the other types of PH has been proposed and is utilized in CTEPH patients. Since 2015, we have been witnessing the rebirth of balloon pulmonary angioplasty, a technique first performed in 2001 but has since fallen out fashion due to major complications. The refinement of such techniques has allowed its safe utilization as a salvage therapy in inoperable patients. In the present keynote lecture, we will describe these therapeutic approaches and results.
Collapse
Affiliation(s)
- Sofia Martin-Suarez
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Antonio Loforte
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Luca Botta
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Carlo Mariani
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Valentina Orioli
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Daniela Votano
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Antonino Costantino
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Valeria Santamaria
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Sara Tassi
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Costanza Fiaschini
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Francesco Campanini
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Massimiliano Palazzini
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Barbara Rossi
- Cardiac Anaesthesia Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Nicolò Antonino Barbera
- Cardiac Anaesthesia Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Fabio Niro
- Cardiovascular Radiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Alessandra Manes
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Fabio Dardi
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| |
Collapse
|
45
|
Faccioli E, Dell'Amore A. End-stage chronic thromboembolic pulmonary hypertension: is there still room for lung transplantation?-the past, the present and the future. Ann Cardiothorac Surg 2022; 11:161-162. [PMID: 35433359 PMCID: PMC9012202 DOI: 10.21037/acs-2021-pte-139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2023]
Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| |
Collapse
|
46
|
Verbelen T, Godinas L, Maleux G, Coolen J, Claessen G, Belge C, Meyns B, Delcroix M. Chronic thromboembolic pulmonary hypertension: diagnosis, operability assessment and patient selection for pulmonary endarterectomy. Ann Cardiothorac Surg 2022; 11:82-97. [PMID: 35433370 PMCID: PMC9012197 DOI: 10.21037/acs-2021-pte-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 07/30/2023]
Abstract
Healthcare providers outside pulmonary hypertension (PH) centers having misinformation or insufficient education, and a general lack of treatment awareness contribute to a massive underdiagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), diagnostic delay and refusal of surgery by patients. Together with the subjective operability assessment, this leads to too few patients undergoing pulmonary endarterectomy (PEA); even though this surgery results in improved survival and exercise capacity. Acute pulmonary embolism (PE) survivors should undergo a CTEPH screening strategy. Patients screened positive and those with CTEPH symptoms (with or without history of PE), should undergo transthoracic echocardiography (TTE) to determine the probability of PH. High PH probability patients should undergo a ventilation/perfusion (V/Q) scan. A negative scan rules out CTEPH. Patients with a positive V/Q scan, but also patients with findings suggestive for CTEPH on computed tomography pulmonary angiography (CTPA) to diagnose acute PE, should be referred to a CTEPH center. Further diagnostic work-up currently consists of catheter based pulmonary angiography, CTPA and right heart catheterization. However, new imaging technologies might replace them in the near future, with one single imaging tool to screen, diagnose and assess operability as the ultimate goal. Operability assessment should be performed by a multidisciplinary CTEPH team. PEA surgery should be organized in a single center per country or for each forty to fifty million inhabitants in order to offer the highest level of expertise. Informing patients about PEA should preferably be done by the treating surgeon. Based on the estimated incidence of CTEPH and with a better education of patients and healthcare providers, despite the advent of new interventional and medical therapies for CTEPH, the number of PEA surgeries performed should still have the potential to grow significantly.
Collapse
Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Coolen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Belge
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
47
|
Kroeger JR, Zöllner J, Gerhardt F, Rosenkranz S, Gertz RJ, Kerszenblat S, Pahn G, Maintz D, Bunck AC. Detection of patients with chronic thromboembolic pulmonary hypertension by volumetric iodine quantification in the lung-a case control study. Quant Imaging Med Surg 2022; 12:1121-1129. [PMID: 35111609 DOI: 10.21037/qims-21-229] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/23/2021] [Indexed: 01/23/2023]
Abstract
Background To evaluate whether volumetric iodine quantification of the lung allows for the automatic identification of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and whether the extent of pulmonary malperfusion correlates with invasive hemodynamic parameters. Methods Retrospective data base search identified 30 consecutive patients with CTEPH who underwent CT pulmonary angiography (CTPA) on a spectral-detector CT scanner. Thirty consecutive patients who underwent an identical CT examination for evaluation of suspected acute pulmonary embolism and had no signs of pulmonary embolism or PH, served as control cohort. Lungs were automatically segmented for all patients and normal and malperfused volumes were segmented based on iodine density thresholds. Results were compared between groups. For correlation analysis between the extent of malperfused volume and mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) 3 patients were excluded because of a time span of more than 30 days between CTPA and right heart catheterization. Results Patients with CTEPH had a higher percentage of malperfused lung compared to controls (43.25%±24.72% vs. 21.82%±20.72%; P=0.001) and showed reduced mean iodine density in malperfused and normal-perfused lung areas, as well as in the vessel volume. Controls showed a left-tailed distribution of iodine density in malperfused lung areas while patients with CTEPH had a more symmetrical distribution (Skew: -0.382±0.435 vs. -0.010±0.396; P=0.004). Patients with CTEPH showed a significant correlation between the percentage of malperfused lung volume and the PVR (r=0.57, P=0.001). Conclusions Volumetric iodine quantification helps to identify patients with CTEPH by showing increased areas of malperfusion. The extent of malperfusion might provide a measurement for disease severity in patients with CTEPH.
Collapse
Affiliation(s)
- Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany.,Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jakob Zöllner
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix Gerhardt
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Rosenkranz
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roman Johannes Gertz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - David Maintz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
48
|
Tzoumas A, Peppas S, Sagris M, Papanastasiou CA, Barakakis PA, Bakoyiannis C, Taleb A, Kokkinidis DG, Giannakoulas G. Advances in treatment of chronic thromboembolic pulmonary hypertension. Thromb Res 2022; 212:30-37. [DOI: 10.1016/j.thromres.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 01/29/2023]
|
49
|
Oka T, Nakanishi R, Kabuki T, Hashimoto H, Fujii T, Dobashi S, Ikeda T. Appropriate Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension Improves Right Ventricular Ejection Fraction via Lung Perfusion Scan. Int Heart J 2022; 63:91-98. [DOI: 10.1536/ihj.21-437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takashi Oka
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Takayuki Kabuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Hidenobu Hashimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Takahiro Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Shintarou Dobashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| |
Collapse
|
50
|
Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2022; 11:jcm11030625. [PMID: 35160075 PMCID: PMC8836771 DOI: 10.3390/jcm11030625] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 02/05/2023] Open
Abstract
The role of electrocardiography (ECG) in chronic thromboembolic pulmonary hypertension (CTEPH) diagnosis and prognosticating has not been yet established. We aimed to assess the relationships of the recommended ECG criteria of right ventricular hypertrophy (RVH) with clot localization in CTEPH patients. ECG patterns of RVH according to the American College of Cardiology Foundation were assessed in patients with newly diagnosed CTEPH. We enrolled 58 (45.3%) patients with proximal and 70 (54.7%) with distal CTEPH. Receiver-operating characteristics curves analysis indicated that the following ECG abnormalities predicted proximal CTEPH localization: RV1 > 6 mm—AUC 0.75 (CI: 0.66–0.84, p < 0.00001); SV6 > 3 mm—AUC 0.70 (CI: 0.60–0.79, p < 0.00001); SI > RI wave—AUC 0.67 (CI: 0.58–0.77, p = 0.0004); RV1:SV1 > 1.0—AUC 0.66 (CI: 0.56–0.76, p = 0.0009); RV1 peak > 0.035 s (QRS < 120 ms)—AUC 0.66 (CI: 0.56–0.75, p = 0.0016); RV1:SV1 > RV3(V4):SV3(V4)—AUC-0.65 (CI: 0.54–0.75, p = 0.0081); RaVR > 4 mm—AUC 0.62 (CI: 0.52–0.71, p = 0.002) and PII > 2.5 mm—AUC 0.62 (CI: 0.52–0.72, p = 0.00162). Pulmonary vascular resistance significantly correlated with amplitudes of RV1 (r = 0.34, p = 0.008), SV6 (r = 0.53, p = 0.000027) and PII (r = 0.44, p = 0.00007). In patients with CTEPH, only 8 out of 23 ECG RVH criteria were useful for differentiating between proximal and distal CTEPH localization and we found that RV1 and SV6 may contribute as potential discriminators.
Collapse
|