Efficacy of Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Disease and Exercise Pulmonary Hypertension

Background: The efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic disease (CTEPD) without pulmonary hypertension (PH) remains unknown. Exercise PH (Ex-PH) is associated with impaired exercise capacity, even when pulmonary hemodynamics are normal at rest. We hypothesized that patients with Ex-PH could be the candidates for BPA. This study aimed to determine the prevalence and clinical profiles of Ex-PH and the effect of BPA on oxygenation and Ex-PH in patients with CTEPD and mean pulmonary arterial pressure (mPAP) ≤ 20 mmHg.

Methods: We retrospectively reviewed 23 patients (median age 65 years) with CTEPD and mPAP ≤20 mmHg at rest who underwent cardiopulmonary exercise testing with right heart catheterization. Patients were divided into two groups: Ex-PH, defined by an mPAP/ cardiac output (CO) slope (mPAP/CO slope) > 3.0, and non-Ex-PH.

Results: Overall, 12 and 11 patients were identified as Ex-PH and non-Ex-PH groups, respectively. There were no significant differences in clinical parameters, including hemodynamics at rest, and blood gas analysis between Ex-PH and non-Ex-PH groups. Among 9 patients with Ex-PH, BPA improved World Health Organization-functional class and PaO₂ at rest and was associated with a decrease in the mPAP/CO slope. All 3 patients discontinued LTOT after BPA. There were no significant complications during each BPA session.

Conclusions: Ex-PH was common among patients with CTEPD without PH. BPA could improve symptoms, oxygenation, and exercising hemodynamics in patients with CTEPD and Ex-PH.