Targeted medical treatment of patients with chronic thromboembolic pulmonary hypertension who undergo balloon pulmonary angioplasty

Abstract Introduction In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), pre-treatment with PH-targeted medical therapy may be beneficial in improving clinical parameters and pulmonary hemodynamics. Purpose This study aims to describe the clinical results of PH-specific therapy prior to BPA. Methods Patients with CTEPH who underwent BPA treatment were selected from the St. Antonius CTEPH database. Medical treatment strategy, clinical parameters, and pulmonary hemodynamics at time of diagnosis and at the first BPA were collected from medical records. Results In total 93 BPA patients (62.4% women; age 60.4±14.1 years; NYHA FC III/IV 60.9%) were included; the majority of patients received dual PH targeted medical therapy (64.1%). Between diagnosis and the first BPA significant improvements were observed for both clinical parameters (6MWD: 26.8m [5.2 - 48.4], Log NTproBNP: -0.5 pg/ml [-0.8 to -0.2]) and pulmonary hemodynamic (mRAP: -2.2 mmHg [-3.7 to -0.8], mPAP: -6.4mmHg [-8.3 to -4.5], CO: 0.5L/min [0.2 - 0.9] and PVR: -2.6WU [-3.3 to -2]). Dual PH targeted medical therapy resulted in significantly greater improvements in PVR (p = 0.03) in comparison to patients without and mono PH targeted medical therapy (CO and mPAP both p-value: 0.01). Conclusion Between diagnosis and the initial BPA, substantial improvements were observed for 6MWD, NTproBNP and most pulmonary hemodynamics in CTEPH patients who underwent BPA. Patients who received dual PH targeted medical therapy had significantly greater improvements compared to patients without (PVR) and on mono PH targeted medical therapy (CO and mPAP).Clinical parameters: Baseline-1st BPAPH medication: ANOVA Post hoc analyses