Pulmonary arterial compliance and exercise capacity after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Romain Sermet; Nicolas Piliero; Alicia Guillien; Simon Madoun; Stéphane Doutreleau; Muriel Salvat; Mathieu Finas; Frédéric Thony; Estelle Vautrin; Hélène Bouvaist; Bruno Degano

doi:10.1183/23120541.00590-2022

Pulmonary arterial compliance and exercise capacity after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

ERJ Open Res. 2023 Mar 27;9(2):00590-2022. doi: 10.1183/23120541.00590-2022. eCollection 2023 Mar.

Authors

Affiliations

¹ Department of Respiratory Medicine and Physiology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
² Department of Cardiology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
³ Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, Universitaire Grenoble Alpes, INSERM, CNRS, Grenoble, France.
⁴ HP2 Laboratory, INSERM U1300, Université Grenoble Alpes, Grenoble, France.
⁵ Department of Radiology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.

Abstract

Objective: To determine whether changes in pulmonary vascular resistance (PVR) and changes in pulmonary artery compliance (C _pa) are associated with changes in exercise capacity assessed either by changes in peak oxygen consumption (V'_O₂ ) or by changes in 6-min walk distance (6MWD) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA).

Methods: Invasive haemodynamic parameters, peak V'_O₂ and 6MWD were measured within 24 h, before and after BPA (interval 3.1±2.4 months) in 34 CTEPH patients without significant cardiac and/or pulmonary comorbidities, of whom 24 received at least one pulmonary hypertension-specific treatment. C _pa was calculated according to the pulse pressure method: C _pa=((SV/PP)/1.76+0.1), where SV is the stroke volume and PP is the pulse pressure. The resistance-compliance (RC)-time of the pulmonary circulation was calculated as the PVR and C _pa product.

Results: After BPA, PVR decreased (562±234 versus 290±106 dyn·s·cm^-5; p<0.001); C _pa increased (0.90±0.36 versus 1.63±0.65 mL·mmHg^-1; p<0.001); but RC-time did not change (0.325±0.069 versus 0.321±0.083 s; p=0.75). There were improvements in peak V'_O₂ (1.11±0.35 versus 1.30±0.33 L·min^-1; p<0.001) and in 6MWD (393±119 versus 432±100 m; p<0.001). After adjustment for age, height, weight and gender, changes in exercise capacity, assessed either by peak V'_O₂ or 6MWD, were significantly associated with changes in PVR, but not with changes in C _pa.

Conclusions: Contrary to what has been reported in CTEPH patients undergoing pulmonary endarterectomy, in CTEPH patients undergoing BPA, changes in exercise capacity were not associated with changes in C _pa.