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Carlozzi LN, Lin CH, Steinberg ZL. Balloon Pulmonary Angioplasty for the Treatment of Chronic Thromboembolic Pulmonary Hypertension. Methodist Debakey Cardiovasc J 2024; 20:57-64. [PMID: 38765209 PMCID: PMC11100548 DOI: 10.14797/mdcvj.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/23/2024] [Indexed: 05/21/2024] Open
Abstract
Chronic thromboembolic pulmonary hypertension is a rare form of pulmonary hypertension in patients who have evidence of chronic thromboembolic occlusion of the pulmonary vasculature. Historically, surgical pulmonary thromboendarterectomy has been the treatment of choice. However, with up to 40% of patients deemed inoperable, balloon pulmonary angioplasty has emerged as an additional treatment strategy. Balloon pulmonary angioplasty is a complementary strategy alongside surgical pulmonary thromboendarterectomy and offers the opportunity for pulmonary revascularization in patients who have more distal disease, higher comorbidities, or residual obstruction following operative intervention. This review examines the history of balloon pulmonary angioplasty, highlights its effectiveness, discusses important complications and risk reduction strategies, and emphasizes the importance of centers forming a multidisciplinary team of providers to manage the complexity of patients with chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
| | - C. Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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Kanezawa M, Shimokawahara H, Ejiri K, Goten C, Okada H, Sato K, Yuasa S, Matsubara H. Effects of medical therapy and age on cardiac output changes following balloon pulmonary angioplasty: Implications for combination therapy in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2024:S1053-2498(24)01661-9. [PMID: 38759765 DOI: 10.1016/j.healun.2024.05.007] [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: 02/06/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Some patients with chronic thromboembolic pulmonary hypertension (CTEPH) exhibit exercise intolerance due to reduced cardiac output (CO) even after successful balloon pulmonary angioplasty (BPA). Medical therapy is a potential option for such cases; however, it is unclear which patients necessitate it even after BPA. METHODS This study included 286 patients with CTEPH who underwent BPA and right heart catheterization one year after the final BPA and classified them into No-medication and Withdrawal groups. The No-medication group comprised patients without pulmonary hypertension (PH) medications before and after BPA, while the Withdrawal group included patients who received PH medications before BPA and discontinued them after BPA. We assessed differences in the changes in CO after BPA from baseline (ΔCO) between the two groups. Additionally, we evaluated the ΔCO among different age categories within each group: younger (< 60 years), middle-aged (60 to 70 years), and older-adults (≥ 70 years). RESULTS After adjusting baseline covariates, overall ΔCO did not differ significantly. However, ΔCO was significantly increased in No-medication group but decreased in Withdrawal group (0.32 and -0.33, difference in ΔCO: -0.65, 95% confidence intervals: -0.90 to -0.40). A significantly positive effect on ΔCO was observed only in younger individuals, with a significant interaction between age and ΔCO in both groups. CONCLUSIONS Increasing CO with BPA alone may be challenging with age in patients with CTEPH. Given that discontinuation of PH medication after BPA decreased CO more than the effect of BPA, medical therapy might be necessary even after successful BPA.
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Affiliation(s)
- Misaki Kanezawa
- 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
| | - Hiroto Shimokawahara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chiaki Goten
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hirofumi Okada
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Kimi Sato
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
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Xie L, Lan P, Liu M, Zhou K. ECMO management for severe pulmonary embolism with concurrent cerebral hemorrhage: a case report. Front Cardiovasc Med 2024; 11:1410134. [PMID: 38803663 PMCID: PMC11128567 DOI: 10.3389/fcvm.2024.1410134] [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: 03/31/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Background Acute pulmonary embolism (APE) is a common and potentially fatal cardiovascular disease that can lead to sudden cardiac arrest in severe cases. When conventional cardiopulmonary resuscitation measures fail to achieve the return of spontaneous circulation (ROSC) in patients with APE, venoarterial extracorporeal membrane oxygenation (ECMO) becomes a viable therapeutic option. As an advanced life support treatment, ECMO ensures the perfusion of critical organs, providing sufficient time for interventions necessary for ROSC. Case introduction We report the case of a patient who experienced cardiac arrest due to pulmonary embolism. During the treatment, the patient received two sessions of external cardiopulmonary resuscitation (ECPR) as supportive care and experienced cerebral hemorrhage. Ultimately, the patient improved and was discharged following support from extracorporeal membrane oxygenation (ECMO), careful anticoagulation strategies, and intervention with balloon pulmonary angioplasty. Conclusion ECMO can serve as an important life support technology for patients with severe APE. Through a cautious anticoagulation therapy, not only was the ECMO support successfully maintained but also was further deterioration of cerebral hemorrhage effectively prevented. For patients with concurrent main pulmonary artery embolism and bleeding, balloon pulmonary angioplasty may be an option.
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Affiliation(s)
| | | | | | - Kechun Zhou
- Department of Emergency, Lishui Central Hospital, Zhejiang, China
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Kayali SM, Dietz BE, Siddiq BS, Ghaly M, Owens TS, Khouzam RN. Chronic thromboembolic pulmonary hypertension and balloon pulmonary angioplasty - Where are we in 2024? Curr Probl Cardiol 2024; 49:102481. [PMID: 38401824 DOI: 10.1016/j.cpcardiol.2024.102481] [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: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Pulmonary endarterectomy (PEA) is the first-line treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients with CTEPH are considered inoperable, and in the last decade, balloon pulmonary angioplasty (BPA) has emerged as a viable therapeutic option for these patients with prohibitive surgical risk or recurrent pulmonary hypertension following PEA. Numerous international centers have increased their procedural volume of BPA and have reported improvements in pulmonary hemodynamics, patient functional class and right ventricular function. Randomized controlled trials have also demonstrated similar findings. Recent refinements in procedural technique, increased operator experience and advancements in procedural technology have facilitated marked reduction in the risk of complications following BPA. Current guidelines recommend BPA for patients with inoperable CTEPH and persistent pulmonary hypertension following PEA. The pulmonary arterial endothelium plays a vital role in the pathophysiologic development and progression of CTEPH.
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Affiliation(s)
- Sharif M Kayali
- University of Tennessee Health Sciences Center, Department of Cardiovascular Medicine, Memphis, TN.
| | - Bernhard E Dietz
- University of Tennessee Health Sciences Center, Department of Internal Medicine, Memphis, TN
| | - Bilal S Siddiq
- University of Tennessee Health Sciences Center, College of Medicine, Memphis, TN
| | - Michael Ghaly
- Baptist Memorial Hospital - North Mississippi, Department of Internal Medicine, Oxford, MS
| | - Timothy S Owens
- University of Tennessee Health Sciences Center, College of Medicine, Memphis, TN
| | - Rami N Khouzam
- Interventional Cardiologist at the Grand Strand Medical Center, Myrtle Beach, SC; Professor, School of Medicine, University of South Carolina, Columbia SC; Professor, Edward Via College of Osteopathic Medicine, Blacksburg, VA; Professor, at the Mercer School of Medicine, Savannah, GA; Professor, University of Tennessee College of Medicine, Memphis, TN
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Ma Y, Guo D, Wang J, Gong J, Hu H, Zhang X, Wang Y, Yang Y, Lv X, Li Y. Effects of right ventricular remodeling in chronic thromboembolic pulmonary hypertension on the outcomes of balloon pulmonary angioplasty: a 2D-speckle tracking echocardiography study. Respir Res 2024; 25:164. [PMID: 38622598 PMCID: PMC11020924 DOI: 10.1186/s12931-024-02803-4] [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: 10/23/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) improves the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricle (RV) is an important predictor of prognosis in CTEPH patients. 2D-speckle tracking echocardiography (2D-STE) can evaluate RV function. This study aimed to evaluate the effectiveness of BPA in CTEPH patients and to assess the value of 2D-STE in predicting outcomes of BPA. METHODS A total of 76 patients with CTEPH underwent 354 BPA sessions from January 2017 to October 2022. Responders were defined as those with mean pulmonary artery pressure (mPAP) ≤ 30 mmHg or those showing ≥ 30% decrease in pulmonary vascular resistance (PVR) after the last BPA session, compared to baseline. Logistic regression analysis was performed to identify predictors of BPA efficacy. RESULTS BPA resulted in a significant decrease in mPAP (from 50.8 ± 10.4 mmHg to 35.5 ± 11.9 mmHg, p < 0.001), PVR (from 888.7 ± 363.5 dyn·s·cm-5 to 545.5 ± 383.8 dyn·s·cm-5, p < 0.001), and eccentricity index (from 1.3 to 1.1, p < 0.001), and a significant increase in RV free wall longitudinal strain (RVFWLS: from 15.7% to 21.0%, p < 0.001). Significant improvement was also observed in the 6-min walking distance (from 385.5 m to 454.5 m, p < 0.001). After adjusting for confounders, multivariate analysis showed that RVFWLS was the only independent predictor of BPA efficacy. The optimal RVFWLS cutoff value for predicting BPA responders was 12%. CONCLUSIONS BPA was found to reduce pulmonary artery pressure, reverse RV remodeling, and improve exercise capacity. RVFWLS obtained by 2D-STE was an independent predictor of BPA outcomes. Our study may provide a meaningful reference for interventional therapy of CTEPH.
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Affiliation(s)
- Yaning Ma
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dichen Guo
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Jianfeng Wang
- Department of Intervention, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juanni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huimin Hu
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xinyuan Zhang
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yeqing Wang
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiuzhang Lv
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yidan Li
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Aggarwal V, Giri J, Visovatti SH, Mahmud E, Matsubara H, Madani M, Rogers F, Gopalan D, Rosenfield K, McLaughlin VV. Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1090-e1107. [PMID: 38450477 DOI: 10.1161/cir.0000000000001197] [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] [Indexed: 03/08/2024]
Abstract
Balloon pulmonary angioplasty continues to gain traction as a treatment option for patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. Recent European Society of Cardiology guidelines on pulmonary hypertension now give balloon pulmonary angioplasty a Class 1 recommendation for inoperable and residual chronic thromboembolic pulmonary hypertension. Not surprisingly, chronic thromboembolic pulmonary hypertension centers are rapidly initiating balloon pulmonary angioplasty programs. However, we need a comprehensive, expert consensus document outlining critical concepts, including identifying necessary personnel and expertise, criteria for patient selection, and a standardized approach to preprocedural planning and establishing criteria for evaluating procedural efficacy and safety. Given this lack of standards, the balloon pulmonary angioplasty skill set is learned through peer-to-peer contact and training. This document is a state-of-the-art, comprehensive statement from key thought leaders to address this gap in the current clinical practice of balloon pulmonary angioplasty. We summarize the current status of the procedure and provide a consensus opinion on the role of balloon pulmonary angioplasty in the overall care of patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. We also identify knowledge gaps, provide guidance for new centers interested in initiating balloon pulmonary angioplasty programs, and highlight future directions and research needs for this emerging therapy.
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Torbicki A, Kurzyna M. MERIT reloaded-what has changed in CTEPH management since 2017? THE LANCET. RESPIRATORY MEDICINE 2024; 12:263-265. [PMID: 38548405 DOI: 10.1016/s2213-2600(24)00040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Europejskie Centrum Zdrowia Otwock (ERN-LUNG), Otwock 05-400, Poland.
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Europejskie Centrum Zdrowia Otwock (ERN-LUNG), Otwock 05-400, Poland
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Hersi K, Ramani GV, Law JY, Sadek AS, Vaidya A, Gladwin MT, Cassady SJ. Diagnosis and management of chronic thromboembolic pulmonary hypertension (CTEPH) in sickle cell disease: A review. Pulm Circ 2024; 14:e12362. [PMID: 38803827 PMCID: PMC11128985 DOI: 10.1002/pul2.12362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 05/29/2024] Open
Abstract
Pulmonary hypertension in sickle cell disease (SCD) is a complex phenomenon resulting from multiple overlapping etiologies, including pulmonary vasoconstriction in the setting of chronic hemolytic anemia, diastolic dysfunction, and chronic thromboembolic disease. The presence of pulmonary hypertension of any cause in SCD confers a significant increase in mortality risk. Evidence to guide the management of patients with sickle cell disease and chronic thromboembolic pulmonary hypertension (CTEPH) is scant and largely the realm of case reports and small case series. Centered on a discussion of a complex young patient with hemoglobin hemoglobin SC who ultimately underwent treatment with pulmonary thromboendarterectomy, we review the available literature to guide management and discuss and overview of treatment of CTEPH in SCD, considering the unique considerations and challenges facing patients suffering from this multisystem disease.
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Affiliation(s)
- Kadija Hersi
- Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Gautam V. Ramani
- Division of Cardiology, Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Jennie Y. Law
- Division of Hematology and Oncology, Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Ahmed S. Sadek
- Division of Cardiology, Department of MedicineLewis Katz School of Medicine at TemplePhiladelphiaPennsylvaniaUSA
| | - Anjali Vaidya
- Division of Cardiology, Department of MedicineLewis Katz School of Medicine at TemplePhiladelphiaPennsylvaniaUSA
| | - Mark T. Gladwin
- Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Steven J. Cassady
- Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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9
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Prins KW, Durbin J, Archer SL. Complete Revascularization of the Pulmonary Circulation in Chronic Thromboembolic Pulmonary Hypertension: Value of Addressing Chronic Total Occlusions. Can J Cardiol 2024; 40:634-636. [PMID: 38030122 PMCID: PMC11009058 DOI: 10.1016/j.cjca.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Kurt W Prins
- Cardiovascular Division, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josh Durbin
- Department of Medicine (Cardiology), Queen's University, Kingston, Ontario, Canada
| | - Stephen L Archer
- Department of Medicine (Cardiology), Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Öngen HG, Akdeniz B, Düzenli MA, Chernyavsky A, Dabar G, Idrees M, Khludeeva E, Kültürsay H, Lukianchikova V, Martynyuk T, Moğulkoç N, Mukarov MA, Mutlu B, Okumuş G, Omarov A, Önen ZP, Sakkijha H, Shostak N, Simakova M, Tokgözoğlu L, Tomskaya T, Yildirim H, Zateyshchikov D, Hechenbichler K, Kessner S, Schauerte I, Turgut N, Vogtländer K, Aldalaan A. Diagnosis and Treatment Patterns of Chronic Thromboembolic Pulmonary Hypertension in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia: A Registry Study. Drugs Real World Outcomes 2024; 11:149-165. [PMID: 38381283 DOI: 10.1007/s40801-023-00407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries. OBJECTIVE This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia. METHODS A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3 years' observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population. RESULTS The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142 patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%. CONCLUSIONS These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common. CLINICALTRIALS gov: NCT02637050; registered December 2015.
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Affiliation(s)
- Hürrem Gül Öngen
- Cerrahpasa Faculty of Medicine, Istanbul University, 34098, Istanbul, Turkey.
| | - Bahri Akdeniz
- Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | | | - Alexander Chernyavsky
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | - Majdy Idrees
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elena Khludeeva
- State Budgetary Healthcare Institution, Primorskaya Regional Clinical Hospital No. 1, Vladivostok, Russia
| | | | - Vera Lukianchikova
- Regional State Budgetary Healthcare Institution, Regional Clinical Hospital No. 1, Khabarovsk, Russia
| | - Tamila Martynyuk
- Federal State Budget Institution, National Medical Center of Cardiology, Moscow, Russia
| | | | - Murat A Mukarov
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Bülent Mutlu
- Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Gülfer Okumuş
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anuar Omarov
- Institute of Cardiology in Almaty, Almaty, Kazakhstan
| | | | | | - Nadezhda Shostak
- State Budgetary Healthcare Institution, Pirogov City Clinical Hospital No. 1 of Moscow City, Moscow, Russia
| | - Maria Simakova
- Federal State Budgetary Institution, Almazov National Medical Research Center, Saint Petersburg, Russia
| | | | - Tatyana Tomskaya
- State Budgetary Institution of the Republic of Sakha (Yakutia), Republican Hospital No. 1, Yakutsk, Russia
| | | | - Dmitry Zateyshchikov
- State Budgetary Healthcare Institution, City Clinical Hospital No. 51 of Moscow Health Department, Moscow, Russia
| | | | | | | | | | | | - Abdullah Aldalaan
- Department of Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Piliero N, Salvat M, Finas M, Curioz F, Traclet J, Ahmad K, Bertoletti L, Vautrin E, Bouvaist H, Degano B. Upfront triple therapy with parenteral prostanoid as a bridge to balloon pulmonary angioplasty in severe chronic thromboembolic pulmonary hypertension. ERJ Open Res 2024; 10:00085-2024. [PMID: 38444667 PMCID: PMC10910263 DOI: 10.1183/23120541.00085-2024] [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: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
In patients with very severe CTEPH eligible for BPA, it is possible to achieve major haemodynamic improvement with upfront triple PH therapy including epoprostenol and then to perform angioplasties https://bit.ly/3vZZvib.
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Affiliation(s)
- Nicolas Piliero
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Muriel Salvat
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Mathieu Finas
- Service de Radiologie, CHU Grenoble Alpes, Grenoble, France
| | - Florence Curioz
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Julie Traclet
- Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Hôpital Louis-Pradel, Université de Lyon, Lyon, France
| | - Kaïs Ahmad
- Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Hôpital Louis-Pradel, Université de Lyon, Lyon, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Équipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | - Estelle Vautrin
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- INSERM U1300, Laboratoire HP2, Université Grenoble Alpes, Grenoble, France
- Service de Pneumologie, CHU Grenoble Alpes, Grenoble, France
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12
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Ribas Sola J, Sánchez-Corral Mena MÁ, Riera-Mestre A. [Update in the management of chronic thrombo-embolic pulmonary hypertension]. Med Clin (Barc) 2024; 162:126-133. [PMID: 37925273 DOI: 10.1016/j.medcli.2023.08.006] [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: 07/12/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 11/06/2023]
Abstract
Chronic thrombo-embolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension (PH) that develops in up to 3% of patients after pulmonary embolism (PE). In these patients, PE does not resolve, leading to organized fibrotic clots, with the development of precapillary PH as a result of the proximal obstruction of the pulmonary arteries. In addition, a distal microvasculopathy may also develop, contributing to the increase of pulmonary vascular resistance. Transthoracic echocardiography is the diagnostic tool that allows to establish the suspicion of PH. Ventilation-perfusion lung scintigraphy is the fundamental tool in the study of patients with suspected CTEPH; if it is normal, virtually rules out the diagnosis. Right heart catheterization is mandatory for the diagnosis of these patients. CTEPH is defined as the existence of symptoms, residual perfusion defects and precapillary PH after a minimum period of three months of anticoagulation. Pulmonary angiography helps determine the extent and surgical accessibility of thromboembolic lesions. CTEPH patients are candidates for long-term anticoagulation. Pulmonary endarterectomy is the treatment of choice, resulting in significant clinical and hemodynamic improvement. About 25% of patients have residual PH post-endarterectomy. Balloon pulmonary angioplasty is an endovascular technique that targets more distal lesions, being potentially useful for patients with inoperable CTEPH or persistent/recurrent PH post-endarterectomy. Both types of patients may also benefit from pharmacological treatment for PH. These three therapies are the cornerstone of CTEPH treatment, which has evolved towards a multimodal approach.
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Affiliation(s)
- Jesús Ribas Sola
- Unidad de Enfermedades Vasculares Pulmonares, Servicio de Neumología, Hospital Universitari de Bellvitge, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España.
| | - Miguel Ángel Sánchez-Corral Mena
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; Unidad de Imagen Cardiaca Avanzada, Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, España
| | - Antoni Riera-Mestre
- Unidad de Imagen Cardiaca Avanzada, Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, España; Unidad Funcional de ETV, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, España.
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13
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Khan S, Randhawa S, Patail H, Spira Y, Frishman WH, Aronow WS, Lanier GM. Pharmacological Update and Emerging Treatments of Pulmonary Hypertension. Cardiol Rev 2024:00045415-990000000-00192. [PMID: 38294225 DOI: 10.1097/crd.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Pulmonary hypertension (PH) is defined as elevated pressures in the pulmonary artery and is associated with significant morbidity and mortality. The World Health Organization classifies PH into 5 distinct groups based on underlying etiology, pathology, and modality of treatment. Therapeutic approach may be challenging due to the extensive spectrum of causes and underlying mechanisms mediating PH. The 5 groups include pulmonary arterial hypertension (group 1), PH secondary to left heart disease (group 2), PH secondary to chronic lung disease (group 3), chronic thromboembolic pulmonary hypertension (group 4), and PH due to miscellaneous causes (group 5). Although significant progress has been made in the treatment of group 1 PH, there is a continued need to develop new therapies for all types of PH. Additionally, most treatments currently available improve functional capacity and symptoms but without a significant benefit in mortality. In this review, we aim to describe the various etiologies of PH and their established pharmacotherapies, as well as expand on emerging therapeutic options for each group.
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Affiliation(s)
- Shazli Khan
- From the Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Sukhbir Randhawa
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY
| | - Haris Patail
- Department of Internal Medicine, University of Connecticut School of Medicine, Hartford, CT
| | - Yaakov Spira
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - William H Frishman
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Gregg M Lanier
- From the Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
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14
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Darie AM. Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension - Holy Grail or Holy Trinity? Int J Cardiol 2024; 395:131423. [PMID: 37813284 DOI: 10.1016/j.ijcard.2023.131423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Andrei M Darie
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
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15
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Cullivan S, Boucly A, Jevnikar M, Lechartier B, Ulrich S, Bertoletti L, Sitbon O, Vonk-Noordegraaf A, Bokan A, Park DH, Genecand L, Guiot J, Jutant EM, Piccari L, Lichtblau M. ERS International Congress 2023: highlights from the Pulmonary Vascular Diseases Assembly. ERJ Open Res 2024; 10:00847-2023. [PMID: 38410705 PMCID: PMC10895433 DOI: 10.1183/23120541.00847-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 02/28/2024] Open
Abstract
Pulmonary vascular diseases such as pulmonary embolism and pulmonary hypertension are important and frequently under-recognised conditions. This article provides an overview of key highlights in pulmonary vascular diseases from the European Respiratory Society International Congress 2023. This includes insights into disease modification in pulmonary arterial hypertension and novel therapies such as sotatercept and seralutinib. Exciting developments in our understanding of the mechanisms underpinning pulmonary hypertension associated with interstitial lung disease are also explored. A comprehensive overview of the complex relationship between acute pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) is provided along with our current understanding of the molecular determinants of CTEPH. The importance of multidisciplinary and holistic care cannot be understated, and this article also addresses advances beyond medication, with a special focus on exercise training and rehabilitation.
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Affiliation(s)
- Sarah Cullivan
- The National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Athénaïs Boucly
- National Heart and Lung Institute, Imperial College London, London, UK
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PulmoTension, Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PulmoTension, Le Kremlin-Bicêtre, France
| | - Benoit Lechartier
- Service de Pneumologie, Département de Médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Silvia Ulrich
- Clinic of Pulmonology, Pulmonary Hypertension Unit, University Hospital Zurich, Zurich, Switzerland
| | - Laurent Bertoletti
- Département of Médecine Vasculaire et Thérapeutique, Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Mines Saint-Étienne, INSERM, SAINBIOSE U1059, CIC 1408, Saint-Étienne, France
| | - Olivier Sitbon
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PulmoTension, Le Kremlin-Bicêtre, France
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aleksandar Bokan
- SLK Clinics, Department of Pneumonology and Intensive Care Medicine, Loewenstein, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Leon Genecand
- Division of Pulmonary Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Guiot
- Department of Respiratory Medicine, University Hospital of Liège (CHU Liège), Liège, Belgium
- GIGA I Research Group, Laboratory of Respiratory Medicine, Vascular and Interstitial Lung Disease Unit and Fibropole Research Group, University of Liège, Liège, Belgium
| | - Etienne-Marie Jutant
- Respiratory Department, CHU de Poitiers, INSERM CIC 1402, IS-ALIVE Research Group, University of Poitiers, Poitiers, France
| | - Lucilla Piccari
- Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain
| | - Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension Unit, University Hospital Zurich, Zurich, Switzerland
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16
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Wang J, Liu J, Tao X, Xie W, Wang S, Zhang S, Zhang Z, Fu Z, Li H, Zhang Y, Li Y, Li X, Zhang Y, Xi L, Liu D, Huang Q, Zhao Y, Zhai Z. Safety and efficacy of balloon pulmonary angioplasty for technically operable chronic thromboembolic pulmonary hypertension. Pulm Circ 2024; 14:e12327. [PMID: 38162296 PMCID: PMC10756009 DOI: 10.1002/pul2.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
Balloon pulmonary angioplasty (BPA) has been proven effective for addressing technically inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the effectiveness of BPA in technically operable CTEPH patients who, for various reasons, did not undergo the procedure remains an area requiring exploration. This study sought to assess the safety and efficacy of BPA in such cases. We collected and reviewed data from CTEPH patients who underwent BPA in a consecutive manner. Following multidisciplinary team (MDT) decisions, patients were classified into two groups: technically inoperable (group A) and operable (group B). Group B comprised patients deemed technically suitable for pulmonary endarterectomy (PEA) but who did not undergo the procedure for various reasons. All patients underwent a comprehensive diagnostic work-up, including right heart categorization at baseline and the last intervention. This study compared changes in hemodynamic parameters, functional capacity, and quality of life between the two groups. In total, 161 patients underwent 414 procedures at our center, with Group A comprising 112 patients who underwent 282 BPA sessions and group B comprising 49 patients who underwent 132 BPA sessions. Significantly, both groups exhibited improvements in hemodynamics, functional capacity, and quality of life. The occurrence rate of complications, including hemoptysis and lung injury, was similar [12 (63.2%) vs. 7 (36.8%), p = 0.68]. BPA demonstrated favorable outcomes in patients with proximal CTEPH who did not undergo pulmonary endarterectomy. However, the clinical impact of BPA in technically operable CTEPH was found to be less significant than in inoperable cases.
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Affiliation(s)
- Jinzhi Wang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Jixiang Liu
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xincao Tao
- Chinese Academy of Medical Sciences Fuwai Hospital Center for Respiratory and Pulmonary Vascular DiseasesBeijingChina
| | - Wanmu Xie
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
| | - Shengfeng Wang
- Department of Epidemiology and BiostatisticsPeking University School of Public HealthBeijingChina
| | - Shuai Zhang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zhu Zhang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zhihui Fu
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- Key Laboratory of Epidemiology of Major Diseases (Peking University)Ministry of EducationBeijingChina
| | - Haobo Li
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- Key Laboratory of Epidemiology of Major Diseases (Peking University)Ministry of EducationBeijingChina
| | - Yunjing Zhang
- Department of Epidemiology and BiostatisticsPeking University School of Public HealthBeijingChina
| | - Yishan Li
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Xincheng Li
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- The First Clinical Medical CollegeShanxi Medical UniversityTaiyuanChina
| | - Yu Zhang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- Department of Pulmonary and Critical Care MedicineSecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Linfeng Xi
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- Department of Pulmonary and Critical Care MedicineSecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Dong Liu
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
- China‐Japan Friendship HospitalCapital Medical UniversityBeijingChina
| | - Qiang Huang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
| | - Yunwei Zhao
- Peking University China‐Japan Friendship School of Clinical MedicineBeijingChina
| | - Zhenguo Zhai
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical SciencesBeijingChina
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17
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Yin Q, Zheng X, Song Y, Wu L, Li L, Tong R, Han L, Bian Y. Decoding signaling mechanisms: unraveling the targets of guanylate cyclase agonists in cardiovascular and digestive diseases. Front Pharmacol 2023; 14:1272073. [PMID: 38186653 PMCID: PMC10771398 DOI: 10.3389/fphar.2023.1272073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Soluble guanylate cyclase agonists and guanylate cyclase C agonists are two popular drugs for diseases of the cardiovascular system and digestive systems. The common denominator in these conditions is the potential therapeutic target of guanylate cyclase. Thanks to in-depth explorations of their underlying signaling mechanisms, the targets of these drugs are becoming clearer. This review explains the recent research progress regarding potential drugs in this class by introducing representative drugs and current findings on them.
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Affiliation(s)
- Qinan Yin
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xingyue Zheng
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yujie Song
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liuyun Wu
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lian Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lizhu Han
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Bian
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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18
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Sato S, Ito T, Tabata T, Ogawa A, Saiki A, Shimizu K. Effect of balloon pulmonary angioplasty on cardio-ankle vascular index and biventricular remodeling in patients with chronic thromboembolic pulmonary hypertension. Front Cardiovasc Med 2023; 10:1325846. [PMID: 38107257 PMCID: PMC10722157 DOI: 10.3389/fcvm.2023.1325846] [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: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by organized pulmonary thrombi, and pulmonary endarterectomy is the only curative treatment. Since balloon pulmonary angioplasty (BPA) has become an established therapeutic option for inoperable CTEPH, prognosis has improved. Recent reports suggest that arterial stiffness evaluated using the cardio-ankle vascular index (CAVI) may play an important role in the cardio-vascular interaction in CTEPH; however, the details remain unclear. This study aimed to clarify the role of CAVI in CTEPH through hemodynamic changes and ventricular remodeling after BPA. Methods and results A total of 23 patients with CTEPH who had undergone BPA were enrolled in this study. The mean pulmonary artery pressure (mPAP) and CAVI significantly decreased after BPA [mPAP, 34 (26-45) mmHg to 20 (19-24) mmHg, p < 0.0001; CAVI, 9.4 (8.0-10.3) to 8.3 (7.5-9.6), p = 0.004]. The echocardiographic right ventricle was significantly decreased, and the left ventricular volume was significantly increased after BPA, indicating significant biventricular remodeling after BPA. Changes in CAVI (ΔCAVI) significantly correlated with changes in mPAP (r = 0.45, p = 0.03). Additionally, ΔCAVI was significantly correlated with changes in both right ventricular area and left ventricular volume. Conclusions Arterial stiffness, evaluated using the CAVI, improved after BPA. Changes in CAVI were significantly correlated with changes in pulmonary arterial pressure and biventricular remodeling. CAVI may play an important role in cardiovascular interactions in patients with CTEPH.
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Affiliation(s)
- Shuji Sato
- Division of Cardiology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Takuro Ito
- Division of Cardiology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Tsuyoshi Tabata
- Department of Clinical Functional Physiology, Toho University Sakura Medical Center, Chiba, Japan
| | - Akihiro Ogawa
- Department of Rehabilitation, Toho University Sakura Medical Center, Chiba, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Kazuhiro Shimizu
- Division of Cardiology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
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19
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Guarino D, Ballerini A, Manes A. What changed after the 2022 guidelines for pulmonary hypertension? Eur J Intern Med 2023; 118:38-40. [PMID: 37919122 DOI: 10.1016/j.ejim.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Daniele Guarino
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
| | - Alberto Ballerini
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy
| | - Alessandra Manes
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy; Cardio-Thoracic-Vascular Department, IRCCS Sant'Orsola University Hospital, Bologna, Italy
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20
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Ito R, Yamashita J, Ikeda S, Nakajima Y, Kasahara T, Sasaki Y, Suzuki S, Takahashi L, Komatsu I, Murata N, Shimahara Y, Ogino H, Chikamori T. Predictors of procedural complications in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. J Cardiol 2023; 82:497-503. [PMID: 37380068 DOI: 10.1016/j.jjcc.2023.06.011] [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: 02/07/2023] [Revised: 05/02/2023] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) is an effective treatment for inoperable chronic thromboembolic pulmonary hypertension, with good results reported for residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). However, BPA is associated with complications, such as pulmonary artery perforation and vascular injury, which can lead to critical pulmonary hemorrhage requiring embolization and mechanical ventilation. Furthermore, the risk factors for occurrence of complications in BPA are unclear; therefore, this study aimed to evaluate predictors of procedural complications in BPA. METHODS In this retrospective study, we collected clinical data (patient characteristics, details of medical therapy, hemodynamic parameters, and details of the BPA procedure) from 321 consecutive sessions involving 81 patients who underwent BPA. Procedural complications were evaluated as endpoints. RESULTS BPA for residual PH after PEA was performed in 141 sessions (43.9 %), which involved 37 patients. Procedural complications were observed in 79 sessions (24.6 %), including severe pulmonary hemorrhage requiring embolization in 29 sessions (9.0 % of all sessions). No patients experienced severe complications requiring intubation with mechanical ventilation or extracorporeal membrane oxygenation. Age ≥ 75 years and mean pulmonary artery pressure ≥ 30 mmHg were independent predictors of procedural complications. Residual PH after PEA was a significant predictor of severe pulmonary hemorrhage requiring embolization (adjusted odds ratio, 3.048; 95 % confidence interval, 1.042-8.914, p = 0.042). CONCLUSIONS Older age, high pulmonary artery pressure, and residual PH after PEA increase the risk of severe pulmonary hemorrhage requiring embolization in BPA.
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Affiliation(s)
- Ryosuke Ito
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan.
| | - Sayo Ikeda
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuki Nakajima
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tomohiro Kasahara
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuichi Sasaki
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shun Suzuki
- Department of Cardiovascular Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Lisa Takahashi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ikki Komatsu
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Naotaka Murata
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Taishiro Chikamori
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
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21
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Delcroix M, Belge C, Maleux G, Godinas L. Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:840-850. [PMID: 37567250 DOI: 10.1055/s-0043-1770122] [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: 08/13/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. The reasons why clots do not resorb are incompletely understood, but the result is partial or complete fibrothrombotic obstruction of pulmonary arteries. A secondary microvasculopathy aggravates the pulmonary hypertension (PH) as a consequence of high flow and shear stress in the nonoccluded arteries. The treatment of CTEPH has long been purely surgical, but many patients were inoperable because of inaccessible lesions or severe comorbidities. Alternatives were developed, including medical therapy and more recently balloon pulmonary angioplasty (BPA). Depending on the generation of the obstructed vessels, the treatment will be surgical, up to the (sub)segmental level, or by BPA for more distal vessels. PH drugs are used to treat the microvasculopathy. The current paper describes the therapeutic management of inoperable patients: the medical approach with PH drugs used in mono- or combination therapy; the proper use of anticoagulants in CTEPH; the technique, indications, and results at short- and long-term of BPA; the multimodal approach for inoperable patients combining PH drugs and BPA; and the effects of rehabilitation. It shows the importance of a multidisciplinary approach to the disease.
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Affiliation(s)
- Marion Delcroix
- Clinical Department of Respiratory Diseases, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven-University of Leuven, University Hospitals of Leuven, Leuven, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven-University of Leuven, University Hospitals of Leuven, Leuven, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Belgium
| | - Geert Maleux
- Clinical Department of Radiology, University Hospitals of Leuven, Leuven, Belgium
| | - Laurent Godinas
- Clinical Department of Respiratory Diseases, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven-University of Leuven, University Hospitals of Leuven, Leuven, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Belgium
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Lichtblau M, Titz A, Bahrampoori B, Schmiedeskamp M, Ulrich S. What changed after the 2022 guidelines for pulmonary hypertension? Eur J Intern Med 2023; 118:1-5. [PMID: 37673774 DOI: 10.1016/j.ejim.2023.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
With an estimated prevalence of around 1%, pulmonary hypertension (PH) presents a relevant burden worldwide. In this review, we aim to give an overview of the novelties from the revised European Society of Cardiology (ESC) /European Respiratory Society (ERS) guidelines for the diagnosis and treatment of PH and their implication for the everyday clinical practice.
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Affiliation(s)
- Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| | - Anna Titz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Mark Schmiedeskamp
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
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23
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Dardi F, Rotunno M, Guarino D, Suarez SM, Niro F, Loforte A, Taglieri N, Ballerini A, Magnani I, Bertozzi R, Donato F, Martini G, Manes A, Saia F, Pacini D, Galiè N, Palazzini M. Comparison of different treatment strategies in patients with chronic thromboembolic pulmonary hypertension: a single centre real-world experience. Int J Cardiol 2023; 391:131333. [PMID: 37673403 DOI: 10.1016/j.ijcard.2023.131333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, there is a substantial proportion of patients deemed not operable in whom other treatment strategies are available: medical therapy and balloon pulmonary angioplasty (BPA). We aimed to compare different CTEPH treatment strategies effect in a real-world setting. METHODS All patients with CTEPH referred to our centre were included. We compare the short-term clinical, functional, exercise and haemodynamic effect of medical therapy (irrespective of subsequent treatment strategies), PEA and BPA (irrespective of previous/subsequent treatment strategies); we also describe the long-term outcome of the different patient groups. RESULTS We included 467 patients (39% were treated only with medical therapy, 43% underwent PEA, 13% underwent BPA and 5% were not treated with any therapy). Patients treated only with medical therapy were the oldest; compared to patients undergoing PEA, they had a lower exercise capacity, a higher risk profile and gained a lower haemodynamic, functional and survival benefit from the treatment. Patients undergoing BPA had a lower haemodynamic improvement but a comparable functional, exercise and risk improvement and a similar survival compared to patients undergoing PEA; their survival is anyway better than patients undergoing only medical treatment. Untreated historical control patients had the worst survival. CONCLUSIONS We confirm the superiority of PEA compared to any alternative treatment in CTEPH patients and we observe that BPA, in patients deemed not operable or with persistent/recurrent PH after PEA, leads to a better outcome than medical therapy alone.
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Affiliation(s)
- Fabio Dardi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy.
| | - Mariangela Rotunno
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Daniele Guarino
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Sofia Martin Suarez
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Fabio Niro
- Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Antonio Loforte
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Alberto Ballerini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Ilenia Magnani
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Riccardo Bertozzi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Federico Donato
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Giulia Martini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Alessandra Manes
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Davide Pacini
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Massimiliano Palazzini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
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24
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Nakazato K, Sugimoto K, Oikawa M, Takeishi Y. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension:its history and development, and regional medical cooperation in Fukushima. Fukushima J Med Sci 2023; 69:167-176. [PMID: 37766558 PMCID: PMC10694517 DOI: 10.5387/fms.2023-09] [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: 03/22/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is designated as an intractable disease by the Ministry of Health, Labour and Welfare of Japan, and has an extremely poor prognosis if untreated. Surgical pulmonary endarterectomy is the curative treatment for cases in which the organized thrombi are located in the central part of the pulmonary artery, but there had been no effective treatment for cases in which the thrombi are located in the peripheral part of the pulmonary artery. Recently, balloon pulmonary angioplasty (BPA), a transcatheter procedure to dilate stenotic or occluded lesions in the peripheral pulmonary artery, has been rapidly developed. Although BPA was once a globally abandoned procedure due to hemorrhagic complications, Japanese experts have improved the technique, and its safety and efficacy have been enhanced. As a result, BPA is now being reevaluated worldwide. This review describes the history and development of BPA in the treatment of CTEPH, as well as the status of this treatment in Fukushima Prefecture.
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Affiliation(s)
- Kazuhiko Nakazato
- Regional Medical Support Center, Fukushima Medical University
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Koichi Sugimoto
- Department of Cardiovascular Medicine, Fukushima Medical University
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
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25
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Jevnikar M, Solinas S, Brenot P, Lechartier B, Kularatne M, Montani D, Savale L, Garcia-Alonso C, Sitbon O, Beurnier A, Boucly A, Bulifon S, Seferian A, Roche A, Mercier O, Simonneau G, Fadel E, Humbert M, Jaïs X. Sequential multimodal therapy in chronic thromboembolic pulmonary hypertension with mixed anatomical lesions: a proof of concept. Eur Respir J 2023; 62:2300517. [PMID: 37802632 DOI: 10.1183/13993003.00517-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Mitja Jevnikar
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- These authors contributed equally
| | - Sabina Solinas
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- These authors contributed equally
| | - Philippe Brenot
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Radiology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Benoit Lechartier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Respiratory division, Lausanne University Hospitals, Lausanne, Switzerland
| | - Mithum Kularatne
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Montani
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Laurent Savale
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Carlos Garcia-Alonso
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Radiology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Antoine Beurnier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Athénaïs Boucly
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sophie Bulifon
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Andrei Seferian
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Anne Roche
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Olaf Mercier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Gérald Simonneau
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Elie Fadel
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marc Humbert
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Xavier Jaïs
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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26
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Adameit MSD, Wiedenroth CB, Omlor A, Schäfers HJ, Guth S, Wilkens H. [Chronic thromboembolic pulmonary hypertension]. Dtsch Med Wochenschr 2023; 148:1514-1523. [PMID: 37949080 DOI: 10.1055/a-2012-0899] [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: 11/12/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease, but an important late sequela after acute pulmonary embolism. Therefore, follow-up after at least three months of sufficient anticoagulation is recommended. Patients with suspected CTEPH should be referred to specialized CTEPH centers for further evaluation and treatment.Three treatment modalities are available: pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and pulmonary hypertension-targeted drugs. The indication for surgery depends mainly on the localization of the pulmonary arterial obstructions. Severe comorbidities as well as advanced age need individual evaluation, but do not present strict exclusion criteria. Multimodal treatments are common practice in inoperable CTEPH. However, treatment decision making in an experienced multidisciplinary team is mandatory.
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27
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Guth S, Wilkens H, Halank M, Held M, Hobohm L, Konstantinides S, Omlor A, Seyfarth HJ, Schäfers HJ, Mayer E, Wiedenroth CB. [Chronic thromboembolic pulmonary hypertension]. Pneumologie 2023; 77:937-946. [PMID: 37963483 DOI: 10.1055/a-2145-4807] [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: 11/16/2023]
Abstract
Chronic thromboembolic pulmonary disease (CTEPD) is an important late complication of acute pulmonary embolism, in which the thrombi transform into fibrous tissue, become integrated into the vessel wall, and lead to chronic obstructions. CTEPD is differentiated into cases without pulmonary hypertension (PH), characterized by a mean pulmonary arterial pressure up to 20 mmHg and a form with PH. Then, it is still referred to as chronic thromboembolic pulmonary hypertension (CTEPH).When there is suspicion of CTEPH, initial diagnostic tests should include echocardiography and ventilation/perfusion scan to detect perfusion defects. Subsequently, referral to a CTEPH center is recommended, where further imaging diagnostics and right heart catheterization are performed to determine the appropriate treatment.Currently, three treatment modalities are available. The treatment of choice is pulmonary endarterectomy (PEA). For non-operable patients or patients with residual PH after PEA, PH-targeted medical therapy, and the interventional procedure of balloon pulmonary angioplasty (BPA) are available. Increasingly, PEA, BPA, and pharmacological therapy are combined in multimodal concepts.Patients require post-treatment follow-up, preferably at (CTE)PH centers. These centers are required to perform a minimum number of PEA surgeries (50/year) and BPA interventions (100/year).
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Affiliation(s)
- Stefan Guth
- Abteilung für Thoraxchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - Heinrike Wilkens
- Klinik für Innere Medizin 5, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Michael Halank
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Matthias Held
- Medizinische Klinik mit Schwerpunkt Pneumologie & Beatmungsmedizin, Missionsärztliche Klinik Würzburg, Würzburg, Deutschland
| | - Lukas Hobohm
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Stavros Konstantinides
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Albert Omlor
- Klinik für Innere Medizin 5, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Hans-Jürgen Seyfarth
- Bereich Pneumologie, Klinik für Onkologie, Gastroenterologie, Hepatologie und Pneumologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Hans-Joachim Schäfers
- Klinik für Thorax-Herz-Gefäßchirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Eckhard Mayer
- Abteilung für Thoraxchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
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28
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Yang JZ, Poch DS, Ang L, Mahmud E, Kim NH. Balloon pulmonary angioplasty in the current era of CTEPH treatment: How did we get here? Pulm Circ 2023; 13:e12312. [PMID: 38027455 PMCID: PMC10661326 DOI: 10.1002/pul2.12312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved pulmonary embolism. The treatment of choice is pulmonary thromboendarterectomy (PTE) surgery and all patients should be evaluated for operability candidacy. Despite advancements in PTE technique allowing more segmental-subsegmental surgeries, up to a third of patients with CTEPH may still be considered inoperable. Over the past decade, there have been increasing treatment options for these inoperable CTEPH patients. Balloon pulmonary angioplasty (BPA) is a percutaneous-based interventional treatment option for select CTEPH cases. Early BPA experiences were plagued by high complication rates, but further refinements in technique and equipment pioneered by Japan led to the worldwide spread and adoption of BPA. Multiple centers have shown that patients experience significant improvements in hemodynamics, quality of life, exercise capacity, and survival with BPA treatment. There remain many questions on best practices, but BPA has evolved into a pivotal cornerstone of CTEPH treatment.
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Affiliation(s)
- Jenny Z. Yang
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep MedicineUC San DiegoLa JollaCaliforniaUSA
| | - David S. Poch
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep MedicineUC San DiegoLa JollaCaliforniaUSA
| | - Lawrence Ang
- Department of Medicine, Division of Cardiovascular MedicineUC San DiegoLa JollaCaliforniaUSA
| | - Ehtisham Mahmud
- Department of Medicine, Division of Cardiovascular MedicineUC San DiegoLa JollaCaliforniaUSA
| | - Nick H. Kim
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep MedicineUC San DiegoLa JollaCaliforniaUSA
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29
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Kabadi A, Kerr K, Fernandes TM. Updates in the diagnosis and management of chronic thromboembolic disease. Curr Opin Pulm Med 2023; 29:340-347. [PMID: 37461845 DOI: 10.1097/mcp.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Chronic thromboembolic disease (CTED) is distinct from chronic thromboembolic pulmonary hypertension (CTEPH) and is defined by dyspnea on exertion after acute pulmonary embolism with the presence of residual perfusion defects and absence of resting pulmonary hypertension. Here, we review clinical features and diagnostic criteria for CTED and summarize treatment options. RECENT FINDINGS The optimal management for CTED is unclear as the long-term outcomes of conservative vs. invasive treatment for this disease have not been reported. There are a few studies evaluating outcomes of pulmonary thromboendarterectomy and balloon pulmonary angioplasty (BPA) in CTED, concluding that these procedures are safe and effective in select patients. However, these trials are small nonrandomized observational studies, reporting outcomes only up to 1 year after the intervention. Conservative management of CTED with observation, pulmonary hypertension-targeted therapy, or cardiopulmonary rehabilitation has not been studied. It is unknown whether these treatments are as effective or superior to pulmonary thromboendarterectomy or BPA in CTED. SUMMARY The management of CTED is individualized and based on symptoms and exercise limitations. Early referral of patients with CTED to a specialized CTEPH center is recommended to determine if watchful waiting, BPA, or pulmonary thromboendarterectomy is most beneficial.
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Affiliation(s)
- Alisha Kabadi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California, USA
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30
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Johnson S, Sommer N, Cox-Flaherty K, Weissmann N, Ventetuolo CE, Maron BA. Pulmonary Hypertension: A Contemporary Review. Am J Respir Crit Care Med 2023; 208:528-548. [PMID: 37450768 PMCID: PMC10492255 DOI: 10.1164/rccm.202302-0327so] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023] Open
Abstract
Major advances in pulmonary arterial hypertension, pulmonary hypertension (PH) associated with lung disease, and chronic thromboembolic PH cast new light on the pathogenetic mechanisms, epidemiology, diagnostic approach, and therapeutic armamentarium for pulmonary vascular disease. Here, we summarize key basic, translational, and clinical PH reports, emphasizing findings that build on current state-of-the-art research. This review includes cutting-edge progress in translational pulmonary vascular biology, with a guide to the diagnosis of patients in clinical practice, incorporating recent PH definition revisions that continue emphasis on early detection of disease. PH management is reviewed including an overview of the evolving considerations for the approach to treatment of PH in patients with cardiopulmonary comorbidities, as well as a discussion of the groundbreaking sotatercept data for the treatment of pulmonary arterial hypertension.
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Affiliation(s)
- Shelsey Johnson
- The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and Critical Care, Boston University School of Medicine, Boston, Massachusetts
- Department of Pulmonary and Critical Care Medicine and
| | - Natascha Sommer
- Excellence Cluster Cardiopulmonary Institute, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Justus Liebig University, Giessen, Germany
| | | | - Norbert Weissmann
- Excellence Cluster Cardiopulmonary Institute, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Justus Liebig University, Giessen, Germany
| | - Corey E. Ventetuolo
- Department of Medicine and
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - Bradley A. Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
- Department of Cardiology and Department of Pulmonary, Allergy, Sleep, and Critical Care Medicine, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and
- The University of Maryland-Institute for Health Computing, Bethesda, Maryland
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31
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Delcroix M, de Perrot M, Jaïs X, Jenkins DP, Lang IM, Matsubara H, Meijboom LJ, Quarck R, Simonneau G, Wiedenroth CB, Kim NH. Chronic thromboembolic pulmonary hypertension: realising the potential of multimodal management. THE LANCET. RESPIRATORY MEDICINE 2023; 11:836-850. [PMID: 37591299 DOI: 10.1016/s2213-2600(23)00292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. Important advances have enabled better understanding, characterisation, and treatment of this condition. Guidelines recommending systematic follow-up after acute pulmonary embolism, and the insight that CTEPH can mimic acute pulmonary embolism on initial presentation, have led to the definition of CTEPH imaging characteristics, the introduction of artificial intelligence diagnosis pathways, and thus the prospect of easier and earlier CTEPH diagnosis. In this Series paper, we show how the understanding of CTEPH as a sequela of inflammatory thrombosis has driven successful multidisciplinary management that integrates surgical, interventional, and medical treatments. We provide imaging examples of classical major vessel targets, describe microvascular targets, define available tools, and depict an algorithm facilitating the initial treatment strategy in people with newly diagnosed CTEPH based on a multidisciplinary team discussion at a CTEPH centre. Further work is needed to optimise the use and combination of multimodal therapeutic options in CTEPH to improve long-term outcomes for patients.
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Affiliation(s)
- Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven-University of Leuven, Leuven, Belgium.
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Xavier Jaïs
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - David P Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Irene M Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Centre for CardioVascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Hiromi Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rozenn Quarck
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven-University of Leuven, Leuven, Belgium
| | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Nick H Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
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32
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Wiedenroth CB, Steinhaus K, Rolf A, Breithecker A, Adameit MSD, Kriechbaum SD, Haas M, Roller F, Hamm CW, Ghofrani HA, Mayer E, Guth S, Liebetrau C. Patient-Reported Long-Term Outcome of Balloon Pulmonary Angioplasty for Inoperable CTEPH. Thorac Cardiovasc Surg 2023. [PMID: 37643729 DOI: 10.1055/s-0043-1772770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) is a promising interventional treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Evidence in favor of BPA is growing, but long-term data remain scarce. The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is validated for the assessment of patients with pulmonary hypertension within three domains: symptoms, activity, and quality of life (QoL). The aim of the present study was to evaluate the long-term effects of BPA on these domains in patients with inoperable CTEPH. METHODS Between March 2014 and August 2019, technically inoperable patients with target lesions for BPA were included in this prospective, observational study. CAMPHOR scores were compared between baseline (before the first BPA) and 6 months after the last intervention and also for scores assessed at annual follow-ups. RESULTS A total of 152 patients had completed a full series of BPA interventions and a 28 (interquartile range [IQR]: 26-32) week follow-up. Further follow-up assessments including the CAMPHOR score were performed 96 (IQR: 70-117) weeks, 178 (IQR: 156-200) weeks, and 250 (IQR: 237-275) weeks after the last intervention. From baseline to the last follow-up, CAMPHOR scores for symptoms, activity, and QoL improved from 9 (IQR: 6-14) to 3 (IQR: 0-9) (p < 0.001), 8 (IQR: 5-12) to 4 (IQR: 2-8) (p < 0.001), and 5 (IQR: 2-9) to 1 (IQR: 0-5) (p < 0.001). CONCLUSION BPA leads to long-lasting, significant improvement of symptoms, physical capacity, and QoL in inoperable CTEPH patients.
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Affiliation(s)
| | - Kristin Steinhaus
- University of Göttingen, Department of Cardiology and Pneumology, Göttingen, Germany
| | - Andreas Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Andreas Breithecker
- Kerckhoff Heart and Thorax Center, Department of Radiology, Bad Nauheim, Germany
- Gesundheitszentrum Wetterau, Department of Radiology, Bad Nauheim, Germany
| | - Miriam S D Adameit
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Steffen D Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
| | - Moritz Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Fritz Roller
- University of Giessen, Department of Radiology, Giessen, Germany
| | - Christian W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
- University of Giessen, Department of Internal Medicine I, Division of Cardiology, Giessen, Germany
| | - H-Ardeschir Ghofrani
- Kerckhoff Heart and Thorax Center, Department of Pulmonology, Bad Nauheim, Germany
- Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL)
- Department of Medicine, Imperial College London, UK
| | - Eckhard Mayer
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Stefan Guth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
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33
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Banaszkiewicz M, Kurzyna P, Kubikowska N, Mucha M, Rudnik A, Gąsecka A, Pietrasik A, Grabowski M, Jaguszewski MJ, Kasprzyk P, Kędzierski P, Ciećwierz D, Żuk G, Szwed P, Piłka M, Florczyk M, Kurzyna M, Darocha S. Emerging Role of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease-Insights from the 2022 ESC Guidelines. J Clin Med 2023; 12:5336. [PMID: 37629379 PMCID: PMC10455782 DOI: 10.3390/jcm12165336] [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: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.
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Affiliation(s)
- Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Paweł Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Nina Kubikowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Magda Mucha
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Aleksander Rudnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | | | - Piotr Kasprzyk
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Piotr Kędzierski
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Dariusz Ciećwierz
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Grzegorz Żuk
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Piotr Szwed
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
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34
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Wiedenroth CB, Pruefer D, Adameit MSD, Mayer E, Guth S. Chronic thromboembolic pulmonary hypertension-medical, interventional, and surgical therapy. Herz 2023; 48:280-284. [PMID: 37186021 DOI: 10.1007/s00059-023-05172-8] [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] [Accepted: 03/02/2023] [Indexed: 05/17/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is an important late sequela of pulmonary embolism and a common form of pulmonary hypertension. Currently, three specific treatment modalities are available: pulmonary endarterectomy, balloon pulmonary angioplasty, and targeted medical therapy. The treatment decision depends mainly on the exact localization of the underlying pulmonary arterial obstructions. Pulmonary endarterectomy is the gold standard treatment of CTEPH. For inoperable patients, riociguat and treprostinil are approved. In addition, interventional therapy is recommended if appropriate target lesions are proven. Evaluation and treatment of patients with CTEPH in experienced centers are mandatory.
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Affiliation(s)
- Christoph B Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - Diethard Pruefer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Miriam S D Adameit
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
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35
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Yuriditsky E, Horowitz JM, Lau JF. Chronic thromboembolic pulmonary hypertension and the post-pulmonary embolism (PE) syndrome. Vasc Med 2023; 28:348-360. [PMID: 37036116 DOI: 10.1177/1358863x231165105] [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: 04/11/2023]
Abstract
Over a third of patients surviving acute pulmonary embolism (PE) will experience long-term cardiopulmonary limitations. Persistent thrombi, impaired gas exchange, and altered hemodynamics account for aspects of the postpulmonary embolism syndrome that spans mild functional limitations to debilitating chronic thromboembolic pulmonary hypertension (CTEPH), the most worrisome long-term consequence. Though pulmonary endarterectomy is potentially curative for the latter, less is understood surrounding chronic thromboembolic disease (CTED) and post-PE dyspnea. Advances in pulmonary vasodilator therapies and growing expertise in balloon pulmonary angioplasty provide options for a large group of patients ineligible for surgery, or those with persistent postoperative pulmonary hypertension. In this clinical review, we discuss epidemiology and pathophysiology as well as advances in diagnostics and therapeutics surrounding the spectrum of disease that may follow months after acute PE.
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Affiliation(s)
- Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - James M Horowitz
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Joe F Lau
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
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36
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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.
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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.
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37
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Lang IM, Andreassen AK, Andersen A, Bouvaist H, Coghlan G, Escribano-Subias P, Jansa P, Kopec G, Kurzyna M, Matsubara H, Meyer BC, Palazzini M, Post MC, Pruszczyk P, Räber L, Roik M, Rosenkranz S, Wiedenroth CB, Redlin-Werle C, Brenot P. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function. Eur Heart J 2023:ehad413. [PMID: 37470202 PMCID: PMC10393078 DOI: 10.1093/eurheartj/ehad413] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
The current treatment algorithm for chronic thromboembolic pulmonary hypertension (CTEPH) as depicted in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnosis and treatment of pulmonary hypertension (PH) includes a multimodal approach of combinations of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapies to target major vessel pulmonary vascular lesions, and microvasculopathy. Today, BPA of >1700 patients has been reported in the literature from centers in Asia, the US, and also Europe; many more patients have been treated outside literature reports. As BPA becomes part of routine care of patients with CTEPH, benchmarks for safe and effective care delivery become increasingly important. In light of this development, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function has decided to publish a document that helps standardize BPA to meet the need of uniformity in patient selection, procedural planning, technical approach, materials and devices, treatment goals, complications including their management, and patient follow-up, thus complementing the guidelines. Delphi methodology was utilized for statements that were not evidence based. First, an anatomical nomenclature and a description of vascular lesions are provided. Second, treatment goals and definitions of complete BPA are outlined. Third, definitions of complications are presented which may be the basis for a standardized reporting in studies involving BPA. The document is intended to serve as a companion to the official ESC/ERS guidelines.
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Affiliation(s)
- Irene M Lang
- Department of Internal Medicine II, Cardiology, and Comprehensive Center of Cardiovascular Medicine CCVM, Medical University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Asger Andersen
- Aarhus University Hospital, Palle Juul Jensens Boulevard 99 8200 Aarhus N Denmark
| | - Helene Bouvaist
- Cardiology Department, Grenoble - Alpes University Hospital, 38043 Grenoble, France
| | - Gerry Coghlan
- Royal Free Hospital, London, Pond Street, Middlesex, London, NW3 2QG
| | | | - Pavel Jansa
- General University Hospital, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Grzegorz Kopec
- Pulmonary Circulation Centre Jagiellonian University Medical College, John Paul II Hospital in Krakow, Pradnicka Str. 80, 31-202 Krakow
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology Centre of Postgraduate Medical Education, EHC Otwock, Borowa 14/18, Otwock 05-400, Poland
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan
| | - Bernhard Christian Meyer
- Medizinische Hochschule Hannover - Institut für Diagnostische und Interventionelle Radiologie Carl-Neuberg-Str. 1, 30625 Hannover
| | - Massimiliano Palazzini
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Zwirki I Wigury 61, 02-091 Warsaw, Poland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern Freiburgstrasse 18 3010 Bern, Switzerland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Zwirki I Wigury 61, 02-091 Warsaw, Poland
| | - Stephan Rosenkranz
- Dept. of Cardiology and Cologne Cardiovascular Research Center, Heart Center at the University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Germany
| | - Christoph B Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Carlo Redlin-Werle
- Department of Internal Medicine II, Cardiology, and Comprehensive Center of Cardiovascular Medicine CCVM, Medical University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria
| | - Philippe Brenot
- Interventional Radiology Department, Marie Lannelongue Hospital, Le Plessis Robinson 92350 France
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38
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Shimokawahara H, Inami T, Kubota K, Taniguchi Y, Hashimoto H, Saito AM, Sekimizu M, Matsubara H. Protocol for a multicentre, double-blind, randomised, placebo-controlled trial of riociguat on peak cardiac index during exercise in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty (THERAPY-HYBRID-BPA trial). BMJ Open 2023; 13:e072241. [PMID: 37407055 DOI: 10.1136/bmjopen-2023-072241] [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] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Balloon pulmonary angioplasty (BPA) and medical therapy, such as soluble guanylate cyclase stimulators, are recommended treatments for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy (PEA). However, monotherapy with BPA or medical therapy cannot always eliminate symptoms such as exertional dyspnoea. Thus, this study aims to clarify the efficacy of continuous treatment with riociguat in inoperable CTEPH patients with normalised haemodynamics after BPA. METHODS AND ANALYSIS This is a double-blind, multicentre, randomised, placebo-controlled trial. Participants with CTEPH who are ineligible for PEA will receive riociguat followed by BPA. Subsequently, participants will be randomised (1:1) into either riociguat continuing or discontinuing groups and will be observed for 16 weeks after randomisation. The primary endpoint will be the change in peak cardiac index (CI) during the cardiopulmonary exercise test. In the primary analysis, the least square mean differences and 95% CIs for the change in peak CI at 16 weeks between the groups will be estimated by a linear mixed-effects model with baseline value as a covariate, treatment group as a fixed effect and study institution as a random effect. ETHICS AND DISSEMINATION National Hospital Organisation Review Board for Clinical Trials (Nagoya) and each participating institution approved this study and its protocols. Written informed consent will be obtained from all participants. The results will be disseminated at medical conferences and in journal publications. REGISTRATION DETAILS Japan Registry of Clinical Trials: jRCT no. 041200052. CLINICALTRIALS gov by National Library of Medicine Registry ID: NCT04600492. TRIAL REGISTRATION NUMBER NCT04600492.
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Affiliation(s)
| | - Takumi Inami
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Kayoko Kubota
- Department of Cardiovascular Medicine and Hypertension, Graduate school of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yu Taniguchi
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroya Hashimoto
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiko M Saito
- Clinical Research Center, NHO Nagoya Medical Center, Nagoya, Japan
| | | | - Hiromi Matsubara
- Department of Cardiology, NHO Okayama Medical Center, Okayama, Japan
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39
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Jain N, Perkins S, Maligireddy AR, Rosenfield K. Evolving Role and Clinical Evidence in the Global Practice of Balloon Pulmonary Angioplasty. Interv Cardiol Clin 2023; 12:417-427. [PMID: 37290844 DOI: 10.1016/j.iccl.2023.03.008] [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
Balloon pulmonary angioplasty (BPA) was first described in 2001 and now has evolved into a class I indication for inoperable or residual chronic thromboembolic pulmonary hypertension. This review article aims to describe evidence from studies performed at various pulmonary hypertension (PH) centers across the globe, to better understand the role of BPA in chronic thromboembolic pulmonary disease with and without PH. Additionally, we hope to highlight innovations and the ever-changing safety and efficacy profile of BPA.
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Affiliation(s)
- Nishant Jain
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Sidney Perkins
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Kenneth Rosenfield
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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Karyofyllis P, Demerouti E, Habibis P, Apostolopoulou S, Tsetika EG, Tsiapras D. Should We Change the Target of Therapy in Pulmonary Hypertension? Life (Basel) 2023; 13:1202. [PMID: 37240847 PMCID: PMC10221333 DOI: 10.3390/life13051202] [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: 04/18/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Despite the evolution of drug therapy in pulmonary arterial hypertension and the more aggressive treatment approach according to the guidelines, patients continue to have unacceptable mortality rates. Furthermore, specific drug therapy alone in chronic thromboembolic pulmonary hypertension also does not seem to have any beneficial impact on survival. As the function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension, the treatment strategy should focus on modifying factors involved in RV dysfunction. Although some previous reports demonstrated that the survival of patients with pulmonary hypertension was associated with mPAP, nevertheless, mPAP is still not considered as a target of therapy. There are many examples of effective mPAP lowering with early and aggressive drug therapy in pulmonary arterial hypertension, or with interventions in chronic thromboembolic pulmonary hypertension. This effective mPAP reduction can lead to reverse RV remodeling, and thus, improvement in survival. In this article, the importance of mPAP lowering is stated, as well as why the change of our current strategy and considering mPAP reduction as the target of therapy could make pulmonary hypertension a chronic but not fatal disease.
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Affiliation(s)
| | - Eftychia Demerouti
- Cardiology Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Pavlos Habibis
- School of Medicine, University of Thessaly, 41221 Larissa, Greece
| | | | | | - Dimitrios Tsiapras
- Cardiology Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Bashir R, Noory A, Oliveros E, Romero C, Maruthi R, Mirza A, Lakhter V, Zhao H, Brisco-Bacik M, Vaidya A, Auger WR, Forfia P. Refined Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: Initial Results of U.S. Regional Program. JACC. ADVANCES 2023; 2:100291. [PMID: 37501703 PMCID: PMC10373249 DOI: 10.1016/j.jacadv.2023.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objectives We sought to evaluate the efficacy and safety of refined balloon pulmonary angioplasty (BPA) in the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH). Background BPA is rapidly evolving therapeutic option for patients with nonsurgical CTEPH. There are few US studies that have reported on the outcomes of this novel therapeutic option. Methods This is a retrospective study of CTEPH patients that underwent BPA at Temple University Hospital. The primary efficacy endpoint was the change in pulmonary vascular resistance (PVR) after BPA as compared to baseline and the primary safety endpoint was the rate of hemoptysis within 24 hours. Secondary endpoints included death, WHO functional class, and 6-minute walk distance (6MWD). We used logistic regression to evaluate factors associated with a hemodynamic and functional response. Results A total of 211 BPA sessions were performed on 77 patients (average 2.7 ± 1.7 sessions/patient). After BPA the mean PVR improved by 26% (P<0.001) while the mean 6MWD improved by 71.7 meters (P <0.001) and WHO functional class improved by one functional class (P <0.001). Ten sessions (4.7%) were complicated by hemoptysis. The independent factors associated with a improved functional and hemodynamic response included the pre-procedural use of riociguat, reduce baseline PA compliance and > 3 BPA sessions per patient. Conclusion This single center study from the US showed that BPA with refined techniques in patients with CTEPH was safe and was associated with significant improvements in pulmonary hemodynamics and functional capacity.
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Affiliation(s)
- Riyaz Bashir
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Ali Noory
- Cardiovascular Institute at Allegheny Health Network, Pittsburg, PA
| | - Estefania Oliveros
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Carlos Romero
- Department of Medicine, Lewis Katz School of Medicine Temple University, Philadelphia, PA
| | - Rohit Maruthi
- Department of Medicine, Lewis Katz School of Medicine Temple University, Philadelphia, PA
| | - Arslan Mirza
- Prairie Heart Institute of Illinois, Springfield IL
| | - Vladimir Lakhter
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Temple University, Philadelphia, PA
| | - Meredith Brisco-Bacik
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Anjali Vaidya
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | | - Paul Forfia
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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42
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Jain N, Sheikh MA, Bajaj D, Townsend W, Krasuski R, Secemsky E, Chatterjee S, Moles V, Agarwal PP, Haft J, Visovatti SH, Cascino TM, Rosenfield K, Nallamothu BK, Mclaughlin VV, Aggarwal V. Periprocedural Complications With Balloon Pulmonary Angioplasty: Analysis of Global Studies. JACC Cardiovasc Interv 2023; 16:976-983. [PMID: 37100561 DOI: 10.1016/j.jcin.2023.01.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular injury have led to considerable refinement in procedural technique. OBJECTIVES The authors sought to better understand the evolution of BPA procedure-related complications over time. METHODS The authors conducted a systematic review of original articles published by pulmonary hypertension centers globally and performed a pooled cohort analysis of procedure-related outcomes with BPA. RESULTS This systematic review identified 26 published articles from 18 countries worldwide from 2013 to 2022. A total of 1,714 patients underwent 7,561 total BPA procedures with an average follow up of 7.3 months. From the first period (2013-2017) to the second period (2018-2022), the cumulative incidence of hemoptysis/vascular injury decreased from 14.1% (474/3,351) to 7.7% (233/3,029) (P < 0.01); lung injury/reperfusion edema decreased from 11.3% (377/3,351) to 1.4% (57/3,943) (P < 0.01); invasive mechanical ventilation decreased from 0.7% (23/3,195) to 0.1% (4/3,062) (P < 0.01); and mortality decreased from 2.0% (13/636) to 0.8% (8/1,071) (P < 0.01). CONCLUSIONS Procedure-related complications with BPA, including hemoptysis/vascular injury, lung injury/reperfusion edema, mechanical ventilation, and death, were less common in the second period (2018-2022), compared with first period (2013-2017), likely from refinement in patient and lesion selection and procedural technique over time.
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Affiliation(s)
- Nishant Jain
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Muhammad A Sheikh
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Divyansh Bajaj
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Whitney Townsend
- University of Michigan Taubman Health Sciences Library, Ann Arbor, Michigan, USA
| | - Richard Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Eric Secemsky
- Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Department of Medicine (E.A.S.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore-Long Island Jewish Medical Centers, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Victor Moles
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Prachi P Agarwal
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott H Visovatti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Thomas M Cascino
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth Rosenfield
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brahmajee K Nallamothu
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Vallerie V Mclaughlin
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vikas Aggarwal
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan, USA.
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43
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Lang IM. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Clinical Outcomes. Eur Cardiol 2023. [DOI: 10.15420/ecr.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare major vessel pulmonary vascular disease that is characterised by fibrotic obstructions deriving from an organised clot. Recent advances in treatments for CTEPH have significantly improved outcomes. Apart from classical surgical pulmonary endarterectomy, balloon pulmonary angioplasty (BPA) and vasodilator drugs that were tested in randomised controlled trials of non-operable patients are now available. In Europe, CTEPH affects males and females equally. In the first European CTEPH Registry, women with CTEPH underwent pulmonary endarterectomy less frequently than men, especially at low-volume centres. In Japan, CTEPH is more common in females and is predominantly treated by BPA. More data on gender-specific outcomes are expected from the results of the International BPA Registry (NCT03245268).
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Affiliation(s)
- Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Ishida K, Kohno H, Matsuura K, Sugiura T, Sanada TJ, Naito A, Shigeta A, Suda R, Sekine A, Masuda M, Sakao S, Tanabe N, Tatsumi K, Matsumiya G. Impact of residual pulmonary hypertension on long-term outcomes after pulmonary endarterectomy in the modern era. Pulm Circ 2023; 13:e12215. [PMID: 37051490 PMCID: PMC10084236 DOI: 10.1002/pul2.12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023] Open
Abstract
Residual pulmonary hypertension (PH) negatively impacts long-term results following pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). We sought to reveal whether modern PH therapy with PH-targeted medicine and balloon pulmonary angioplasty (BPA) improved long-term results of residual PH after PEA. Long-term findings of 80 patients who survived PEA between 2011 and 2019 were retrospectively investigated. One month after PEA, 30 patients developed residual PH defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg, of whom 23 were treated by PH-targeted medicine and 9 by BPA. Patients with residual PH acquired considerably better functional status and exercise capacity after PEA, however, exhibited significantly worse survival rates than those without. Eleven patients died during follow-up: 8 patients with residual PH and 3 controls. Among patients with residual PH, the deceased had a significantly lower %decrease in mPAP from 1 month to 1 year following PEA (7.4 [-32.6 to 8.0] % vs. 10.4 [3.7-27.8] %, p = 0.03) and higher mPAP at 1 year following PEA (39.5 [33.25-42.5] vs. 27 [26-34] mmHg, p < 0.01) despite PH-targeted medicine than the survived. No patients passed away from right heart failure, and there was no difference between the groups in CTEPH-related mortality. Modern PH therapy was used to address the majority of residual PH. Long-term survival after PEA was negatively impacted by residual PH, but it appeared that long-term mortality was also correlated with unrelieved residual PH despite PH-targeted medicine. Modern PH therapy may have enhanced functional status and excercise capacity, and averted fatal right heart failure.
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Affiliation(s)
- Keiichi Ishida
- Department of Cardiovascular SurgeryChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Hiroki Kohno
- Department of Cardiovascular SurgeryChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Kaoru Matsuura
- Department of Cardiovascular SurgeryChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Toshihiko Sugiura
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Takayuki J. Sanada
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Akira Naito
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Ayako Shigeta
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Rika Suda
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Ayumi Sekine
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Masahisa Masuda
- Department of Cardiovascular SurgeryChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Seiichiro Sakao
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Nobuhiro Tanabe
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Koichiro Tatsumi
- Department of RespirologyChiba University Graduate School of MedicineChibaChiba‐shiJapan
| | - Goro Matsumiya
- Department of Cardiovascular SurgeryChiba University Graduate School of MedicineChibaChiba‐shiJapan
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Cullivan S, Gaine S, Sitbon O. New trends in pulmonary hypertension. Eur Respir Rev 2023; 32:32/167/220211. [PMID: 36813291 PMCID: PMC9949382 DOI: 10.1183/16000617.0211-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/12/2022] [Indexed: 02/24/2023] Open
Abstract
Pulmonary hypertension (PH) is a prevalent disease of the pulmonary vasculature that is characterised by considerable morbidity and mortality. Substantial efforts have been made in recent years to improve disease recognition, diagnosis and management, and this is reflected in current guidelines. The haemodynamic definition of PH has been revised and a definition for exercise PH has been provided. Risk stratification has been refined and the importance of comorbidities and phenotyping have been highlighted. These changes provide an opportunity to potentially identify pulmonary vascular disease at an earlier stage and to enhance patient-centred, goal-orientated treatment decisions. A promising fourth treatment pathway for pulmonary arterial hypertension and potential targeted therapies for group 3 PH are on the horizon, concepts which seemed inconceivable only a few years ago. Beyond medication, there is a greater appreciation for the importance of supervised training in stable PH and the possible role of interventional therapies in select cases. The landscape of PH is changing and it is characterised by progress, innovation and opportunities. In this article, we highlight some of the new trends in PH, with a specific focus on the revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and management of PH.
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Affiliation(s)
- Sarah Cullivan
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Olivier Sitbon
- Department of Respiratory and Intensive Care Medicine, CHU Bicêtre, Paris-Saclay University, INSERM URM_S999, Le Kremlin-Bicêtre, France
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46
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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.
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47
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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.
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48
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Simonneau G, Fadel E, Vonk Noordegraaf A, Toshner M, Lang IM, Klok FA, McInnis MC, Screaton N, Madani MM, Martinez G, Salaunkey K, Jenkins DP, Matsubara H, Brénot P, Hoeper MM, Ghofrani HA, Jaïs X, Wiedenroth CB, Guth S, Kim NH, Pepke-Zaba J, Delcroix M, Mayer E. Highlights from the International Chronic Thromboembolic Pulmonary Hypertension Congress 2021. Eur Respir Rev 2023; 32:32/167/220132. [PMID: 36754432 PMCID: PMC9910339 DOI: 10.1183/16000617.0132-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/14/2022] [Indexed: 02/10/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. It is caused by persistent obstruction of pulmonary arteries by chronic organised fibrotic clots, despite adequate anticoagulation. The pulmonary hypertension is also caused by concomitant microvasculopathy which may progress without timely treatment. Timely and accurate diagnosis requires the combination of imaging and haemodynamic assessment. Optimal therapy should be individualised to each case and determined by an experienced multidisciplinary CTEPH team with the ability to offer all current treatment modalities. This report summarises current knowledge and presents key messages from the International CTEPH Conference, Bad Nauheim, Germany, 2021. Sessions were dedicated to 1) disease definition; 2) pathophysiology, including the impact of the hypertrophied bronchial circulation, right ventricle (dys)function, genetics and inflammation; 3) diagnosis, early after acute pulmonary embolism, using computed tomography and perfusion techniques, and supporting the selection of appropriate therapies; 4) surgical treatment, pulmonary endarterectomy for proximal and distal disease, and peri-operative management; 5) percutaneous approach or balloon pulmonary angioplasty, techniques and complications; and 6) medical treatment, including anticoagulation and pulmonary hypertension drugs, and in combination with interventional treatments. Chronic thromboembolic pulmonary disease without pulmonary hypertension is also discussed in terms of its diagnostic and therapeutic aspects.
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Affiliation(s)
- Gérald Simonneau
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique and Institut National de la Santé et de la Recherche Médicale Unité 999, Le Kremlin-Bicêtre, France
| | - Elie Fadel
- Research and Innovation Unit, INSERM UMR-S 999, Marie Lannelongue Hospital, Université Paris-Sud, Université Paris-Saclay, Le Plessis-Robinson, France,Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Université Paris-Sud, Université Paris-Saclay, Le Plessis-Robinson, France,Université Paris-Sud and Université Paris-Saclay, School of Medicine, Kremlin-Bicêtre, France
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mark Toshner
- Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | - Irene M. Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Frederikus A. Klok
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Micheal C. McInnis
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Michael M. Madani
- Cardiovascular and Thoracic Surgery, University of California-San Diego, La Jolla, CA, USA
| | | | - Kiran Salaunkey
- Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | | | - Hiromi Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Philippe Brénot
- Department of Radiology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School and Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Hossein A. Ghofrani
- Pulmonary Vascular Research, Justus-Liebig University and Pulmonary Hypertension Division, University Hospital Giessen, Giessen, Germany,Department of Pneumology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Xavier Jaïs
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique and Institut National de la Santé et de la Recherche Médicale Unité 999, Le Kremlin-Bicêtre, France
| | | | - Stefan Guth
- 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
| | | | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium .,M. Delcroix and E. Mayer equal contribution (co-last authors)
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany,Meeting organiser,M. Delcroix and E. Mayer equal contribution (co-last authors)
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Wiedenroth CB, Mayer E, Guth S. Therapie der chronisch thromboembolischen pulmonalen Hypertonie. AKTUELLE KARDIOLOGIE 2023. [DOI: 10.1055/a-1953-5670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
ZusammenfassungDie chronisch thromboembolische pulmonale Hypertonie (CTEPH) ist eine wichtige und oft gut behandelbare Form der pulmonalen Hypertonie. Es stehen aktuell 3 Therapiemodalitäten zur
Verfügung: die pulmonale Endarteriektomie, die pulmonale Ballonangioplastie und die gezielte medikamentöse Behandlung. Das therapeutische Konzept hängt maßgeblich von der Lokalisation der
zugrunde liegenden pulmonalarteriellen fibrösen Obstruktionen ab. Die pulmonale Endarteriektomie ist der Goldstandard in der Behandlung der CTEPH. Für inoperable Patienten stehen
mittlerweile 2 zugelassene Substanzen (Riociguat und Treprostinil) zur Verfügung. Daneben wird bei Vorhandensein entsprechender Zielgebiete die interventionelle Therapie empfohlen.
Evaluation und Behandlung von CTEPH-Patienten sollte in entsprechend erfahrenen Zentren erfolgen.
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Affiliation(s)
| | - Eckhard Mayer
- Thoracic Surgery, Kerckhoff Klinik GmbH, Bad Nauheim, Deutschland
| | - Stefan Guth
- Thoracic Surgery, Kerckhoff Klinik GmbH, Bad Nauheim, Deutschland
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50
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Effectiveness and Safety of Balloon Pulmonary Angioplasty for the Treatment of Patients with Persistent Pulmonary Hypertension after Pulmonary Endarterectomy. J Clin Med 2023; 12:jcm12030905. [PMID: 36769552 PMCID: PMC9918088 DOI: 10.3390/jcm12030905] [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: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Background: Pulmonary endarterectomy (PEA) is the "gold standard" treatment for operable patients with chronic thromboembolic pulmonary hypertension (CTEPH). Persistent pulmonary hypertension (PH) after PEA confers a worse prognosis. Balloon pulmonary angioplasty (BPA) could represent a useful therapy in this setting, but evidence about its effectiveness and safety in patients with previous PEA is limited. (2) Methods: A total of 14 patients with persistent PH after PEA were treated with BPA in a single PH center. Hemodynamic and clinical effects of BPA and complications of the procedure were retrospectively collected. (3) Results: After BPA, the mean pulmonary arterial pressure fell from 50.7 ± 15.3 mmHg to 38.0 ± 7.9 mmHg (25.0% decrease; 95% confidence interval (CI) 14.0-35.5%; p = 0.01). Pulmonary vascular resistances were reduced from 8.5 ± 3.6 WU to 5.3 ± 2.2 WU (37.6% decrease; 95% CI 18.8-56.5%; p = 0.01). WHO functional class was also improved with BPA. Severe BPA-related complications were infrequent and no periprocedural deaths were observed. (4) Conclusions: BPA is an effective and safe therapy for patients with CTEPH and persistent PH after PEA.
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