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Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

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Abstract

Balloon pulmonary angioplasty (BPA) has emerged as an effective treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Renal function has been identified as a prognostic marker in patients with pulmonary hypertension in previous studies. We, therefore, aimed to investigate the clinical parameters associated with improvements in renal function in patients with CTEPH. A total of 45 consecutive patients with inoperable CTEPH undergoing BPA (mean age 62.2 ± 15.1 years) were included in the study. We evaluated the patients’ clinical characteristics at baseline and at 1-year post-BPA, and investigated the association between renal function and hemodynamic parameters, including right heart function. Hemodynamics and renal function showed sustained improvements at 1 year after BPA in 64.4% of patients. Improved estimated glomerular filtration rate (eGFR) was significantly correlated with increased cardiac index (r = 0.433, p = 0.003) and mixed venous oxygen saturation (SvO2; r = 0.459, p = 0.002), and with decreased mean pulmonary arterial pressure (r = − 0.420, p = 0.004) and pulmonary vascular resistance (r = -− 0.465, p = 0.001). Multivariate analysis revealed that an increase in SvO2 immediately after the final BPA was associated with improved eGFR after the 1st year (odds ratio 1.041; 95% confidence interval 1.004–1.078; P = 0.027). The cut-off value for predicting improved eGFR was an increase in SvO2 after the final BPA of >125.4% over the baseline value (specificity 100%, sensitivity 24.1%). In conclusion, BPA improved symptoms, right heart function, hemodynamics, and renal function up to the chronic phase. Increasing SvO2 by >125.4% above baseline in the acute phase is important for improving renal function at 1 year after BPA in CTEPH patients.

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Acknowledgements

We thank Jane Charbonneau, DVM, and Susan Furness, PhD, from Edanz Group (https://www.edanzediting.com/ac) for editing drafts of this manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan

    Sarasa Isobe, Yuji Itabashi, Takashi Kawakami, Masaharu Kataoka, Shun Kohsaka, Toshimitsu Tsugu, Mai Kimura, Mitsuaki Sawano, Toshiomi Katsuki, Takashi Kohno, Jin Endo & Keiichi Fukuda

  2. Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan

    Mitsushige Murata

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  1. Sarasa Isobe
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  2. Yuji Itabashi
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  3. Takashi Kawakami
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  13. Keiichi Fukuda
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Correspondence to Yuji Itabashi.

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Isobe, S., Itabashi, Y., Kawakami, T. et al. Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Heart Vessels 34, 688–697 (2019). https://doi.org/10.1007/s00380-018-1284-4

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