SPC365

Pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison of long-term hemodynamic responses to exercise

Session: SESSÃO DE COMUNICAÇÕES ORAIS 02 – HIPERTENSÃO PULMONAR: DESENVOLVIMENTOS NA ESTRATIFICAÇÃO DE RISCO, DIAGNÓSTICO E TRATAMENTO
Speaker: Rita Calé

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Calé; Mariana Martinho; Filipa Ferreira; Sofia Alegria; Débora Repolho; João Luz; Ana Rita Pereira; Patrícia Araujo; Sílvia Vitorino; Hélder Pereira; Daniel Caldeira

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:Arial,sans-serif"><span style="color:black"><strong>Introduction:</strong> This study evaluates the long-term hemodynamic outcomes of right heart catheterization (RHC) at rest and during exercise in chronic thromboembolic pulmonary hypertension (CTEPH) patients treated with balloon pulmonary angioplasty and pulmonary endarterectomy.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:Arial,sans-serif"><span style="color:black">The objective was to evaluate whether disease resolution, particularly under exercise conditions, is consistently achieved in both treatment groups.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Arial,sans-serif"><span style="color:black"><strong>Methods:</strong> This was a prospective single-center registry of a Portuguese Pulmonary Hypertension referral center. Between 2017 and 2020, a total of 13 consecutive patients with CTEPH who underwent pulmonary endarterectomy (PEA Group) and 12 patients who completed a balloon pulmonary angioplasty program (BPA Group) were prospectively evaluated, with all patients having follow-up periods of over one year. The selection for PEA or BPA was conducted by a specialized CTEPH expert team. RHC at rest and during exercise was performed both prior to the procedure and after an average follow-up period of 45&plusmn;15 months. Long term rest hemodynamics and exercise mean pulmonary artery pressure /cardiac output (mPAP/CO) slope were compared between groups.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Arial,sans-serif"><span style="color:black"><strong>Results: </strong>Demographics were similar between groups. At baseline, a higher proportion of patients in the BPA group were receiving pulmonary vasodilator therapy compared to the PEA group (91.7% vs. 38.5%, p=0.008). One patient in the BPA group died because of cancer after 28 months of follow-up. Both PEA and BPA significantly reduced mPAP (from 42.7&plusmn;13.9 mmHg at baseline to 23.1&plusmn;5.6 mmHg at follow-up; p&lt;0.001 and from 47.7&plusmn;9.3 mmHg at baseline to 29.8&plusmn;8.8 mmHg; p&lt;0.001) and pulmonary vascular resistance (from 9.9&plusmn;5.4 WU at baseline to 3.2&plusmn;1.9 WU at follow-up; p&lt;0.001 and from 11.2&plusmn;3.9 WU at baseline to 3.8&plusmn;1.3 WU; p&lt;0.001). At follow-up, the PEA group demonstrated better resting hemodynamics, with lower mPAP (p=0.038) and a greater proportion of patients achieving normal hemodynamics at rest</span></span><span style="font-family:Arial,sans-serif">&nbsp;<span style="color:black"> (mPAP&lt;20mmHg in 17.4% vs 0%, p=0.093). However, in the long term, exercise hemodynamics remain impaired in both groups (mPAP/CO slope in both PEA and BPA groups was 4.5</span></span><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span><span style="font-family:Arial,sans-serif"><span style="color:black">2.2 mmHg/L/min and 7.3</span></span><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span><span style="font-family:Arial,sans-serif"><span style="color:black">5.5 mmHg/l/min, respectively; p=0.154; figure 1). An abnormal slope (&gt; 3.0 mmHg/L/min) was observed in 70.0% of patients in the PEA group compared to 85.7% in the BPA group (p=0.603).</span></span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Arial,sans-serif"><span style="color:black">Conclusion:&nbsp;</span></span></span></span></span></strong><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:Arial,sans-serif"><span style="color:black">The analysis demonstrates that both BPA and PEA improve resting hemodynamics. While PEA showed lower mPAP values at long-term follow-up, many patients exhibit persistent abnormal hemodynamic responses to exercise over time, as reflected in the mPAP/CO slopes, regardless of treatment modality. These results highlight the importance of comprehensive patient evaluation, including exercise testing, in the long-term follow-up of CTEPH patients, and suggests the need for further studies to address exercise-induced pulmonary hypertension in these patients.</span></span></span></span></span></p>