Abstract 15274: Determinants of Exercise Tolerance After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension
Introduction: In patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), balloon pulmonary angioplasty (BPA) has become an alternative therapy to improve hemodynamics, right ventricular (RV) function and exercise intolerance. Exercise intolerance, a key feature of CTEPH, remains even after BPA. However, the determinants of exercise capacity after BPA in patients with CTEPH have not been elucidated. The purpose of this study was to identify the determinants after BPA in patients with CTEPH.
Method: We analyzed the consecutive 9 patients with CTEPH who underwent BPA. Six months after their final session of BPA, respiratory function test was performed at rest. In addition, we performed right heart catheterization, cardiopulmonary exercise test, and echocardiography simultaneously to observe hemodynamics and respiratory change during exercise by ergometer at supine position. As the indices of RV function, we used tricuspid annular plane systolic excursion (TAPSE) and RV-S’ using tissue Doppler imaging by echocardiography.
Result: The median age was 73.0 (25%, 75%: 68.5, 76.0) years old. The median peak VO2/kg was 15.1 (14.1, 16.9) ml/min/kg, median mean pulmonary artery pressure (mPAP) increased from 22.0 (18.0, 23.5) mmHg at rest to 54.0 (47.5, 62.5) mmHg at peak and PVR also increased from 268 (294, 407) dynes s cm-5 at rest to 361 (255, 515) dynes s cm-5 at peak. The peak VO2/kg significantly correlated with PVR at peak (Figure A: R=-0.70, P=0.033), delta mPA / delta cardiac output (B: R=-0.80, P=0.008), rest PvO2 (C: R=0.69, P=0.039) and %VC (D: R=0.81, P=0.008). In contrast, there was no significant association between peak VO2/kg and left ventricular ejection fraction, brain natriuretic peptide, TAPSE, RV-S’, cardiac output or hemoglobin levels.
Conclusion: We for the first time found that the exercise tolerance was determined by the hemodynamics and respiratory function, but not cardiac function, in patients with CTEPH after BPA.
Author Disclosures: S. Miyanaga: None. K. Kubota: None. N. Iwatani: None. K. Higo: None. Y. Horizoe: None. H. Chaen: None. N. Uchiyama: None. S. Ojima: None. S. Kawasoe: None. T. Kubozono: None. M. Miyata: None. M. Ohishi: None.
- © 2016 by American Heart Association, Inc.