Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment
ABSTRACT In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), pretreatment with PH‐targeted medical therapy may be beneficial to improve clinical parameters and pulmonary hemodynamics. This study aims to describe clinical results of...
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| Format: | Article |
| Language: | English |
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Wiley
2025-01-01
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| Series: | Pulmonary Circulation |
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| Online Access: | https://doi.org/10.1002/pul2.70028 |
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| author | D. P. Staal F. J. vanLeusden M. C. J. vanThor J. Peper B. J. M. W. Rensing J. P. vanKuijk B. J. M. Mulder D. van denHeuvel K. A. Boomars S. Boerman J. J. Mager M. C. Post |
| author_facet | D. P. Staal F. J. vanLeusden M. C. J. vanThor J. Peper B. J. M. W. Rensing J. P. vanKuijk B. J. M. Mulder D. van denHeuvel K. A. Boomars S. Boerman J. J. Mager M. C. Post |
| author_sort | D. P. Staal |
| collection | DOAJ |
| description | ABSTRACT In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), pretreatment with PH‐targeted medical therapy may be beneficial to improve clinical parameters and pulmonary hemodynamics. This study aims to describe clinical results of PH‐targeted therapy prior to BPA. All consecutive patients with CTEPH who underwent BPA treatment were selected from our CTEPH database. Medical treatment strategy, clinical parameters, and pulmonary hemodynamics at time of diagnosis and at the first BPA were analyzed. In total 92 CTEPH patients who started BPA treatment (64.1% women; 60.4 ± 14.1 years of age; 62.0% NYHA FC III/IV) were included. Most patients received dual oral PH‐targeted medical therapy (68.5%) prior to BPA. Between diagnosis and first BPA (median time 13.9 [7.5–30.7] months) significant improvements were observed in patients treated with PH‐targeted medical therapy for both clinical (6MWD: +28.2 m [5.1–51.3], log NTproBNP: −0.4 pg/ml [−0.8 to −0.1]) as well as pulmonary hemodynamic parameters (mPAP: −6.5 mmHg [−8.5 to −4.5], CO: +0.6 L/min [0.2–1.0] and PVR: −2.8 WU [−3.5 to −2.1]). The overall complication rate per BPA (out of a total of 441 procedures) was 15.0% for patients on monotherapy and 14.9% for those on dual/triple PH‐targeted medical therapy. No severe complications occurred. In conclusion, pretreatment with PH‐targeted medical therapy prior to BPA results in an improvement in clinical‐ and pulmonary hemodynamic parameters. |
| format | Article |
| id | doaj-art-cbe4a8ab69894d55920c5b545f2eda35 |
| institution | DOAJ |
| issn | 2045-8940 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj-art-cbe4a8ab69894d55920c5b545f2eda352025-08-20T02:49:47ZengWileyPulmonary Circulation2045-89402025-01-01151n/an/a10.1002/pul2.70028Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal TreatmentD. P. Staal0F. J. vanLeusden1M. C. J. vanThor2J. Peper3B. J. M. W. Rensing4J. P. vanKuijk5B. J. M. Mulder6D. van denHeuvel7K. A. Boomars8S. Boerman9J. J. Mager10M. C. Post11Department of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Radiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Respiratory Medicine Erasmus University Medical Centre Rotterdam The NetherlandsDepartment of Respiratory Medicine St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Respiratory Medicine St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsABSTRACT In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), pretreatment with PH‐targeted medical therapy may be beneficial to improve clinical parameters and pulmonary hemodynamics. This study aims to describe clinical results of PH‐targeted therapy prior to BPA. All consecutive patients with CTEPH who underwent BPA treatment were selected from our CTEPH database. Medical treatment strategy, clinical parameters, and pulmonary hemodynamics at time of diagnosis and at the first BPA were analyzed. In total 92 CTEPH patients who started BPA treatment (64.1% women; 60.4 ± 14.1 years of age; 62.0% NYHA FC III/IV) were included. Most patients received dual oral PH‐targeted medical therapy (68.5%) prior to BPA. Between diagnosis and first BPA (median time 13.9 [7.5–30.7] months) significant improvements were observed in patients treated with PH‐targeted medical therapy for both clinical (6MWD: +28.2 m [5.1–51.3], log NTproBNP: −0.4 pg/ml [−0.8 to −0.1]) as well as pulmonary hemodynamic parameters (mPAP: −6.5 mmHg [−8.5 to −4.5], CO: +0.6 L/min [0.2–1.0] and PVR: −2.8 WU [−3.5 to −2.1]). The overall complication rate per BPA (out of a total of 441 procedures) was 15.0% for patients on monotherapy and 14.9% for those on dual/triple PH‐targeted medical therapy. No severe complications occurred. In conclusion, pretreatment with PH‐targeted medical therapy prior to BPA results in an improvement in clinical‐ and pulmonary hemodynamic parameters.https://doi.org/10.1002/pul2.70028balloon pulmonary angioplastychronic thromboembolic pulmonary hypertensionpulmonary hypertension targeted medical therapy |
| spellingShingle | D. P. Staal F. J. vanLeusden M. C. J. vanThor J. Peper B. J. M. W. Rensing J. P. vanKuijk B. J. M. Mulder D. van denHeuvel K. A. Boomars S. Boerman J. J. Mager M. C. Post Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment Pulmonary Circulation balloon pulmonary angioplasty chronic thromboembolic pulmonary hypertension pulmonary hypertension targeted medical therapy |
| title | Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment |
| title_full | Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment |
| title_fullStr | Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment |
| title_full_unstemmed | Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment |
| title_short | Optimizing Medical Pretreatment for Balloon Pulmonary Angioplasty: Overshoot or Stride Toward Optimal Multimodal Treatment |
| title_sort | optimizing medical pretreatment for balloon pulmonary angioplasty overshoot or stride toward optimal multimodal treatment |
| topic | balloon pulmonary angioplasty chronic thromboembolic pulmonary hypertension pulmonary hypertension targeted medical therapy |
| url | https://doi.org/10.1002/pul2.70028 |
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