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Effect of Balloon Pulmonary Angioplasty on Homogenization of Lung Perfusion Blood Volume by Dual-Energy Computed Tomography in Patients with Chronic Thromboembolic Pulmonary Hypertension

  • CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
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Abstract

Objective

Balloon pulmonary angioplasty (BPA) is used to treat patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH); the goal is to improve pulmonary perfusion. We aimed to evaluate lung perfusion blood volume (PBV) with haemodynamic and exercise-capacity parameters to assess the efficacy of BPA in the treatment of CTEPH.

Methods

We retrospectively studied 33 patients over a 6-year period. DECT pulmonary angiography was performed before and after BPA. DECT provided iodine distribution maps; whole-lung and regional PBV images and quantification were generated using post-processing software. A mosaic pattern suggesting perfusion inhomogeneity is typical in CTEPH. Hypothetically, BPA treatment would promote homogenization that would be reflected in the calculated standard deviation.

Results

Lung perfusion images showed decreased heterogeneity after BPA. There was a significant difference before and after BPA in the whole-lung PBV and in the regional standard deviation for pulmonary arterial pressure (R = 0.37, p = 0.032 and R = 0.57, p = 0.006), pulmonary vascular resistance (R = 0.51, p = 0.023 and R = 0.60, p = 0.002), transtricuspid pressure gradient (R = 0.50, p = 0.0028 and R = 0.61, p = 0.0001), brain natriuretic peptide (R = 0.54, p = 0.0012 and R = 0.46, p = 0.0078), and 6-min walking distance (R = 0.59, p = 0.003 and R = 0.26, p = 0.14). The effects were especially pronounced after the first BPA procedure.

Conclusion

Decreased lung heterogeneity may suggest BPA efficacy in treating CTEPH. After BPA treatment, improved lung PBV and improved regional standard deviation showed a strong positive correlation with haemodynamic parameters and exercise capacity, which also suggests that BPA is effective in treating CTEPH.

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Abbreviations

BPA:

Balloon pulmonary angioplasty

CTEPH:

Chronic thromboembolic pulmonary hypertension

PBV:

Perfusion blood volume

PTE:

Pulmonary thromboembolism

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Authors and Affiliations

  1. Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hirofumi Koike, Eijun Sueyoshi, Takamasa Nishimura, Yusuke Iwano, Taiga Oka & Masataka Uetani

  2. Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Kouji Maemura

Authors
  1. Hirofumi Koike
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  2. Eijun Sueyoshi
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  3. Takamasa Nishimura
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  4. Yusuke Iwano
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  5. Taiga Oka
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  6. Masataka Uetani
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  7. Kouji Maemura
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Correspondence to Hirofumi Koike.

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Koike, H., Sueyoshi, E., Nishimura, T. et al. Effect of Balloon Pulmonary Angioplasty on Homogenization of Lung Perfusion Blood Volume by Dual-Energy Computed Tomography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Lung 199, 475–483 (2021). https://doi.org/10.1007/s00408-021-00471-5

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  • DOI: https://doi.org/10.1007/s00408-021-00471-5

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