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Zhang Y, Zhang Y, Liao C, Wang X. Prognostic implication of glomerular filtration rates in patients with chronic thromboembolic pulmonary hypertension who have undergone balloon pulmonary angioplasty. Exp Ther Med 2024; 27:18. [PMID: 38223330 PMCID: PMC10785012 DOI: 10.3892/etm.2023.12306] [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: 01/11/2023] [Accepted: 09/07/2023] [Indexed: 01/16/2024] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) plays a key role in the deterioration of lung hemodynamics and contributes to secondary dysfunction of the right heart, which is consistently accompanied by systemic malperfusion and a reduced glomerular filtration rate (GFR). The prognosis of CTEPH is markedly influenced by renal function. The aim of the present study was to evaluate the prognostic value of GFR in patients with CTEPH who have undergone balloon pulmonary angioplasty (BPA). From December 2012 to September 2020, a total of 47 patients diagnosed with CTEPH who received BPA were retrospectively studied. Patients were categorized according to their renal function on admission into two groups: GFR >53 and ≤53. Biological, clinical and demographic data of the patients were collected. Data for the two groups in hospital and during follow-up were systematically analyzed and compared. All-cause mortality, death from right heart failure (RHF) and rehospitalization associated with RHF were considered major adverse events (MAEs). The results revealed that the 6-min walk distance, N-terminal pro-B type natriuretic peptide (NT-proBNP), Troponin I and right ventricle diameter were significantly lower, and tricuspid annular plane systolic excursion was significantly higher in the GFR >53 group compared with the GFR ≤53 group at final follow-up. In addition, GFR levels were significantly correlated with NT-proBNP at baseline and final follow-up. Furthermore, based on a multivariate analysis, it was determined that the decreased GFR was an independent predictor of MAEs during follow-up. Therefore, it may be concluded that in addition to being associated with right ventricular function, decreased GFR is also a prognostic marker in CTEPH treated with BPA.
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Affiliation(s)
- Yu Zhang
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Yongxiang Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Chang Liao
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Xiaoxu Wang
- Department of Infectious Disease, Heilongjiang Provincial People's Hospital, Harbin, Heilongjiang 150001, P.R. China
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2
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Roller FC, Schüssler A, Hasse A, Kriechbaum S, Richter M, Guth S, Tello K, Breithecker A, Liebetrau C, Hamm CW, Mayer E, Seeger W, Krombach GA, Wiedenroth CB. Effects of BPA on right ventricular mechanical dysfunction in patients with inoperable CTEPH - A cardiac magnetic resonance study. Eur J Radiol 2021; 147:110111. [PMID: 34952330 DOI: 10.1016/j.ejrad.2021.110111] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to assess effects of balloon pulmonary angioplasty (BPA) on right ventricular (RV) mechanical dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) via MRI. METHOD MRI at 1.5 Tesla and right heart catheterization were performed before and 6 months after BPA in 30 CTEPH patients (mean age 63.4 ± 10.6 years; 17 female). Feature-tracking strain analysis, including global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain, was performed and compared with right ventricular function, myocardial remodelling (assessed by native T1 times), and pulmonary haemodynamics (mean pulmonary arterial pressure and pulmonary vascular resistance). RESULTS RVEF (35.9% to 48.4%) increased and mPAP (42.1 mmHg to 33.1 mmHg) and PVR (551.8 to 377.7 dyn∙s/cm5) decreased after BPA (all p < 0.0001). Moreover, RV strain increased (GLS -19.9 to -24.0%, p = 0.0003; GCS -9.4 to -11.0%, p = 0.0022; GRS 38.2 to 50.7%, p = 0.001) and septal native area-adjusted T1 time (AA-T1) decreased (1019.4 to 988.7 ms, p < 0.0001). GLS revealed the best correlations with RVEF (before BPA r = -0.75; after BPA r = -0.54), mPAP (r = 0.36; r = 0.52), PVR (r = 0.49; r = 0.48), and AA-T1 (r = 0.44; 0.19). CONCLUSION RV mechanical dysfunction, pulmonary haemodynamics, and myocardial remodelling are markedly improved by BPA. Moreover, RV strain values showed good correlations with RV function, pulmonary haemodynamics, and myocardial remodelling. Therefore, strain analysis might provide new insights regarding therapy outcome, monitoring, and prognosis.
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Affiliation(s)
- Fritz C Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany.
| | - Armin Schüssler
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Alexander Hasse
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | | | - Manuel Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Andreas Breithecker
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | | | - Christian W Hamm
- Department of Cardiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany; Department of Cardiology, Campus Kerckhoff, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Frankfurt am Main, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Gabriele A Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
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3
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Kriechbaum SD, Wiedenroth CB, Peters K, Barde MA, Ajnwojner R, Wolter JS, Haas M, Roller FC, Guth S, Rieth AJ, Rolf A, Hamm CW, Mayer E, Keller T, Liebetrau C. 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; 25:578-586. [PMID: 32901511 DOI: 10.1080/1354750x.2020.1821776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This study examined sST2, GDF-15, and galectin-3 as indicators of disease severity and therapy response in chronic thromboembolic pulmonary hypertension (CTEPH). METHODS This study included 57 inoperable CTEPH patients who underwent balloon pulmonary angioplasty and 25 controls without cardiovascular disease. Biomarker levels were examined in relation to advanced hemodynamic impairment [tertile with worst right atrial pressure (RAP) and cardiac index], hemodynamic therapy response [normalized hemodynamics (meanPAP ≤25 mmHg, PVR ≤3 WU and RAP ≤6 mmHg) or a reduction of meanPAP ≥25%; PVR ≥ 35%, RAP ≥25%]. RESULTS GDF-15 [820 (556-1315) pg/ml vs. 370 (314-516) pg/ml; p < 0.001] and sST2 [53.7 (45.3-74.1) ng/ml vs. 48.7 (35.5-57.0) ng/ml; p = 0.02] were higher in CTEPH patients than in controls. At baseline, a GDF-15 level ≥1443 pg/ml (AUC 0.88; OR 31.4) and a sST2 level ≥65 ng/ml (AUC 0.80; OR 10.9) were associated with advanced hemodynamic impairment. At follow-up GDF-15 ≤ 958 pg/ml (AUC = 0.74, OR 18) identified patients with optimal hemodynamic therapy response and ≤760 pg/ml (AUC = 0.79, OR 14). CONCLUSION GDF-15 and sST2 levels are higher in CTEPH and identified patients with advanced hemodynamic impairment. Further, decreased GDF-15 levels at follow-up were associated with hemodynamic therapy response. The diagnostic strength was not superior to NT-proBNP.
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Affiliation(s)
- Steffen D Kriechbaum
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Christoph B Wiedenroth
- Department of Thoracic Surgery, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany
| | - Karina Peters
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Marta A Barde
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Ruth Ajnwojner
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Jan-Sebastian Wolter
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Moritz Haas
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Fritz C Roller
- Department of Radiology, Justus Liebig University Giessen, Giessen, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany
| | - Andreas J Rieth
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany.,Division of Cardiology, Justus Liebig University Giessen, Medical Clinic I, Giessen, Germany
| | - Andreas Rolf
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany.,Division of Cardiology, Justus Liebig University Giessen, Medical Clinic I, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany.,Division of Cardiology, Justus Liebig University Giessen, Medical Clinic I, Giessen, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany
| | - Till Keller
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany.,Division of Cardiology, Justus Liebig University Giessen, Medical Clinic I, Giessen, Germany
| | - Christoph Liebetrau
- Department of Cardiology, University of Giessen, Heart and Thorax Center, Campus Kerckhoff, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany.,Division of Cardiology, Justus Liebig University Giessen, Medical Clinic I, Giessen, Germany
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4
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Kriechbaum SD, Wiedenroth CB, Hesse ML, Ajnwojner R, Keller T, Sebastian Wolter J, Haas M, Roller FC, Breithecker A, Rieth AJ, Guth S, Rolf A, Hamm CW, Mayer E, Liebetrau C. Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:268-275. [PMID: 30987470 DOI: 10.1080/00365513.2019.1601765] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Balloon pulmonary angioplasty (BPA), for chronic thromboembolic pulmonary hypertension, improves pulmonary and systemic hemodynamics. The kidney might benefit from this effect. However, staged BPA therapy comes along with repetitive administration of contrast agent. This study examined the overall effect of BPA therapy on renal function. This study included consecutive patients who underwent BPA treatment and completed a 6-month follow-up between March 2014 and March 2017. Biomarker-based evaluation of renal function was performed at baseline, consecutively prior to and after each BPA and at 6-month follow-up. The 51 patients underwent an average of 5 (±2) BPA sessions. In this course, patients received 133 (±48; 21-300) mL of contrast agent per session and 691 (±24; 240-1410) mL during the whole sequence. Acute kidney injury occurred after 6 (2.3%) procedures. The creatinine [80.1 (IQR 67.8-96.8) µmol/L vs. 77.4 (IQR 66.9-91.5) µmol/L, p = .02] and urea level [13.7 (IQR10.7-16.6) mmol/L vs. 12.5 (IQR 10.0-15.5) mmol/L, p = .02] decreased from baseline to the 6-month follow-up. The estimated glomerular filtration rate (eGFR) [79 (IQR 59-94) mL/min/m2 vs. 79.6 (IQR 67.1-95.0) mL/min/m2, p = .11] did not change. The Chronic kidney disease (CKD) stages at baseline were: G1:15; G2:23; G3a:10; G3b:2; G4:1; G5:0. Among patients with a CKD-stage ≥2, analysis revealed an increase of eGFR, decrease of creatinine and urea from baseline to 6-month follow-up. Among those patients, the baseline-CKD-stage improved in 14 (41.2%) patients. BPA therapy improves pulmonary and systemic hemodynamics, with positive effects on renal function. Repetitive administration of contrast agent seems not to be harmful regarding renal function.
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Affiliation(s)
- Steffen D Kriechbaum
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Christoph B Wiedenroth
- c Department of Thoracic Surgery , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - Maura L Hesse
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Ruth Ajnwojner
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | | | - Jan Sebastian Wolter
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Moritz Haas
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Fritz C Roller
- d Department of Radiology , Justus Liebig University Giessen , Giessen , Germany
| | - Andreas Breithecker
- e Department of Radiology , Gesundheitszentrum Wetterau , Bad Nauheim , Germany
| | - Andreas J Rieth
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Stefan Guth
- c Department of Thoracic Surgery , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - Andreas Rolf
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,f Medical Clinic I Division of Cardiology , Justus Liebig University Giessen , Giessen , Germany
| | - Christian W Hamm
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,f Medical Clinic I Division of Cardiology , Justus Liebig University Giessen , Giessen , Germany
| | - Eckhard Mayer
- c Department of Thoracic Surgery , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - Christoph Liebetrau
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,f Medical Clinic I Division of Cardiology , Justus Liebig University Giessen , Giessen , Germany
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Huang WC, Hsu CH, Sung SH, Ho WJ, Chu CY, Chang CP, Chiu YW, Wu CH, Chang WT, Lin L, Lin SL, Cheng CC, Wu YJ, Wu SH, Hsieh TY, Hsu HH, Fu M, Dai ZK, Kuo PH, Hwang JJ, Cheng SM. 2018 TSOC guideline focused update on diagnosis and treatment of pulmonary arterial hypertension. J Formos Med Assoc 2019; 118:1584-1609. [PMID: 30926248 DOI: 10.1016/j.jfma.2018.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/18/2018] [Accepted: 12/14/2018] [Indexed: 01/04/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized as a progressive and sustained increase in pulmonary vascular resistance, which may induce right ventricular failure. In 2014, the Working Group on Pulmonary Hypertension of the Taiwan Society of Cardiology (TSOC) conducted a review of data and developed a guideline for the management of PAH.4 In recent years, several advancements in diagnosis and treatment of PAH has occurred. Therefore, the Working Group on Pulmonary Hypertension of TSOC decided to come up with a focused update that addresses clinically important advances in PAH diagnosis and treatment. This 2018 focused update deals with: (1) the role of echocardiography in PAH; (2) new diagnostic algorithm for the evaluation of PAH; (3) comprehensive prognostic evaluation and risk assessment; (4) treatment goals and follow-up strategy; (5) updated PAH targeted therapy; (6) combination therapy and goal-orientated therapy; (7) updated treatment for PAH associated with congenital heart disease; (8) updated treatment for PAH associated with connective tissue disease; and (9) updated treatment for chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Chih-Hsin Hsu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shih-Hsien Sung
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Jing Ho
- Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Ping Chang
- Division of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Wei Chiu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Hsien Wu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ting Chang
- Division of Cardiovascular Medicine, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Lin Lin
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Shoa-Lin Lin
- Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan; Pulmonary Hypertension Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yih-Jer Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Pulmonary Hypertension Interventional Medicine, Cardiovascular Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Shu-Hao Wu
- Pulmonary Hypertension Interventional Medicine, Cardiovascular Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Tsu-Yi Hsieh
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Morgan Fu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan.
| | - Shu-Meng Cheng
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Kriechbaum SD, Wiedenroth CB, Keller T, Wolter JS, Ajnwojner R, Peters K, Haas MA, Roller FC, Breithecker A, Rieth AJ, Guth S, Rolf A, Bandorski D, Hamm CW, Mayer E, Liebetrau C. Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. PLoS One 2018; 13:e0204683. [PMID: 30252896 PMCID: PMC6155553 DOI: 10.1371/journal.pone.0204683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023] Open
Abstract
Aims Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress. Methods and results This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU. In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8±219.2dyn×sec×cm-5) decreased significantly within the 6-MFU (meanPAP: 32.6±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm-5, P<0.001). At BL, the median hs-cTnT level was 11 (IQR 6–16) ng/L and the median NT-proBNP level was 820 (IQR 153–1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5–12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84–464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (rrs = 0.42; p = 0.005), the meanPAP (rrs = 0.32; p = 0.029) and the NT-proBNP (rrs = 0.51; p<0.001) levels at BL. Conclusion Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.
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Affiliation(s)
- Steffen D. Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- * E-mail:
| | | | - Till Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Jan Sebastian Wolter
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Ruth Ajnwojner
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Karina Peters
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Moritz A. Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Fritz C. Roller
- Justus Liebig University Giessen, Department of Radiology, Giessen, Germany
| | | | - Andreas J. Rieth
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Stefan Guth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Andreas Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Dirk Bandorski
- Justus Liebig University of Giessen, Department of Internal Medicine, Division of Pulmonology, Giessen, Germany
| | - Christian W. Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Eckhard Mayer
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
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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 2018; 29:1565-1573. [DOI: 10.1007/s00330-018-5702-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 01/20/2023]
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Kriechbaum SD, Wiedenroth CB, Wolter JS, Hütz R, Haas M, Breithecker A, Roller FC, Keller T, Guth S, Rolf A, Hamm CW, Mayer E, Liebetrau C. N-terminal pro-B-type natriuretic peptide for monitoring after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2017; 37:639-646. [PMID: 29329761 DOI: 10.1016/j.healun.2017.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/25/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) is an emerging interventional treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). The non-invasive monitoring of CTEPH patients is a clinical challenge. In this study we examined changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients undergoing BPA for inoperable CTEPH and related them to peri-procedural success. METHODS In this study we analyzed a total of 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between March 2014 and March 2017. Serum samples for NT-proBNP measurement were collected before every BPA and at 6-MFU. RESULTS The 51 patients underwent 265 interventions involving angioplasty of a total of 410 vessels. The 6-month survival rate was 96.1%. The baseline (BL) mean pulmonary artery pressure (PAP) was 39.5 ± 12.1 mm Hg, pulmonary vascular resistance (PVR) was 515.8 ± 219.2 dynes/s/cm5 and the median NT-proBNP level was 820 (153 to 1,871.5) ng/liter. At BL, World Health Organization functional class (FC) was ≥III in 96.1% of the patients, whereas, at 6-MFU, 11.8% were in WHO FC ≥III. At 6-MFU, mean PAP (32.6 ± 12.6 mm Hg; p < 0.001), PVR (396.9 ± 182.6 dynes/s/cm5; p < 0.001) and NT-proBNP (159.3 [84.4 to 464.3] ng/liter; p < 0.001) levels were reduced. The decrease in NT-proBNP levels correlated with the decrease in mean PAP (rrs = 0.43, p = 0.002) and PVR (rrs = 0.50, p = 0.001). A reduction in the NT-proBNP level of 46% indicated a decrease in mean PAP of ≥25% (area under the curve [AUC] = 0.71) and a reduction of 61% indicated a decrease in PVR of ≥35% (AUC 0.77). CONCLUSIONS Our results demonstrate that NT-proBNP levels decrease after BPA, providing valuable evidence of procedural success. NT-proBNP measurement allows identification of patients who are BPA non-responders and may thus be a valuable adjunct in therapy monitoring.
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Affiliation(s)
- Steffen D Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany.
| | | | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Regula Hütz
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Moritz Haas
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
| | | | - Fritz C Roller
- Department of Radiology, Justus Liebig University Giessen, Giessen, Germany
| | - Till Keller
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany; Medical Clinic I, Division of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany; Medical Clinic I, Division of Cardiology, Justus Liebig University Giessen, Giessen, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany; Medical Clinic I, Division of Cardiology, Justus Liebig University Giessen, Giessen, Germany
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Abstract
Pulmonary hypertension (PH) comprises a group of pulmonary vascular diseases that are characterized by progressive exertional dyspnea and right heart insufficiency ultimately resulting in right heart decompensation. The classification is into five clinical subgroups that form the absolutely essential basis for decisions on the indications for different pharmacological and non-pharmacological forms of treatment. The guidelines were updated in 2015 and in addition to the hitherto existing pharmacological treatment options of phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostacyclins, the soluble guanylate cyclase stimulator riociguat has now been incorporated for treatment of certain forms of PH. This article provides an overview of the new treatment recommendations in the current guidelines, e. g. for PH patients who are in intensive care units due to surgical interventions or progressive right heart insufficiency.
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Luft FC. Editorial Commentary: Chronic thromboembolic pulmonary hypertension evolves diagnostically and therapeutically. Trends Cardiovasc Med 2016; 27:38-40. [PMID: 27544725 DOI: 10.1016/j.tcm.2016.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Friedrich C Luft
- Experimental and Clinical Research Center, A Joint Cooperation between the Max-Delbrück Center for Molecular Medicine and the Charité Medical Faculty, Lindenbergerweg 80, Berlin 13125, Germany.
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