title: Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension.
abstract: OBJECTIVE
  To examine the effect of balloon pulmonary angioplasty (BPA) on chronic thromboembolic pulmonary hypertension (CTEPH) in patients with inoperable disease or persistent pulmonary hypertension after pulmonary endarterectomy.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Referred patients with inoperable or persistent CTEPH.
  
  
  METHODS
  Twenty consecutive CTEPH patients (10 females), aged 60±10 years.
  Right heart catheterisation, functional capacity (cardiopulmonary exercise testing (CPET) and NYHA class) and blood sampled biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T examined at the time of diagnosis and repeated in all patients 3 months after the last BPA.
  
  
  RESULTS
  Seventy-three catheterisations were performed with 18.6±6.1 BPAs per patient on segmental and subsegmental arteries. Two deaths occurred following the first BPA, with an overall 10% periprocedural death rate. Reperfusion oedema complicated seven procedures. Comparisons before and after BPA showed significant haemodynamic improvements, including decreased mean pulmonary artery pressure (mPAP) (45±11 mm Hg vs 33±10 mm Hg; p<0.001) and increased cardiac output (4.9±1.6 L/min vs 5.4±1.9 L/min; p=0.011). Reduced right ventricular strain was indicated by significantly lower plasma levels of NT-proBNP and troponin T. Significant improvement in functional capacity was evident as assessed by NYHA class (3.0±0.5 vs 2.0±0.5; p<0.001) and CPET (13.6±5.6 mL/kg/min vs 17.0±6.5 mL/kg/min; p<0.001). Seventeen patients (85%) were alive after 51±30 months of follow-up.
  
  
  CONCLUSIONS
  BPA may offer an alternative form of treatment in selected CTEPH patients. While prognostic markers such as haemodynamics, functional capacity and biomarkers improve, significant periprocedural complications must be recognised. Randomised trials are warranted.
authors.affiliation: Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. aandreas@ous-hf.no
authors.forename: Arne K
authors.initials: AK
authors.lastname: Andreassen
authors.forename: Asgrimur
authors.initials: A
authors.lastname: Ragnarsson
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
authors.forename: Odd
authors.initials: O
authors.lastname: Geiran
authors.forename: Rune
authors.initials: R
authors.lastname: Andersen
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002908:Chronic Disease; D004691:Endarterectomy; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009664:Norway; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D016278:Ventricular Function, Right
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain