1
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Kim NH, D'Armini AM, Delcroix M, Jaïs X, Jevnikar M, Madani MM, Matsubara H, Palazzini M, Wiedenroth CB, Simonneau G, Jenkins DP. Chronic thromboembolic pulmonary disease. Eur Respir J 2024:2401294. [PMID: 39209473 DOI: 10.1183/13993003.01294-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024]
Abstract
Chronic thromboembolic pulmonary hypertension is a complication of pulmonary embolism and a treatable cause of pulmonary hypertension. The pathology is a unique combination of mechanical obstruction due to failure of clot resolution, and a variable degree of microvascular disease, that both contribute to pulmonary vascular resistance. Accordingly, multiple treatments have been developed to target the disease components. However, accurate diagnosis is often delayed. Evaluation includes high-quality imaging modalities, necessary for disease confirmation and for appropriate treatment planning. All patients with chronic thromboembolic pulmonary disease, and especially those with pulmonary hypertension, should be referred to expert centres for multidisciplinary team decision on treatment. The first decision remains assessment of operability, and the best improvement in symptoms and survival is achieved by the mechanical therapies, pulmonary endarterectomy and balloon pulmonary angioplasty. With the advances in multimodal therapies, excellent outcomes can be achieved with 3-year survival of >90%.
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Affiliation(s)
- Nick H Kim
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrea M D'Armini
- Department of Cardio-Thoracic and Vascular Surgery, Heart and Lung Transplantation and Pulmonary Hypertension Unit, Foundation IRCCS Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy
| | - Marion Delcroix
- Clinical Department of Respiratory Disease, Pulmonary Hypertension Center, UZ Leuven, Leuven, Belgium
| | - Xavier Jaïs
- AP-HP, Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- AP-HP, Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Michael M Madani
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Massimiliano Palazzini
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Universita di Bologna, Bologna, Italy
| | | | - Gérald Simonneau
- Pneumologie Kremlin Bicetre University Hospital, National Reference Center for Pulmonary Hypertension, Paris Saclay University, Paris, France
| | - David P Jenkins
- Cardiothoracic Surgery and Transplantation, Royal Papworth Hospital, Cambridge, UK
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2
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Watabe K, Goda A, Tobita K, Yokoyama S, Kikuchi H, Takeuchi K, Inami T, Soejima K, Kohno T. Determinants of physical quality of life in patients with chronic thromboembolic pulmonary hypertension after treatment: Insights from invasive exercise stress test. J Heart Lung Transplant 2024; 43:1278-1287. [PMID: 38636934 DOI: 10.1016/j.healun.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Impaired quality of life (QoL) is prevalent among patients with chronic thromboembolic pulmonary hypertension (CTEPH) despite improved survival due to medical advances. We clarified the physical QoL of patients with CTEPH with mildly elevated pulmonary hemodynamics and evaluated its determinants using a database of patients with CTEPH evaluated for hemodynamics during exercise. METHODS The QoL was measured in 144 patients with CTEPH (age, 66 (58-73) years; men/women, 48/96) with mildly elevated mean pulmonary artery pressure (<30 mm Hg) at rest after treatment with balloon pulmonary angioplasty and/or pulmonary endarterectomy using the Short-Form 36 (SF-36) questionnaire. The enrolled patients were divided into 2 groups: physical component summary (PCS) scores in the SF-36 over 50 as PCS-good and those under 50 as PCS-poor. RESULTS The median PCS in SF-36 score was 43.4 (IQR 32.4-49.5) points. The PCS-poor group (n = 110) was older and had lower exercise capacity and SaO2 during exercise. PCS scores were correlated with 6-minute walk distance (rs=0.40, p < 0.001), quadriceps strength (rs=0.34, p < 0.001), peak VO2 (rs=0.31, p < 0.001), SaO2 at rest (rs=0.35, p < 0.001) and peak exercise (rs=0.33, p < 0.001), home oxygen therapy usage (rs=-0.28, p = 0.001), and pulmonary vascular resistance at peak exercise (rs=-0.26, p = 0.002). CONCLUSIONS The impairment of physical QoL was common in patients with CTEPH with improved hemodynamics; exercise capacity, hypoxemia, and hemodynamic status during exercise were related to the physical QoL.
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Affiliation(s)
- Kosuke Watabe
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan.
| | - Kazuki Tobita
- Department of Rehabilitation, Kyorin University Hospital, Tokyo, Japan
| | - Sachi Yokoyama
- Department of Rehabilitation, Kyorin University Hospital, Tokyo, Japan; Nursing Department, Yumino Heart Clinic, Tokyo, Japan
| | - Hanako Kikuchi
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Kaori Takeuchi
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Takumi Inami
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
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3
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Staal DP, Hendriks PM, van Thor MCJ, van de Groep LD, van den Toorn LM, Mulder BM, Chandoesing PP, Kauling RM, Boerman S, van den Bosch AE, Mager JJ, Boomars KA, Post MC. Inoperable chronic thromboembolic pulmonary hypertension: Evolution of prognosis over 10 years of new emerging therapies. Pulm Circ 2024; 14:e12419. [PMID: 39175520 PMCID: PMC11340011 DOI: 10.1002/pul2.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/17/2024] [Accepted: 07/14/2024] [Indexed: 08/24/2024] Open
Abstract
Therapies for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) include balloon pulmonary angioplasty (BPA) and PH-specific medical therapy. This study compares survival and its predictors before and after the introduction of BPA. BPA was independently associated with survival; however, there was no difference in overall survival between the two cohorts.
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Affiliation(s)
- Diederik P. Staal
- Department of CardiologySt. Antonius HospitalNieuwegein/Utrechtthe Netherlands
| | - Paul M. Hendriks
- Department of Cardiology, Erasmus MCUniversity Medical Centre RotterdamRotterdamthe Netherlands
- Department of Respiratory Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamthe Netherlands
| | | | | | - Leon M. van den Toorn
- Department of Respiratory Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamthe Netherlands
| | | | - Prewesh P. Chandoesing
- Department of Respiratory Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamthe Netherlands
| | - Robert M. Kauling
- Department of Cardiology, Erasmus MCUniversity Medical Centre RotterdamRotterdamthe Netherlands
| | - Sanne Boerman
- Department of Respiratory MedicineSt. Antonius HospitalNieuwegein/Utrechtthe Netherlands
| | | | - Johannes J. Mager
- Department of Respiratory MedicineSt. Antonius HospitalNieuwegein/Utrechtthe Netherlands
| | - Karin A. Boomars
- Department of Respiratory Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamthe Netherlands
| | - Martijn C. Post
- Department of CardiologySt. Antonius HospitalNieuwegein/Utrechtthe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
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4
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Boucly A, Bertoletti L, Fauvel C, Dewavrin MG, Gerges C, Grynblat J, Guignabert C, Hascoet S, Jaïs X, Jutant EM, Lamblin N, Meyrignac O, Riou M, Savale L, Tromeur C, Turquier S, Valentin S, Simonneau G, Humbert M, Sitbon O, Montani D. Evidence and unresolved questions in pulmonary hypertension: Insights from the 5th French Pulmonary Hypertension Network Meeting. Respir Med Res 2024; 86:101123. [PMID: 38972109 DOI: 10.1016/j.resmer.2024.101123] [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: 03/30/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
Pulmonary hypertension (PH) continues to present significant challenges to the medical community, both in terms of diagnosis and treatment. The advent of the updated 2022 European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines has introduced pivotal changes that reflect the rapidly advancing understanding of this complex disease. These changes include a revised definition of PH, updates to the classification system, and treatment algorithm. While these guidelines offer a critical framework for the management of PH, they have also sparked new discussions and questions. The 5th French Pulmonary Hypertension Network Meeting (Le Kremlin-Bicêtre, France, 2023), addressed these emergent questions and fostering a deeper understanding of the disease's multifaceted nature. These discussions were not limited to theoretical advancements but extended into the practical realms of patient management, highlighting the challenges and opportunities in applying the latest guidelines to clinical practice.
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Affiliation(s)
- Athénaïs Boucly
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - 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
| | - Charles Fauvel
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | | | - Christian Gerges
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julien Grynblat
- University of Paris-Saclay, School of Medicine, le Kremlin-Bicêtre, France
| | - Christophe Guignabert
- University of Paris-Saclay, School of Medicine, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - Sébastien Hascoet
- University of Paris-Saclay, School of Medicine, le Kremlin-Bicêtre, France; Hôpital Marie Lannelongue, Faculté de Médecine, Paris-Saclay, Université Paris-Saclay, Le Plessis Robinson, France
| | - Xavier Jaïs
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - Etienne-Marie Jutant
- Respiratory Department, CHU de Poitiers, INSERM CIC 1402, IS-ALIVE Research Group, University of Poitiers, Poitiers, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Olivier Meyrignac
- Assistance Publique - Hôpitaux de Paris (AP-HP) - Biomaps - Laboratoire d'Imagerie Multimodale - CEA - INSERM - CNRS, DMU 14 Smart Imaging - Department of Radiology, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Marianne Riou
- Department of Physiology and Functional Exploration, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Laurent Savale
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - Cécile Tromeur
- Department of Internal Medicine and Pulmonology, CHU Brest, France. INSERM 1304 GETBO (groupe d'étude de thrombose et de bretagne occidentale), Brest, France
| | - Ségolène Turquier
- Department of Physiology and Functional Exploration, Hôpital Louis Pradel, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Simon Valentin
- Université de Lorraine, CHRU-Nancy, Pôle des Spécialités Médicales/Département de Pneumologie- IADI, INSERM U1254, Nancy, France
| | - Gérald Simonneau
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - Marc Humbert
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - Olivier Sitbon
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France
| | - David Montani
- University of Paris-Saclay, School 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, Bicêtre Hospital, le Kremlin-Bicêtre, France; INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Marie Lannelongue Hospital and Bicêtre Hospital, France.
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5
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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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6
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Skoro‐Sajer N, Sheares K, Forfia P, Heresi GA, Jevnikar M, Kopeć G, Moiseeva O, Terra‐Filho M, Whitford H, Zhai Z, Beaudet A, Gressin V, Meijer C, Tan YZ, Abe K. Treatment and management of chronic thromboembolic pulmonary hypertension (CTEPH): A global cross-sectional scientific survey (CLARITY). Pulm Circ 2024; 14:e12406. [PMID: 38947169 PMCID: PMC11214874 DOI: 10.1002/pul2.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/30/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024] Open
Abstract
Advances in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) over the past decade changed the disease landscape, yet global insight on clinical practices remains limited. The CTEPH global cross-sectional scientific survey (CLARITY) aimed to gather information on the current diagnosis, treatment, and management of CTEPH and to identify unmet medical needs. This paper focuses on the treatment and management of CTEPH patients. The survey was circulated to hospital-based medical specialists through Scientific Societies and other medical organizations from September 2021 to May 2022. The majority of the 212 respondents involved in the treatment of CTEPH were from centers performing up to 50 pulmonary endarterectomy (PEA) and/or balloon pulmonary angioplasty (BPA) procedures per year. Variation was observed in the reported proportion of patients deemed eligible for PEA/BPA, as well as those that underwent the procedures, including multimodal treatment and subsequent follow-up practices. Prescription of pulmonary arterial hypertension-specific therapy was reported for a variable proportion of patients in the preoperative setting and in most nonoperable patients. Reported use of vitamin K antagonists and direct oral anticoagulants was similar (86% vs. 82%) but driven by different factors. This study presents heterogeneity in treatment approaches for CTEPH, which may be attributed to center-specific experience and region-specific barriers to care, highlighting the need for new clinical and cohort studies, comprehensive clinical guidelines, and continued education.
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Affiliation(s)
- Nika Skoro‐Sajer
- Division of Cardiology, Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | | | - Paul Forfia
- Temple University HospitalPhiladelphiaPennsylvaniaUSA
| | | | | | - Grzegorz Kopeć
- Pulmonary Circulation Center Jagiellonian University Medical College, John Paul II Hospital in KrakowKrakowPoland
| | - Olga Moiseeva
- Almazov National Medical Research CenterSt. PetersburgRussia
| | - Mario Terra‐Filho
- Pulmonary Division, Heart Institute (Incor)University of Sao PauloSao PauloBrazil
| | | | - Zhenguo Zhai
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pulmonary and Critical Care MedicineCenter of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing ChinaBeijingChina
| | - Amélie Beaudet
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Market AccessAllschwilSwitzerland
| | - Virginie Gressin
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical AffairsAllschwilSwitzerland
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7
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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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8
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Adachi T, Adachi S, Nakano Y, Yasuda K, Nishiyama I, Hirose M, Murohara T. Detrimental Impact of Comorbid Mental Disorders in Chronic Thromboembolic Pulmonary Hypertension - A Retrospective Observational Study. Circ Rep 2024; 6:80-85. [PMID: 38464987 PMCID: PMC10920025 DOI: 10.1253/circrep.cr-23-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/14/2024] [Accepted: 01/23/2024] [Indexed: 03/12/2024] Open
Abstract
Background: The relationship between the prognosis of patients with both chronic thromboembolic pulmonary hypertension (CTEPH) and a mental disorder (MD) remains unclear. Methods and Results: The study group comprised 157 patients with CTEPH who underwent right heart catheterization and were subdivided into 2 groups according to the presence of MDs: MD and non-MD. The patients with MDs were defined as those who had visited a psychiatrist and were under psychotropic drug treatment. The primary outcome was a composite of all-cause death and worsening of PH. The median follow-up period was 1,164 days. The incidence of the primary composite outcome was higher in the MD group than in the non-MD group (24.0% vs. 6.8%), whereas the all-cause mortality rate was comparable between groups (12.0% vs. 6.1%). The mean pulmonary arterial pressure, cardiac index, and pulmonary vascular resistance at baseline were all similar between groups. The Cox proportional hazards model indicated that MD was an independent risk factor for the primary composite outcome (hazard ratio, 2.990; 95% confidence interval, 1.034-8.642). Conclusions: In the present study, concomitant CTEPH and MD was significantly associated with a poor prognosis and such patients should be carefully followed.
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Affiliation(s)
- Takeshi Adachi
- Department of Cardiology, Nagoya University Hospital Nagoya Japan
| | - Shiro Adachi
- Department of Cardiology, Nagoya University Hospital Nagoya Japan
| | - Yoshihisa Nakano
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kenichiro Yasuda
- Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Nagoya Japan
| | - Itsumure Nishiyama
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
| | - Miku Hirose
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Hospital Nagoya Japan
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9
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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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10
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Ghani H, Pepke-Zaba J. Chronic Thromboembolic Pulmonary Hypertension: A Review of the Multifaceted Pathobiology. Biomedicines 2023; 12:46. [PMID: 38255153 PMCID: PMC10813488 DOI: 10.3390/biomedicines12010046] [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: 11/30/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Chronic thromboembolic pulmonary disease results from the incomplete resolution of thrombi, leading to fibrotic obstructions. These vascular obstructions and additional microvasculopathy may lead to chronic thromboembolic pulmonary hypertension (CTEPH) with increased pulmonary arterial pressure and pulmonary vascular resistance, which, if left untreated, can lead to right heart failure and death. The pathobiology of CTEPH has been challenging to unravel due to its rarity, possible interference of results with anticoagulation, difficulty in selecting the most relevant study time point in relation to presentation with acute pulmonary embolism (PE), and lack of animal models. In this article, we review the most relevant multifaceted cross-talking pathogenic mechanisms and advances in understanding the pathobiology in CTEPH, as well as its challenges and future direction. There appears to be a genetic background affecting the relevant pathological pathways. This includes genetic associations with dysfibrinogenemia resulting in fibrinolysis resistance, defective angiogenesis affecting thrombus resolution, and inflammatory mediators driving chronic inflammation in CTEPH. However, these are not necessarily specific to CTEPH and some of the pathways are also described in acute PE or deep vein thrombosis. In addition, there is a complex interplay between angiogenic and inflammatory mediators driving thrombus non-resolution, endothelial dysfunction, and vascular remodeling. Furthermore, there are data to suggest that infection, the microbiome, circulating microparticles, and the plasma metabolome are contributing to the pathobiology of CTEPH.
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Affiliation(s)
- Hakim Ghani
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge CB2 0AY, UK;
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11
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Saveeta F, Payal F, Bai Bansari R. Comment on "Riociguat and Balloon Pulmonary Angioplasty Improve Prognosis in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension". Curr Probl Cardiol 2023; 48:101967. [PMID: 37479007 DOI: 10.1016/j.cpcardiol.2023.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Fnu Saveeta
- Peoples University of Medical and Health Sciences for Women, Pakistan, Nawabshah, Sindh, Pakistan.
| | - Fnu Payal
- Ghulam Muhammad Mahar Medical College Sukkur, Sukkur, Sindh, Pakistan
| | - Raveena Bai Bansari
- Peoples University of Medical and Health Sciences for Women, Pakistan, Nawabshah, Sindh, Pakistan
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12
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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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13
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Wiedenroth CB, Guth S. Response to Huang et al regarding "Riociguat and balloon pulmonary angioplasty improve prognosis in patients with inoperable chronic thromboembolic pulmonary hypertension". J Heart Lung Transplant 2023; 42:1635. [PMID: 37348690 DOI: 10.1016/j.healun.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Christoph B Wiedenroth
- From the Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany.
| | - Stefan Guth
- From the Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
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14
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Kariki O, Karyofyllis P, Mililis P, Saplaouras A, Dragasis S, Chatziantoniou A, Alexiou D, Patsiotis IG, Letsas KP, Efremidis M. Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry. J Electrocardiol 2023; 81:26-31. [PMID: 37506539 DOI: 10.1016/j.jelectrocard.2023.07.006] [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: 04/26/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) has provided an effective invasive treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The hemodynamic improvement achieved by BPA has significantly increased the long-term prognosis of these patients, mostly by reversing the negative remodeling of the right ventricle (RV). MATERIALS AND METHODS In a cohort of 17 patients with symptomatic CTEPH hemodynamic data were collected before and after the completion of BPA sessions. After the confirmation of statistically significant hemodynamic improvement, we examined the changes in certain prespecified electrocardiographic (ECG) parameters (PR interval duration, QRS duration, QTc interval duration, R wave and S wave amplitude in lead I, R wave and S wave amplitude in precordial leads V1, V5 and V6) before the initiation and one month after the completion of BPA sessions. In addition, ECGs were qualitatively assessed before and after treatment for the presence of ECG abnormalities related to PH, proposed by the guidelines of the European Society of Cardiology (ESC). The term ESC criteria 1-6 was used for their description. RESULTS Statistically significant correlation (p < 0.05) was found between the reduction in mean pulmonary artery pressure (mPAP) and the decrease of the depth of the S wave in leads I (p 0.0069), V5 (p 0.0003), V6 (p 0.0011) and in the R wave amplitude in leads V5 (p 0.0122) and V6 (p 0.0185). From the ESC criteria, RV strain pattern was the commonest in the initial cohort, with significant improvement after therapies. CONCLUSION Hemodynamic improvement after BPA therapies is correlated with improved ECG amplitude parameters in leads I, V5 and V6. RV strain pattern is common among untreated patients with significant improvement after therapies.
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Affiliation(s)
- Ourania Kariki
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Panagiotis Karyofyllis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Panagiotis Mililis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Athanasios Saplaouras
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stylianos Dragasis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Anastasios Chatziantoniou
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Dimitris Alexiou
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ilias G Patsiotis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Konstantinos P Letsas
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Michael Efremidis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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15
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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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16
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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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17
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Huang Y, Zhang QZ, Lv SJ. Comments and opinions regarding "Riociguat and balloon pulmonary angioplasty improve prognosis in patients with inoperable chronic thromboembolic pulmonary Hypertension". J Heart Lung Transplant 2023; 42:1316-1317. [PMID: 36948267 DOI: 10.1016/j.healun.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Affiliation(s)
- Yuan Huang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Qin-Zhe Zhang
- Department of Pulmonary and Critical Care Medicine, Affiliated Minzu Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Shi-Jia Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
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18
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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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19
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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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20
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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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21
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Schüssler A, Lug Q, Kremer N, Harth S, Kriechbaum SD, Richter MJ, Guth S, Wiedenroth CB, Tello K, Steiner D, Seeger W, Krombach GA, Roller FC. Evaluation of diagnostic accuracy of dual-energy computed tomography in patients with chronic thromboembolic pulmonary hypertension compared to V/Q-SPECT and pulmonary angiogram. Front Med (Lausanne) 2023; 10:1194272. [PMID: 37425315 PMCID: PMC10324648 DOI: 10.3389/fmed.2023.1194272] [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: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose The relevance of dual-energy computed tomography (DECT) for the detection of chronic thromboembolic pulmonary hypertension (CTEPH) still lies behind V/Q-SPECT in current clinical guidelines. Therefore, our study aimed to assess the diagnostic accuracy of DECT compared to V/Q-SPECT with invasive pulmonary angiogram (PA) serving as the reference standard. Methods A total of 28 patients (mean age 62.1 years ± 10.6SD; 18 women) with clinically suspected CTEPH were retrospectively included. All patients received DECT with the calculation of iodine maps, V/Q-SPECT, and PA. Results of DECT and V/Q-SPECT were compared, and the percent of agreement, concordance (utilizing Cohen's kappa), and accuracy (kappa2) to PA were calculated. Furthermore, radiation doses were analyzed and compared. Results In total, 18 patients were diagnosed with CTEPH (mean age 62.4 years ± 11.0SD; 10 women) and 10 patients had other diseases. Compared to PA, accuracy and concordance for DECT were superior to V/Q-SPECT in all patients (88.9% vs. 81.3%; k = 0.764 vs. k = 0.607) and in CTEPH patients (82.4% vs. 70.1%; k = 0.694 vs. k = 0.560). Furthermore, the mean radiation dose was significantly lower for DECT vs. V/Q-SPECT (p = 0.0081). Conclusion In our patient cohort, DECT is at least equivalent to V/Q-SPECT in diagnosing CTEPH and has the added advantage of significantly lower radiation doses in combination with simultaneous assessment of lung and heart morphology. Hence, DECT should be the subject of ongoing research, and if our results are further confirmed, it should be implemented in future diagnostic PH algorithms at least on par with V/Q-SPECT.
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Affiliation(s)
- Armin Schüssler
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | - Quirin Lug
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | - Nils Kremer
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
| | - Sebastian Harth
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | | | - Manuel J. Richter
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Khodr Tello
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
| | - Dagmar Steiner
- Department of Nuclear Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Werner Seeger
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
- DZHK (German Centre for Cardiovascular Research), Frankfurt am Main, Germany
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | - Fritz Christian Roller
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
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