title: Pulmonary edema predictive scoring index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty.
abstract: OBJECTIVE
  This study sought to identify useful predictors for hemodynamic improvement and risk of reperfusion pulmonary edema (RPE), a major complication of this procedure.
  
  
  BACKGROUND
  Percutaneous transluminal pulmonary angioplasty (PTPA) has been reported to be effective for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). PTPA has not been widespread because RPE has not been well predicted.
  
  
  METHODS
  We included 140 consecutive procedures in 54 patients with CTEPH. The flow appearance of the target vessels was graded into 4 groups (Pulmonary Flow Grade), and we proposed PEPSI (Pulmonary Edema Predictive Scoring Index) = (sum total change of Pulmonary Flow Grade scores) × (baseline pulmonary vascular resistance). Correlations between occurrence of RPE and 11 variables, including hemodynamic parameters, number of target vessels, and PEPSI, were analyzed.
  
  
  RESULTS
  Hemodynamic parameters significantly improved after median observation period of 6.4 months, and the sum total changes in Pulmonary Flow Grade scores were significantly correlated with the improvement in hemodynamics. Multivariate analysis revealed that PEPSI was the strongest factor correlated with the occurrence of RPE (p < 0.0001). Receiver-operating characteristic curve analysis demonstrated PEPSI to be a useful marker of the risk of RPE (cutoff value 35.4, negative predictive value 92.3%).
  
  
  CONCLUSIONS
  Pulmonary Flow Grade score is useful in determining therapeutic efficacy, and PEPSI is highly supportive to reduce the risk of RPE after PTPA. Using these 2 indexes, PTPA could become a safe and common therapeutic strategy for CTEPH.
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Inami
authors.forename: Masaharu
authors.initials: M
authors.lastname: Kataoka
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Shimura
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Ishiguro
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yanagisawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taguchi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshino
authors.forename: Toru
authors.initials: T
authors.lastname: Satoh
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011652:Pulmonary Circulation; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: B-type natriuretic peptide; BNP; CI; CO; CTEPH; PAP; PAWP; PEPSI; PTPA; PVR; Pulmonary Edema Predictive Scoring Index; RAP; ROC; RPE; cardiac output; chronic thromboembolic pulmonary hypertension; confidence interval; flow appearance; percutaneous transluminal pulmonary angioplasty; pulmonary arterial pressure; pulmonary artery wedge pressure; pulmonary vascular resistance; receiver-operating characteristic; reperfusion pulmonary edema; right atrial pressure