Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension
Background: The hemodynamic results of balloon pulmonary angioplasty vary among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies revealed that microvasculopathy accounted for residual pulmonary hypertension after pulmonary endarterectomy, which could b...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:d30783cb16394a6095c15d21a29263642021-12-02T08:13:20ZDiffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension2297-055X10.3389/fcvm.2021.762267https://doaj.org/article/d30783cb16394a6095c15d21a29263642021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.762267/fullhttps://doaj.org/toc/2297-055XBackground: The hemodynamic results of balloon pulmonary angioplasty vary among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies revealed that microvasculopathy accounted for residual pulmonary hypertension after pulmonary endarterectomy, which could be reflected by the diffusing capacity for carbon monoxide (DLCO). We aimed to identify whether the DLCO could predict the BPA response.Materials and Methods: We retrospectively analyzed 75 consecutive patients with inoperable CTEPH who underwent BPA from May 2018 to January 2021 at Fuwai Hospital. According to the hemodynamics at follow-up after the last BPA, patients were classified as “BPA responders” (defined as a mean pulmonary arterial pressure ≤ 30 mmHg and/or a reduction of pulmonary vascular resistance ≥ 30%) or “BPA nonresponders.”Results: At the baseline, BPA responders had significantly higher DLCO values than nonresponders, although the other variables were comparable. In BPA responders, the DLCO decreased after the first BPA session and then returned to a level similar to the baseline at follow-up. Conversely, the DLCO increased constantly from the baseline to follow-up in nonresponders. Multivariate logistic analysis showed that a baseline DLCO of <70% and a percent change in DLCO between the baseline and the period within 7 days after the first BPA session (ΔDLCO) of > 6% were both independent predictors of an unfavorable response to BPA. Receiver operator characteristic analysis showed that the combination of a baseline DLCO < 70% and ΔDLCO > 6% demonstrated a better area under the curve than either of these two variables used alone.Conclusions: A baseline DLCO < 70% and ΔDLCO > 6% could independently predict unfavorable responses to BPA. Measuring the DLCO dynamically facilitates the identification of patients who might have unsatisfactory hemodynamic results after BPA.Xin LiYi ZhangQin LuoQing ZhaoQixian ZengTao YangQi JinQi JinLu YanAnqi DuanJiaran LiuChenhong AnXiuping MaChangming XiongZhihui ZhaoZhihong LiuFrontiers Media S.A.articlechronic thromboembolic pulmonary hypertensiondiffusing capacity for carbon monoxideballoon pulmonary angioplastyright heart catheterizationmicrovasculopathyDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021) |
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chronic thromboembolic pulmonary hypertension diffusing capacity for carbon monoxide balloon pulmonary angioplasty right heart catheterization microvasculopathy Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
chronic thromboembolic pulmonary hypertension diffusing capacity for carbon monoxide balloon pulmonary angioplasty right heart catheterization microvasculopathy Diseases of the circulatory (Cardiovascular) system RC666-701 Xin Li Yi Zhang Qin Luo Qing Zhao Qixian Zeng Tao Yang Qi Jin Qi Jin Lu Yan Anqi Duan Jiaran Liu Chenhong An Xiuping Ma Changming Xiong Zhihui Zhao Zhihong Liu Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension |
| description |
Background: The hemodynamic results of balloon pulmonary angioplasty vary among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies revealed that microvasculopathy accounted for residual pulmonary hypertension after pulmonary endarterectomy, which could be reflected by the diffusing capacity for carbon monoxide (DLCO). We aimed to identify whether the DLCO could predict the BPA response.Materials and Methods: We retrospectively analyzed 75 consecutive patients with inoperable CTEPH who underwent BPA from May 2018 to January 2021 at Fuwai Hospital. According to the hemodynamics at follow-up after the last BPA, patients were classified as “BPA responders” (defined as a mean pulmonary arterial pressure ≤ 30 mmHg and/or a reduction of pulmonary vascular resistance ≥ 30%) or “BPA nonresponders.”Results: At the baseline, BPA responders had significantly higher DLCO values than nonresponders, although the other variables were comparable. In BPA responders, the DLCO decreased after the first BPA session and then returned to a level similar to the baseline at follow-up. Conversely, the DLCO increased constantly from the baseline to follow-up in nonresponders. Multivariate logistic analysis showed that a baseline DLCO of <70% and a percent change in DLCO between the baseline and the period within 7 days after the first BPA session (ΔDLCO) of > 6% were both independent predictors of an unfavorable response to BPA. Receiver operator characteristic analysis showed that the combination of a baseline DLCO < 70% and ΔDLCO > 6% demonstrated a better area under the curve than either of these two variables used alone.Conclusions: A baseline DLCO < 70% and ΔDLCO > 6% could independently predict unfavorable responses to BPA. Measuring the DLCO dynamically facilitates the identification of patients who might have unsatisfactory hemodynamic results after BPA. |
| format |
article |
| author |
Xin Li Yi Zhang Qin Luo Qing Zhao Qixian Zeng Tao Yang Qi Jin Qi Jin Lu Yan Anqi Duan Jiaran Liu Chenhong An Xiuping Ma Changming Xiong Zhihui Zhao Zhihong Liu |
| author_facet |
Xin Li Yi Zhang Qin Luo Qing Zhao Qixian Zeng Tao Yang Qi Jin Qi Jin Lu Yan Anqi Duan Jiaran Liu Chenhong An Xiuping Ma Changming Xiong Zhihui Zhao Zhihong Liu |
| author_sort |
Xin Li |
| title |
Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension |
| title_short |
Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension |
| title_full |
Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension |
| title_fullStr |
Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension |
| title_full_unstemmed |
Diffusing Capacity for Carbon Monoxide Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension |
| title_sort |
diffusing capacity for carbon monoxide predicts response to balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/d30783cb16394a6095c15d21a2926364 |
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