Balloon Pulmonary Angioplasty Improves Biventricular Functions and Pulmonary Flow in Chronic Thromboembolic Pulmonary Hypertension

Background; It remains to be determined whether balloon pulmonary angioplasty (BPA) improves biventricular cardiac functions and pulmonary flow in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods and Results: We enrolled 30 consecutive patients with inoperable CTEPH who underwent BPA, and carried out serial cardiac magnetic resonance imaging (CMR; M/F, 9/21; median age, 65.2 years). No patient died during the treatment or follow-up period. BPA significantly improved WHO functional class (III/IV, 83.0 to 4.0%), 6-min walking distance (330.2 +/- 168.7 to 467.3 +/- 114.4m), mean pulmonary artery pressure (40.8 +/- 10.7 to 23.2 +/- 4.94 mmHg), pulmonary vascular resistance (9.26 +/- 4.19 to 3.35 +/- 1.40 WU) and cardiac index (2.19 +/- 0.64 to 2.50 +/- 0.57 L.min.m(2); all P<0.01). CMR also showed improvement of right ventricular (RV) ejection fraction (EF; 41.3 +/- 12.4 to 50.7 +/- 8.64%), left ventricular (LV) end-diastolic volume index (72.1 +/- 14.0 to 81.6 +/- 18.6 ml/m(2)) and LV stroke volume index (41.0 +/- 9.25 to 47.8 +/- 12.3 ml/m(2); all P<0.01). There was a significant correlation between change in RVEF and LVEF (Pearson's r=0.45, P=0.01). Average velocity in the main pulmonary artery was also significantly improved (7.50 +/- 2.43 to 9.79 +/- 2.92 cm/s, P<0.01). Conclusions: BPA improves biventricular functions and pulmonary flow in patients with inoperable CTEPH.