The following is a summary of “Effects of right ventricular remodeling in chronic thromboembolic pulmonary hypertension on the outcomes of balloon pulmonary angioplasty: a 2D-speckle tracking echocardiography study,” published in the April 2024 issue of Pulmonology by Ma et al.
Balloon pulmonary angioplasty (BPA) has emerged as a significant intervention in improving outcomes for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The right ventricle (RV) plays a pivotal role in predicting prognosis in CTEPH cases, and its assessment is crucial for treatment decisions. Utilizing 2D-speckle tracking echocardiography (2D-STE), this study aimed to evaluate the effectiveness of BPA in patients with CTEPH and assess the prognostic value of 2D-STE parameters in predicting BPA outcomes.
A cohort of 76 patients with CTEPH underwent 354 BPA sessions between January 2017 and October 2022. Responders to BPA were identified as individuals achieving a mean pulmonary artery pressure (mPAP) ≤ 30 mmHg or exhibiting a ≥ 30% reduction in pulmonary vascular resistance (PVR) following the last BPA session compared to baseline. Logistic regression analysis was conducted to discern predictors of BPA efficacy.
BPA yielded a significant reduction in mPAP (from 50.8 ± 10.4 mmHg to 35.5 ± 11.9 mmHg, p < 0.001), PVR (from 888.7 ± 363.5 dyn·s·cm−5 to 545.5 ± 383.8 dyn·s·cm−5, p < 0.001), and eccentricity index (from 1.3 to 1.1, p < 0.001), along with a notable increase in RV free wall longitudinal strain (RVFWLS: from 15.7% to 21.0%, p < 0.001). Significant enhancements were also observed in the 6-minute walking distance (from 385.5 m to 454.5 m, p < 0.001). Upon adjustment for confounding variables, multivariate analysis revealed that RVFWLS emerged as the sole independent predictor of BPA efficacy, with an optimal cutoff value of 12%.
BPA effectively reduced pulmonary artery pressure, reversed RV remodeling, and enhanced exercise capacity among patients with CTEPH. Importantly, RVFWLS obtained through 2D-STE emerged as a robust independent predictor of BPA outcomes. These findings offer valuable insights into the potential of 2D-STE parameters to guide interventional strategies in managing CTEPH.
Source: respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02803-4
