Original ArticleEvaluation of balloon pulmonary angioplasty using lung perfusion SPECT in patients with chronic thromboembolic pulmonary hypertension
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.
References (26)
- et al.
Recent progress in the diagnosis and management of chronic thromboembolic pulmonary hypertension
Respir Investig
(2013) - et al.
Longterm follow-up of patients with pulmonary thromboembolism late prognosis and evolution of hemodynamic and respiratory data
Chest
(1982) - et al.
Chronic thromboembolic pulmonary hypertension
J Am Coll Cardiol
(2013) - et al.
Prognostic factors in medically treated patients with chronic pulmonary embolism
Chest
(2001) - et al.
Longterm follow-up of patients with pulmonary thromboembolism
Chest
(1982) - et al.
Effect of orally active prostacyclin analogue on survival in patients with chronic thromboembolic pulmonary hypertension without major vessel obstruction
Chest
(2003) - et al.
Prognostic value of the pre-transplant diastolic pulmonary artery pressure to pulmonary capillary wadge pressure gradient in cardiac transplant recipients with pulmonary hypertension
J Heart Lung Transplant
(2014) - et al.
Effects of beraprost sodium, an oral prostacyclin analogue, in patients with pulmonary arterial hypertension: a randomized, double-blind, placebo-controlled trial
J Am Coll Cardiol
(2002) - et al.
Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (EARLY study): a double-blind, randomised controlled trial
Lancet
(2008) - et al.
Do change of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension? A meta-analysis of 22 randomized trials
J Am Coll Cardiol
(2012)
3-dimensional SPECT/CT fusion imaging-guided balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
JACC Cardiovasc Interv
Chronic major-vessel thromboembolic pulmonary hypertension
Circulation
Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism
N Engl J Med
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