In non-operable CTEPH, 3-year survival rates were similar (94-98%) regardless of medical pretreatment before BPA; post-BPA medical de-escalation occurred in 20% but may reduce cardiac index.
Does medical therapy before or de-escalation after balloon pulmonary angioplasty affect survival and hemodynamics in patients with non-operable CTEPH?
Medical therapy before balloon pulmonary angioplasty does not significantly impact 3-year survival in non-operable CTEPH, while de-escalation of therapy after the procedure may negatively affect cardiac index.
Abstract Background We aimed to evaluate the role of medical therapy before and after balloon pulmonary angioplasty (BPA) for non-operable chronic thromboembolic pulmonary hypertension (CTEPH) in the modern management era. Methods This Japanese nationwide, multicenter, prospective observational registry including 37 centers analyzed data newly registered from August 2018–December 2023. Pretreatment before BPA was analyzed in patients who were treatment naïve or received medical therapy only at registration (n=557). De-escalation or escalation of medical therapy after BPA was analyzed in patients who underwent BPA (n=966). Results The BPA pretreatment analysis in 557 patients showed that approximately 70% of the patients received medical therapy, of which 18% received combination therapy. Patients who received monotherapy or combination therapy had more severe baseline hemodynamics than those who did not. The 3-year survival did not significantly differ between the no, mono, and combination pretreatment groups (94%, 98%, and 97%, respectively; p=0.852). The BPA post-treatment analysis in 966 patients showed that 20% of patients underwent de-escalation of medical therapy. Patients with de-escalation of medical therapy had a higher proportion of those with New York Heart Association functional class I (35% vs. 24%, p0.01) and lower mean pulmonary artery pressure (20.9±5.8 vs. 24.1±7.3 mmHg, p0.01); however, they had a lower cardiac index (2.66±0.61 vs. 2.84±0.70 L/min/m2, p=0.01) at last follow-up compared to patients without de-escalation. Conclusion Patients with severe disease tended to undergo pre-treatment before BPA; however, patient survival did not differ across pretreatment types. De-escalation of medical therapy can affect cardiac index after BPA.
Sakamoto et al. (2025) studied this question. In non-operable CTEPH, 3-year survival rates were similar (94-98%) regardless of medical pretreatment before BPA; post-BPA medical de-escalation occurred in 20% but may reduce cardiac index.