BACKGROUND Balloon pulmonary angioplasty (BPA) has exhibited substantial progress in the management of chronic thromboembolic pulmonary hypertension (CTEPH). However, nearly one-half of the patients with CTEPH experience persistent pulmonary hypertension after undergoing BPA, emphasizing the need for enhanced therapies. OBJECTIVES The authors sought to investigate the clinical significance of functional assessment-guided dilation of the pulmonary artery (PA) in patients with CTEPH undergoing BPA treatment. METHODS The prospective single-center cohort study enrolled 95 patients who underwent 278 consecutive BPA sessions. Lung parenchymal perfusion was assessed via 2-dimensional perfusion angiography, and pressure catheter measurements were taken to determine the PA pressure ratios. The correlation between lung perfusion and the pressure ratio was analyzed to establish an optimal target pressure ratio. Patients were stratified into 2 groups, a pressure-guided group (n = 28) and an angiographic group (n = 63), to evaluate whether optimizing the pressure ratio led to improvements in residual PH and complications. RESULTS The pressure ratio and lung perfusion measurements of 141 PA lesions were analyzed. A piecewise linear regression model identified a target pressure ratio of 0.7, associated with significant enhancement in lung perfusion. The pressure-guided strategy achieved a higher rate of mean pulmonary artery pressure <25 mm Hg (92.8% [26/28 patients] vs 60.3% [38/63 patients]; P = 0.001) and a concurrent reduction in BPA relevant complications (3.9% [4/101 sessions] vs 12.9% [23/177 sessions]; P = 0.019). CONCLUSIONS Functional assessment-guided PA dilation with a target pressure ratio of 0.7 proved beneficial in BPA treatment for patients with CTEPH. This approach improved the residual PH and reduced complications, highlighting its potential to enhance CTEPH management outcomes.

中文翻译：

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通过使用压力导管和血管造影肺灌注的目标终点优化来改善球囊肺血管成形术。


背景 球囊肺血管成形术 （BPA） 在慢性血栓栓塞性肺动脉高压 （CTEPH） 的管理方面取得了重大进展。然而，近一半的 CTEPH 患者在接受 BPA 后出现持续性肺动脉高压，这强调了加强治疗的必要性。目的 作者试图探讨功能评估指导的肺动脉 （PA） 扩张在接受 BPA 治疗的 CTEPH 患者中的临床意义。方法 前瞻性单中心队列研究招募了 95 名患者，这些患者连续接受了 278 次 BPA 治疗。通过 2 维灌注血管造影评估肺实质灌注，并进行压力导管测量以确定 PA 压力比。分析肺灌注与压力比之间的相关性，以建立最佳目标压力比。将患者分为 2 组，压力引导组 （n = 28） 和血管造影组 （n = 63），以评估优化压力比是否会导致残余 PH 和并发症的改善。结果 分析 141 例 PA 病灶的压力比值和肺灌注测量值。分段线性回归模型确定目标压力比为 0.7，与肺灌注的显着增强相关。压力引导策略实现了更高的平均肺动脉压 <25 mm Hg 发生率 （92.8% [26/28 名患者] vs 60.3% [38/63 名患者];P = 0.001）和 BPA 相关并发症同时减少 （3.9% [4/101 次] 对 12.9% [23/177 次];P = 0.019）。结论 目标压力比为 0.7 的功能评估指导的 PA 扩张被证明对 CTEPH 患者的 BPA 治疗有益。 这种方法改善了残留 PH 并减少了并发症，突出了其增强 CTEPH 管理结果的潜力。