What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic thromboembolic pulmonary hypertension (n=103). Intervention: Inhaled nitric oxide (acute vasoreactivity testing) vs. Baseline. Primary outcome: Persistent/recurrent pulmonary hypertension, long-term survival, and freedom from lung transplantation.

What does this research mean for the field?

A decrease in mean pulmonary arterial pressure >10.4% under inhaled nitric oxide predicts long-term survival and freedom from lung transplantation in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2009Open Access

Pulmonary Vascular Reactivity and Prognosis in Patients With Chronic Thromboembolic Pulmonary Hypertension

Key Result

A decrease in mean pulmonary arterial pressure >10.4% under inhaled nitric oxide predicts long-term survival and freedom from lung transplantation in patients with CTEPH undergoing endarterectomy.

Study Design

Type

Cohort (n=103)

Structured PICO

Does acute pulmonary vasoreactivity testing with inhaled nitric oxide predict postoperative outcomes in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy?

Population

103 patients with chronic thromboembolic pulmonary hypertension (CTEPH), mean age 56.3+/-15.3 years, 53 women. 62 of these patients underwent pulmonary endarterectomy.

Intervention

Acute vasoreactivity testing using right-sided heart catheterization with inhalation of 40 ppm nitric oxide for 20 minutes.

Comparator

Patients with vs without significant acute vasoreactivity (e.g., decrease in mPAP >10.4%).

Outcome

Persistent/recurrent pulmonary hypertension after pulmonary endarterectomy, long-term survival, and freedom from lung transplantation.hard clinical

Acute pulmonary vasoreactivity testing with inhaled nitric oxide identifies patients with CTEPH who are likely to have better long-term survival and freedom from lung transplantation after pulmonary endarterectomy.

Abstract

BACKGROUND: Surgical pulmonary endarterectomy is the preferred treatment for chronic thromboembolic pulmonary hypertension. Persistent pulmonary hypertension after pulmonary endarterectomy has been recognized as a major determinant of poor outcome. We tested whether acute vasoreactivity identifies chronic thromboembolic pulmonary hypertension patients prone to develop persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and whether the degree of acute vasoreactivity affects survival or freedom from lung transplantation. METHODS AND RESULTS: Right-sided heart catheterization at baseline and after inhalation of 40 ppm nitric oxide for 20 minutes was performed in 103 patients (56.3+/-15.3 years old, 53 women). Reductions in mean pulmonary arterial pressure (DeltamPAP; -8.8+/-12.6%; P10.4% with nitric oxide inhalation had a better postoperative outcome. A significant correlation was found between DeltamPAP and immediate postoperative pulmonary vascular resistance (r=0.5, P10.4% under inhaled nitric oxide is a predictor of long-term survival and freedom from lung transplantation in adult patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy.