Pulmonary Haemodynamics After Mechanical Therapy With PEA and BPA Predict Survival in Patients With CTEPH - A Prospective Analysis From the National UK CURATE Registry
Eilish Turner-Frick, Hakim Ghani, Paula Appenzeller, Liliana Amaral-Almeida, Katherine Bunclark, John Cannon, Karen Sheares, Mark Toshner, Dolores Taboada, Choo Ng …
https://doi.org/10.1002/pul2.70419
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated by mechanical therapy with pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA). Haemodynamic treatment goal is ill-defined. We explored post-procedure mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and its relationship with 5-Year survival and exercise capacity Using 6-min Walk Distance (6MWD). Consecutive PEA and BPA patients from the UK CURATE database, treated between 2007 and 2022 and 2015–2022, respectively, stratified by 3-month follow-up mPAP and PVR by right heart catheter (RHC), had 5-year survival and 6MWD compared, adjusted for age, sex, drug treatment, and comorbidities in the PEA cohort. Those treated by PEA achieving an mPAP ≤ 25 mmHg had significantly better survival than higher mPAP groups (all pairwise comparisons p < 0.001), with no additional survival advantage below mPAP of 25 mmHg. Those with PVR ≤ 300 dyne.s.cm−5 also had better 5-year survival (p < 0.001). Continuous PVR modelling showed a 17% decrease in 5-year survival for every 100 dyne.s.cm−5 increase in post-operative PVR (p < 0.001). And these results remained significant after proportional hazard modelling. Those treated by BPA achieving an mPAP ≤ 30 mmHg and PVR ≤ 300 had a significantly better 5-year survival with no additional survival advantage below these values. Continuous PVR modelling showed a 48% decrease in 5-year survival for every 100 dyne.s.cm−5 increase in post-operative PVR (p = 0.008). In conclusion, post-procedure haemodynamics predict 5-year survival after mechanical therapy for CTEPH. Achieving a mPAP ≤ 25 mmHg for PEA and ≤ 30 mmHg for BPA, or a PVR ≤ 300 dyne.s.cm−5 for both, conferred a better prognosis.
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