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Balloon pulmonary angioplasty (BPA) and pulmonary vasodilators were both found to improve functional and hemodynamic outcomes in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), accordingly to a study published in Scientific Reports.
Treatment options for patients with CTEPH are limited. Researchers sought to compare the efficacy and safety outcomes of BPA and pulmonary vasodilators in patients with inoperable CTEPH.
In this systematic review, studies in which outcomes for >5 patients with inoperable CTEPH were reported, were examined. The SCOPUS database was searched for eligible studies from 1945 to 2019. Patients with CTEPH were defined as being inoperable if they had distal disease that was not amenable to surgery, unacceptable perioperative risk, or recurrent or persistent CTEPH after thromboendarterectomy. The study’s primary outcome was change in six-minute walk distance (6MWD), and secondary outcomes included World Health Organization (WHO)/New York Heart Association functional class (WHO FC), change in pulmonary vascular resistance (PVR), change in mean pulmonary arterial pressure (mPAP), change in cardiac index, and safety outcomes.
In total, 34 studies (n=1604) were identified for analysis (n=755 undergoing BPA; average age, 62.8 years; 41.2% men and n=849 receiving pulmonary vasodilators; average age, 59.8 years).
Both BPA and pulmonary vasodilators treatments resulted in significant improvement in: 6MWD (BPA: 71.0 meters; 95% CI: 47.4–94.5 meters with BPA; pulmonary vasodilators: 47.8 meters; 95% CI: 34.5–61.2 meters), PVR (BPA: −3.1 Wood Units (WU); 95% CI, −4.9 to −1.4 WU; pulmonary vasodilators: −1.6 WU; 95% CI: −2.4 to −0.8 WU), and mPAP (−14.8 mmHg; 95% CI, −18.2 to −11.5 mmHg; pulmonary vasodilators: −4.9 mmHg; 95% CI, −6.9 to −2.8 mmHg).
Cardiac index was comparable in patients who received BPA vs pulmonary vasodilators, and most patients were WHO FC II and III after receiving these interventions.
BPA was associated with more complications than medical therapy.
Limitations of the study include biases inherent to its observational nature and the lack of head-to-head data comparing pulmonary vasodilators with BPA.
“More high-quality randomized data with long-term follow-up is needed to definitively examine the role of BPA and pulmonary vasodilators for the treatment of inoperable CTEPH,” noted the study authors.
Reference
Kalra R, Duval S, Thenappan T, Raveendran G, Pritzker M, Prisco SZ, et al. Comparison of balloon pulmonary angioplasty and pulmonary vasodilators for inoperable chronic thromboembolic pulmonary hypertension: A systematic review and meta-analysis. Sci Rep. 2020; 10: 8870.
