Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

Abstract

Objective: Although the underlying pathology of chronic thromboembolic pulmonary hypertension (CTEPH) is mechanical obliteration of the major pulmonary vessels, high pulsatile stress penetrating into the normal distal pulmonary microvasculature resulting from reduced pulmonary arterial compliance (C PA ) may cause progressive deterioration in pulmonary hemodynamics. Hypothetically, balloon pulmonary angioplasty (BPA) may be beneficial in reducing C PA and pulsatile stress in patients with CTEPH. Methods: In total, 26 patients with available pre-and post-BPA right heart catheterization results were included in the study. BPA was performed in a series of staged procedures by 2 experienced interventional cardiologists. Results: The median C PA showed a 59.2% increase (1.03 to 1.64 mL/mm Hg, p=0.005). The median pre-BPA pulsatile stress product decreased by 20.7% (4,266 to 3,380 mm Hg/min, p=0.003). A linear regression model established that the percent change in C PA after BPA accounted for 21.8% of the explained variability in the change in 6-minute walk test (p=0.009). Conclusion:Our results indicate that BPA decreases C PA and pulmonary pulsatile stress. These changes may be partly responsible for the improvement in functional capacity after BPA.

Pulmonary arterial compliance and exercise capacity after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

“…In a study involving 26 patients, A kaslan et al [ 22 ] reported that the percentage change in C pa after BPA accounted for 22% of the explained variability in the change in 6MWD after BPA [ 22 ]. Nevertheless, it should be noted that the pre- and post-BPA characteristics of these 26 patients were rather unusual, as improvement in 6MWD was major (median values from 320 to 450 m) despite a rather modest and incomplete haemodynamic improvement (mPAP: from 47 to 37 mmHg; PVR: from 739 to 408 dyn·s·cm −5 ).…”

Hemodynamic indices in pulmonary hypertension: a narrative review

“…Treatment with the oral prostacyclin treprostinil also led to improvements in PAC in patients with PAH, as the PAC increased from 1.5 to 1.9 mL/mmHg at 24 weeks of treatment ( 91 ). Balloon pulmonary angioplasty improved PAC in patients with CTEPH from 1.03 to 1.64 mL/mmHg, a change that may have contributed to the concomitant improvement in functional capacity ( 92 ).…”