Efficacy of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary disease and exercise pulmonary hypertension

The efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic disease (CTEPD) without pulmonary hypertension (PH) remains unknown. Exercise PH (Ex-PH) is associated with impaired exercise capacity, even when pulmonary hemodynamics are normal at rest. We hypothesized that patients with Ex-PH could be the candidates for BPA. This study aimed to determine the prevalence and clinical profiles of Ex-PH and the effect of BPA on oxygenation and Ex-PH in patients with CTEPD and mean pulmonary arterial pressure (mPAP) ≤ 20 mmHg. We retrospectively reviewed 23 patients (median age 65 years) with CTEPD and mPAP ≤20 mmHg at rest who underwent cardiopulmonary exercise testing with right heart catheterization. Patients were divided into two groups: Ex-PH, defined by an mPAP/cardiac output (CO) slope (mPAP/CO slope) > 3.0, and non-Ex-PH. Overall, 12 and 11 patients were identified as Ex-PH and non-Ex-PH groups, respectively. There were no significant differences in clinical parameters, including hemodynamics at rest, and blood gas analysis between Ex-PH and non-Ex-PH groups. Among 9 patients with Ex-PH, BPA improved World Health Organization-functional class and PaO2 at rest and was associated with a decrease in the mPAP/CO slope. All 3 patients discontinued LTOT after BPA. There were no significant complications during each BPA session. Ex-PH was common among patients with CTEPD without PH. BPA could improve symptoms, oxygenation, and exercising hemodynamics in patients with CTEPD and Ex-PH. [Display omitted] •Approximately 50 % of patients with CTEPD without PH had Ex-PH.•BPA improved exercising hemodynamics and oxygenation in patients with CTEPD and Ex-PH.•The mPAP/CO slope could be a parameter to determine the indication for BPA.