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Thorac Cardiovasc Surg
DOI: 10.1055/s-0043-1772770
Original Thoracic

Patient-Reported Long-Term Outcome of Balloon Pulmonary Angioplasty for Inoperable CTEPH

Christoph B. Wiedenroth
1   Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
,
Kristin Steinhaus
2   University of Göttingen, Department of Cardiology and Pneumology, Göttingen, Germany
,
Andreas Rolf
3   Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
,
Andreas Breithecker
4   Kerckhoff Heart and Thorax Center, Department of Radiology, Bad Nauheim, Germany
5   Gesundheitszentrum Wetterau, Department of Radiology, Bad Nauheim, Germany
,
Miriam S. D. Adameit
1   Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
,
Steffen D. Kriechbaum
3   Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
6   German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
,
Moritz Haas
3   Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
,
Fritz Roller
7   University of Giessen, Department of Radiology, Giessen, Germany
,
Christian W. Hamm
3   Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
6   German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
8   University of Giessen, Department of Internal Medicine I, Division of Cardiology, Giessen, Germany
,
H.-Ardeschir Ghofrani
9   Kerckhoff Heart and Thorax Center, Department of Pulmonology, Bad Nauheim, Germany
10   Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL)
11   Department of Medicine, Imperial College London, UK
,
Eckhard Mayer
1   Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
,
Stefan Guth    *
1   Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
,
Christoph Liebetrau   *
3   Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
6   German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
12   Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
› Author Affiliations Funding Funded by the Deutsche Forschungsgemeinschaft (DFG) and the Collaborative Research Center (CRC) 1213, central project CP01.
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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.

Keywords

chronic thromboembolic pulmonary hypertension - balloon pulmonary angioplasty - long-term outcome - CAMPHOR

Data Availability Statement

The data underlying this article will be shared on reasonable request to the corresponding author.


Authors' Contribution

Study conception and design: C.B.W., H.A.G., E.M., S.G., C.L.. Data analysis: C.B.W., A.R., K.S., S.G., C.L.. All authors have drafted and revised the manuscript and approved the version to be published. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


* These authors contributed equally as last authors.




Publication History

Received: 06 May 2023

Accepted: 18 July 2023

Article published online:
29 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kim NH, Delcroix M, Jais X. et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J 2019; 53 (01) 1801915
    CrossrefPubMedSearch in Google Scholar
  • 2 Delcroix M, Torbicki A, Gopalan D. et al. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J 2021; 57 (06) 2002828
    CrossrefPubMedSearch in Google Scholar
  • 3 Humbert M, Kovacs G, Hoeper MM. et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43 (38) 3618-3731
    CrossrefPubMedSearch in Google Scholar
  • 4 de Perrot M, Gopalan D, Jenkins D. et al. Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT. J Heart Lung Transplant 2021; 40 (11) 1301-1326
    CrossrefPubMedSearch in Google Scholar
  • 5 Pepke-Zaba J, Delcroix M, Lang I. et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 2011; 124 (18) 1973-1981
    CrossrefPubMedSearch in Google Scholar
  • 6 Guth S, D'Armini AM, Delcroix M. et al. Current strategies for managing chronic thromboembolic pulmonary hypertension: results of the worldwide prospective CTEPH Registry. ERJ Open Res 2021; 7 (03) 00850-02020
    CrossrefPubMedSearch in Google Scholar
  • 7 Delcroix M, Lang I, Pepke-Zaba J. et al. Long-term outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. Circulation 2016; 133 (09) 859-871
    CrossrefPubMedSearch in Google Scholar
  • 8 Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 2012; 5 (06) 748-755
    CrossrefPubMedSearch in Google Scholar
  • 9 Kataoka M, Inami T, Hayashida K. et al. Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 2012; 5 (06) 756-762
    CrossrefPubMedSearch in Google Scholar
  • 10 Sugimura K, Fukumoto Y, Satoh K. et al. Percutaneous transluminal pulmonary angioplasty markedly improves pulmonary hemodynamics and long-term prognosis in patients with chronic thromboembolic pulmonary hypertension. Circ J 2012; 76 (02) 485-488
    CrossrefPubMedSearch in Google Scholar
  • 11 Olsson KM, Wiedenroth CB, Kamp JC. et al. Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: the initial German experience. Eur Respir J 2017; 49 (06) 1602409
    CrossrefPubMedSearch in Google Scholar
  • 12 Brenot P, Jaïs X, Taniguchi Y. et al. French experience of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Eur Respir J 2019; 53 (05) 1802095
    CrossrefPubMedSearch in Google Scholar
  • 13 Hoole SP, Coghlan JG, Cannon JE. et al. Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: the UK experience. Open Heart 2020; 7 (01) e001144
    CrossrefPubMedSearch in Google Scholar
  • 14 Mahmud E, Patel M, Ang L, Poch D. Advances in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Pulm Circ 2021; 11 (02) 20 458940211007385
    CrossrefPubMedSearch in Google Scholar
  • 15 Wiedenroth CB, Ghofrani HA, Adameit MSD. et al. Sequential treatment with riociguat and balloon pulmonary angioplasty for patients with inoperable chronic thromboembolic pulmonary hypertension. Pulm Circ 2018; 8 (03) 20 45894018783996
    CrossrefPubMedSearch in Google Scholar
  • 16 Ghofrani HA, D'Armini AM, Grimminger F. et al; CHEST-1 Study Group. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 2013; 369 (04) 319-329
    CrossrefPubMedSearch in Google Scholar
  • 17 Inami T, Kataoka M, Yanagisawa R. et al. Long-term outcomes after percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Circulation 2016; 134 (24) 2030-2032
    CrossrefPubMedSearch in Google Scholar
  • 18 Aoki T, Sugimura K, Tatebe S. et al. Comprehensive evaluation of the effectiveness and safety of balloon pulmonary angioplasty for inoperable chronic thrombo-embolic pulmonary hypertension: long-term effects and procedure-related complications. Eur Heart J 2017; 38 (42) 3152-3159
    CrossrefPubMedSearch in Google Scholar
  • 19 Jaïs X, Brenot P, Bouvaist H. et al. Balloon pulmonary angioplasty versus riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension (RACE): a multicentre, phase 3, open-label, randomised controlled trial and ancillary follow-up study. Lancet Respir Med 2022; 10 (10) 961-971
    CrossrefPubMedSearch in Google Scholar
  • 20 Ogo T. Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension. Curr Opin Pulm Med 2015; 21 (05) 425-431
    CrossrefPubMedSearch in Google Scholar
  • 21 McGoon MD, Ferrari P, Armstrong I. et al. The importance of patient perspectives in pulmonary hypertension. Eur Respir J 2019; 53 (01) 1801919
    CrossrefPubMedSearch in Google Scholar
  • 22 McKenna SP, Doughty N, Meads DM, Doward LC, Pepke-Zaba J. The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR): a measure of health-related quality of life and quality of life for patients with pulmonary hypertension. Qual Life Res 2006; 15 (01) 103-115
    CrossrefPubMedSearch in Google Scholar
  • 23 McCabe C, Bennett M, Doughty N, MacKenzie Ross R, Sharples L, Pepke-Zaba J. Patient-reported outcomes assessed by the CAMPHOR questionnaire predict clinical deterioration in idiopathic pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Chest 2013; 144 (02) 522-530
    CrossrefPubMedSearch in Google Scholar
  • 24 Newnham M, Bunclark K, Abraham N. et al. CAMPHOR score: patient-reported outcomes are improved by pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. Eur Respir J 2020; 56 (04) 1902096
    CrossrefPubMedSearch in Google Scholar
  • 25 Kriechbaum SD, Wiedenroth CB, Wolter JS. et al. N-terminal pro-B-type natriuretic peptide for monitoring after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2018; 37 (05) 639-646
    CrossrefPubMedSearch in Google Scholar
  • 26 Kriechbaum SD, Wiedenroth CB, Keller T. et al. Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. PLoS One 2018; 13 (09) e0204683
    CrossrefPubMedSearch in Google Scholar
  • 27 Roller FC, Kriechbaum S, Breithecker A. et al. Correlation of native T1 mapping with right ventricular function and pulmonary haemodynamics in patients with chronic thromboembolic pulmonary hypertension before and after balloon pulmonary angioplasty. Eur Radiol 2019; 29 (03) 1565-1573
    CrossrefPubMedSearch in Google Scholar
  • 28 Kriechbaum SD, Wiedenroth CB, Hesse ML. et al. Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension. Scand J Clin Lab Invest 2019; 79 (04) 268-275
    CrossrefPubMedSearch in Google Scholar
  • 29 Kriechbaum SD, Wiedenroth CB, Peters K. et al. Galectin-3, GDF-15, and sST2 for the assessment of disease severity and therapy response in patients suffering from inoperable chronic thromboembolic pulmonary hypertension. Biomarkers 2020; 25 (07) 578-586
    CrossrefPubMedSearch in Google Scholar
  • 30 Wiedenroth Md CB, Rieth Md AJ, Kriechbaum Md S. et al. Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension. Pulm Circ 2020; 10 (03) 20 45894020917884
    CrossrefPubMedSearch in Google Scholar
  • 31 Roller FC, Schüssler A, Hasse A. et al. Effects of BPA on right ventricular mechanical dysfunction in patients with inoperable CTEPH - a cardiac magnetic resonance study. Eur J Radiol 2022; 147: 110111
    CrossrefPubMedSearch in Google Scholar
  • 32 Voorburg JA, Cats VM, Buis B, Bruschke AV. Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism. Chest 1988; 94 (06) 1249-1253
    CrossrefPubMedSearch in Google Scholar
  • 33 Feinstein JA, Goldhaber SZ, Lock JE, Ferndandes SM, Landzberg MJ. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation 2001; 103 (01) 10-13
    CrossrefPubMedSearch in Google Scholar
  • 34 Pitton MB, Herber S, Mayer E, Thelen M. Pulmonary balloon angioplasty of chronic thromboembolic pulmonary hypertension (CTEPH) in surgically inaccessible cases. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 2003; 175 (05) 631-634
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 Minatsuki S, Kodera S, Kiyosue A. et al. Balloon pulmonary angioplasty improves quality of life in Japanese patients with chronic thromboembolic pulmonary hypertension. J Cardiol 2020; 76 (02) 205-210
    CrossrefPubMedSearch in Google Scholar
  • 36 Darocha S, Pietura R, Pietrasik A. et al. Improvement in quality of life and hemodynamics in chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty. Circ J 2017; 81 (04) 552-557
    CrossrefPubMedSearch in Google Scholar
  • 37 Tamada N, Nakayama K, Yanaka K. et al. Pulmonary endarterectomy and balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension - similar effects on health-related quality of life. Circ Rep 2019; 1 (05) 228-234
    CrossrefPubMedSearch in Google Scholar
  • 38 Jansa P, Heller S, Svoboda M. et al. Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: impact on clinical and hemodynamic parameters, quality of life and risk profile. J Clin Med 2020; 9 (11) 3608
    CrossrefPubMedSearch in Google Scholar
  • 39 Miura K, Katsumata Y, Kawakami T. et al. Exercise tolerance and quality of life in hemodynamically partially improved patients with chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty. PLoS One 2021; 16 (07) e0255180
    CrossrefPubMedSearch in Google Scholar