Comparison of Hemodynamic Responses to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension in Japan and The Netherlands: A Multicenter Study
Abstract
BACKGROUND
Mean pulmonary arterial pressures (mPAP) after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) consistently has been lower in Japan compared with non-Japanese cohorts.
RESEARCH QUESTION
What factors are associated with higher mPAP after BPA?
STUDY DESIGN AND METHODS
This retrospective multicenter study screened 200 consecutive patients with CTEPH who underwent BPA at 2 centers in The Netherlands and 2 centers in Japan. After excluding patients with prior pulmonary endarterectomy or lacking follow-up hemodynamic data, 138 patients were analyzed. Comorbidities, lesion distribution and morphologic features, PH medication, procedural details, and hemodynamic parameters were compared between the 2 countries' cohorts. Multivariable regression analysis was performed to identify factors associated with high mPAP at follow-up.
RESULTS
The proportion of male patients (55% vs 24%), BMI (mean [SD], 26 [4] kg/m2 vs 23 [5] kg/m2), the prevalence of atrial fibrillation (9% vs 0%), and smoking rate (43% vs 23%) were higher and diffusing capacity of the lung for carbon monoxide (Dlco) was lower (mean [SD], 69% [15%] vs 79% [19%]) in the cohort from The Netherlands. Proximal lesion distribution and severity on CT imaging were comparable between the 2 countries. The Japanese cohort demonstrated a greater mPAP reduction (mean [SE], -16% [40%] mm Hg vs -10% [28%] mm Hg; P = .03 for interaction), with a lower mPAP at follow-up…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 200 participants or records.
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