Balloon Pulmonary Angioplasty for Treatment of CTEPH in Patients With COPD

Safety and efficacy outcomes for balloon pulmonary angioplasty (BPA) for nonoperable chronic thromboembolic pulmonary hypertension (CTEPH) are not affected by comorbid chronic obstructive pulmonary disease (COPD) status, according to results of a study published in the Journal of the American Heart Association.

This retrospective study evaluated patient records from Kobe University Hospital in Japan collected between 2011 and 2021. Patients (N=133) diagnosed with CTEPH that was determined to be nonoperable were evaluated for safety and efficacy outcomes on the basis of COPD status after receiving BPA. Patients with forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of less than 70% were diagnosed with COPD.

The study population comprised patients with a mean age of 68±11 years, 23% were men, with a BMI of 23.4±3.6, 71% had a New York Heart Association (NYHA) functional class III or IV, 32% had a previous acute pulmonary embolism, and 21% a previous deep vein thromboembolism. The patients with (n=32) and without (n=101) COPD were well-balanced at baseline, except more of the COPD group were current or past smokers, they had shorter walking distance in the 6-minute walking test, and more received inhalant therapy than the nonCOPD group (all P £.042).

Compared with baseline, after BPA significant improvements in mean pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) were observed in both groups (all P <.001) but the change in PAP (mean difference [MD], -14.4 vs -17.0 mm Hg; P =.226) and PVR (MD, -55.6% vs -58.9%; P =.495) from baseline did not differ significantly between the COPD and nonCOPD groups, respectively. Conversely, significant improvements in the percent predicted vital capacity (VC) were only observed among the group without COPD (P =.003) and FEV1/FVC improvements were only observed among the COPD group (P =.021).

The rates of severe lung injury with hemoptysis requiring mechanical ventilation were 1.6% for the COPD cohort and 3.0% for the nonCOPD group (P =.535).

At a median follow-up of 37.9 months, the mortality rates were 6.3% for patients with COPD and 6.9% for patients without COPD. Deaths occurred due to malignant tumor (n=4), pneumonia (n=1), sepsis (n=1), and severe aortic stenosis (n=1). In patients with COPD, 1-year survival rates were 100% and 5-year survival rates were 93.5%. In patients without COPD, 1-year survival rates were 98% and 5-year survival rates were 93%.

In the multivariate analysis, postBPA improvement in oxygenation among the patients with COPD was associated with percent predicted VC (b, 0.368; P =.024) and percent predicted diffusing capacity for lung carbon monoxide (b, 0.465; P =.028) at baseline.

The limitations of this study included the retrospective, single-center, observational study design.

“The efficacy and safety of BPA in patients with nonoperable CTEPH and concurrent COPD were similar to those in patients without COPD, and the hemodynamics nearly normalized despite comorbid COPD,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.