Abstract 13929: Pulmonary Artery Diameter Index Predicts the Complications of Balloon Pulmonary Angioplasty
Backgrounds: Balloon pulmonary angioplasty (BPA) has been an attractive strategy as a new treatment for peripheral type chronic thromboembolic pulmonary hypertension (CTEPH). However, BPA occasionally causes fatal complications such as hemorrhagic pulmonary edema, and asymptomatic mild lung injury detected on computed tomography (CT) image is not rare. Pathogenesis of lung injury after BPA has been considered to be a direct vascular injury due to guide wire or balloon, cytokine release at the time of reperfusion, and vulnerability of peripheral pulmonary vascular wall. However, predictive factors of lung injury have not been established.
The pulmonary artery expansion of the central portion is frequently observed in patients with advanced pulmonary hypertension and the pulmonary artery diameter can be measured easily and accurately by CT.
Therefore, we focused on the pulmonary artery diameter and investigated the association between complications after BPA.
Methods: The subject consisted of 16 CTEPH patients diagnosed by right heart catheterization and pulmonary arteriography who underwent BPA (2 males, 14 females, age 60.5 ± 11 years. Initial hemodynamic indices of study subjects were mean pulmonary artery pressure (mPAP) 48.8±12.8 mmHg, cardiac output (CO) 3.62±1.07 L/min, and pulmonary vascular resistance (PVR) 11.6±8.15 WoodUnits. Patients were divided into two groups: group N (no symptoms or signs of any complications, n=9) and group C (symptoms such as hemoptysis or lung infiltration on CT image without symptoms, n=7). We measured pulmonary artery diameter on CT at the transition from the main trunk to the right pulmonary artery and corrected by body surface area. We defined this as the pulmonary diameter index.
Results: CO was lower in group C than in group N, but there was no difference in mPAP, PVR, BNP, and the use of pulmonary vasodilators between two groups. Pulmonary artery diameter index in group C was significantly higher than that in group N (21.95 ± 5.89 vs. 14.22 ± 2.41 mm/m2, P<0.01). ROC curve indicated 85.7% sensitivity and 88.9% specificity using cut-off value of 18.0 to predict the complications after BPA.
Conclusions: Our study suggested that pulmonary artery diameter index would be a novel predictor of the complications after BPA.
Author Disclosures: K. Sugimoto: Other; Significant; Author belongs to endowed department sponsored by Actelion Pharmaceuticals Japan. K. Nakazato: None. A. Yoshihisa: None. N. Sakamoto: None. T. Yamaki: None. H. Kunii: None. Y. Takeishi: None.
- © 2015 by American Heart Association, Inc.