Photo Credit: Rasi Bhadramani

The following is a summary of “Development and validation of a nomogram for predicting hemodynamic response to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension,” published in the DECEMBER 2023 issue of Pulmonology by Xin, et al.

Balloon pulmonary angioplasty (BPA) stands as an effective intervention for alleviating pulmonary hypertension among patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). Given the significance of identifying predictors that signal an unfavorable hemodynamic response to BPA, researchers sought to design and authenticate a nomogram. This instrument aimed to aid clinicians in foreseeing the hemodynamic outcomes after BPA.

From May 2018 to April 2022, they retrospectively amassed data on patients diagnosed with CTEPH who underwent BPA. A favorable hemodynamic response post-BPA was characterized by a mean pulmonary arterial pressure not exceeding 30 mmHg and/or a decline in pulmonary vascular resistance by at least 30% during follow-up.

In the study involving 155 participants, those manifesting a favorable hemodynamic response post-BPA exhibited a notably reduced occurrence of occlusive lesions (11.11% vs. 26.32%, P = 0.017), elevated diffusing capacity of the lungs for carbon monoxide (63.77% ± 14.10% vs. 59.11% ± 11.78%, P = 0.039), and superior cardiac morphology compared to their counterparts. Two distinct models, namely LASSO regression and random forest, were utilized for predictive modeling. The LASSO regression model outperformed the random forest model, showcasing superior predictive metrics with a higher area under the curve (0.745 vs. 0.740) and a reduced Brier score (0.192 vs. 0.195). Based on the LASSO regression outcomes, a nomogram was developed, incorporating parameters such as the right ventricular end-diastolic diameter to left ventricular end-diastolic diameter ratio, the count of treated pulmonary vessels, and the proportion of occlusive lesions. When subjected to validation, the LASSO model retained its robust predictive capacity, yielding a C index 0.744.

The research culminated in creating a highly accurate nomogram tailored for predicting hemodynamic outcomes post-BPA. This tool holds promise in enhancing clinical decision-making processes related to BPA interventions.

Source: resmedjournal.com/article/S0954-6111(23)00328-1/fulltext