Elsevier

Journal of Nuclear Cardiology

Volume 29, Issue 6, December 2022, Pages 3392-3400
Journal of Nuclear Cardiology

Original Article
Evaluation of balloon pulmonary angioplasty using lung perfusion SPECT in patients with chronic thromboembolic pulmonary hypertension

https://doi.org/10.1007/s12350-022-02971-0Get rights and content

Abstract

Background

The aim of this study was to evaluate the effect of balloon pulmonary angioplasty (BPA) using lung perfusion single-photon emission computed tomography (SPECT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and Results

20 consecutive patients (64 ± 15 years) who were diagnosed with CTEPH and underwent BPA were included in this study. All patients underwent lung perfusion SPECT before and after BPA. The relationship between functional %volume of the lung calculated from the lung perfusion SPECT (FVL-LPSPECT), and other clinical parameters before and after BPA was assessed using the Wilcoxon signed-rank test. The correlation between each parameter and mean pulmonary artery pressure (mPAP) using the Spearman’s correlation was performed. To determine predictors of mPAP for evaluating treatment effectiveness, significant parameters were included in multiple regression analysis. After BPA, world health organization functional classification, six-minute walk distance (6MWD), mPAP, and FVL-LPSPECT significantly improved. FVL-LPSPECT (r = − 0.728, P < 0.001) and 6MWD (r = − 0.571, P = 0.009) were significant correlation of mPAP. In the multiple regression analysis, FVL-LPSPECT was the most significant predictor of improvement in mPAP after BPA (P < 0.001).

Conclusions

This study demonstrated that the lung perfusion SPECT could be a potential measurement of the effectiveness of BPA in patients with CTEPH.

Introduction

The annual number of patients with acute pulmonary embolism in the United States is estimated at 600,000.1,2 Chronic thromboembolic pulmonary hypertension (CTEPH) develops in approximately 3.8% of patients surviving the acute phase of pulmonary embolism.2,3 The pathology of CTEPH is related to increased flow resistance through the pulmonary circulation that results from obstruction of the pulmonary arteries by thromboembolism and vascular remodeling.4 Increased pulmonary arterial pressure (PAP) leads to right ventricular pressure overload and dysfunction and is associated with considerable mortality.5 Patients with a severe grade of CTEPH have a poor prognosis; the 5-year-mortality rate is reported to be more than 50%.6 More than a third of patients with CTEPH are considered inoperable.7

In recent years, the therapeutic options for patients of CTEPH with technically inoperable disease have expanded with balloon pulmonary angioplasty (BPA).8 Moreover, there has been a significant improvement in the prognosis of CTEPH.9 However, the quantitative measurement of treatment effectiveness in patients with CTEPH using imaging modalities has not been well-established. In the present study, we aimed to investigate the effectiveness of BPA in patients with CTEPH using lung perfusion single-photon emission computed tomography (SPECT).

Section snippets

Patient population

A total of 20 consecutive patients diagnosed with CTEPH between January 2017 and January 2021 were included in this study. They were diagnosed as having inoperable CTEPH based on the standard criteria.10 All participants underwent BPA, and lung perfusion SPECT and chest computed tomography (CT) were performed before and after BPA (Figure 1). We assessed the patients’ clinical characteristics, including age, sex, medical history, blood biochemistry data, echocardiography data, and medications.

Results

The patients’ characteristics, including coronary risk factors, number of BPA sessions, medication for CTEPH, are presented in Table 1. The mean age of the 20 patients was 64 ± 15 years, and six (30%) of them were male. Hypertension was the most common complication (n = 4, 20%). The duration of pulmonary embolism from the index episode in patients with CTEPH in this study was 48.7 ± 83.0 months, and that of pulmonary hypertension was 18.3 ± 34.4 months. In this study, all patients were

Discussion

To our knowledge, this is the first study to objectively evaluate the effectiveness of BPA in patients with CTEPH using imaging modalities. The findings of the present study demonstrated that FVL-LPSPECT calculated using lung perfusion SPECT and CT could be a potential measurement of the effectiveness of BPA in patients with CTEPH.

New Knowledge Gained

Lung perfusion SPECT is a valuable imaging modality that can be used during decision making related to the treatment of pulmonary artery lesions and for the measurement of the effectiveness of BPA.

Conclusion

In this study, FVL-LPSPECT calculated using lung perfusion SPECT could potentially measure the effectiveness of BPA in patients with CTEPH.

Acknowledgments

We are grateful to the radiology technologists Mr. Tadashi Kokubo, Mr. Nobutomo Ishii, Mr. Takushi Okubo, and Mr. Fuyuki Washizuka for their technical assistance in the administration of lung perfusion SPECT and chest CT.

Funding

This work was supported by JSPS KAKENHI Grant Number JP20K16804.

Declarations

Disclosures

All authors declare that there is no any potential conflict of interest.

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