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Ventilation/perfusion imaging predicts response to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

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Abstract

Objects

Although balloon pulmonary angioplasty (BPA) has emerged as an alternative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH), it is followed in some patients by residual PH. We studied the efficacy of BPA on pulmonary blood flow and the predictive value of ventilation/perfusion (V/Q) scanning.

Methods

We retrospectively reviewed the clinical database, which included patients diagnosed with CTEPH who had received BPA. All patients undergone V/Q scanning to quantify the extent of pulmonary perfusion abnormality before and after BPA. Pulmonary hemodynamics were assessed by right heart catheterization, and cardiac function and exercise capacity were evaluated at baseline and post-BPA. A total of 120 CTEPH patients were included for analysis.

Results

BPA significantly alleviated mean pulmonary arterial pressure (mPAP: 48.0 ± 12.9 mmHg vs 34.7 ± 10.3 mmHg, P < 0.001) and pulmonary vascular resistance (PVR: 8.8 ± 4.1 Wood units vs 5.2 ± 3.0 Wood units, P < 0.001), and improved cardiac function (N-terminal pro B-type natriuretic peptide: 1628.7 ± 2887.2 pg/mL vs 400.4 ± 669.3 pg/mL, P < 0.001) and exercise capacity (6-minute walking distance: 386 ± 122 m vs 461 ± 86 m, P < 0.001). The extent of pulmonary perfusion abnormality represented by the percentage of perfusion defects (PPDs%) was improved after BPA (50.1 ± 13.6 vs 35.6 ± 14.2, P < 0.001), with the right and inferior lung lobes benefitting the most. PPDs% < 35.5 at baseline and greater restoration of PPDs% after BPA (∆PPDs% > 20.6) were associated with a better response to BPA (PPDs% < 35.5: odds ratio [OR] 10.857, 95% confidence interval [95%CI] 1.393–84.635, P = 0.023; ∆PPDs% > 20.6: OR 1.035, 95% CI 1.002–1.068, P = 0.036).

Conclusion

BPA significantly restored pulmonary blood flow, predominantly in the right and inferior lobes. V/Q scanning has the potential to predict the therapeutic response to BPA for CTEPH.

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Acknowledgements

The work was supported by grants from the National Natural Science Foundation of China (81801733). L.W. thanks for the support from Young Elite Scientists Sponsorship program by CAST (2018-QNRC001).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China

    Lei Wang, Xu Han, Meng Wang, Xinghong Ma, Hailong Zhang & Wei Fang

  2. Department of Structural Heart Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China

    Chaowu Yan

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  1. Lei Wang
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  2. Xu Han
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  3. Meng Wang
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  4. Xinghong Ma
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  5. Hailong Zhang
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  6. Chaowu Yan
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  7. Wei Fang
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Correspondence to Wei Fang.

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The ethics committee of Fuwai hospital approved the study (No. 2021–1498).

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Wang, L., Han, X., Wang, M. et al. Ventilation/perfusion imaging predicts response to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Ann Nucl Med 36, 515–522 (2022). https://doi.org/10.1007/s12149-022-01731-x

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  • DOI: https://doi.org/10.1007/s12149-022-01731-x

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