What is the clinical evidence from this study?

Study design: Observational. Population: Chronic thromboembolic pulmonary hypertension (CTEPH) (n=13). Intervention: Pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) vs. Healthy controls and pre-treatment baseline. Primary outcome: Blood stagnation volume (× 10^-7 m3) (p=<0.01).

What does this research mean for the field?

In patients with chronic thromboembolic pulmonary hypertension, blood stagnation volume is significantly increased compared to controls, and this blood flow disturbance is subsequently improved by treatments such as balloon pulmonary angioplasty and pulmonary endarterectomy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 20, 2023Open Access

Pulmonary artery blood flow dynamics in chronic thromboembolic pulmonary hypertension

Q: What are the key findings of this study?

In patients with chronic thromboembolic pulmonary hypertension, blood stagnation volume was significantly increased compared to controls (3.97 vs 1.02 × 10^-7 m3, p<0.01), which was subsequently improved by balloon pulmonary angioplasty.

Q: What does this research mean for the field?

In patients with chronic thromboembolic pulmonary hypertension, blood stagnation volume is significantly increased compared to controls, and this blood flow disturbance is subsequently improved by treatments such as balloon pulmonary angioplasty and pulmonary endarterectomy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

HTHideo TsubataKyoto Prefectural University NNNaohiko NakanishiKyoto Prefectural University of Medicine KIKeiichi ItataniNagoya City University

Key Result

In patients with chronic thromboembolic pulmonary hypertension, blood stagnation volume was significantly increased compared to controls (3.97 vs 1.02 × 10^-7 m3, p<0.01), which was subsequently improved by balloon pulmonary angioplasty.

Study Design

Type

Observational (n=13)

Multicenter

Yes

Structured PICO

Do pulmonary endarterectomy and balloon pulmonary angioplasty improve pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension?

Population

13 participants: 10 patients with chronic thromboembolic pulmonary hypertension (CTEPH) (mean age 66.8, 80% female; 5 central type, 5 peripheral type) and 3 healthy controls.

Intervention

Pulmonary endarterectomy (PEA) for central type CTEPH (n=5) and balloon pulmonary angioplasty (BPA) for peripheral type CTEPH (n=5).

Comparator

Healthy controls (n=3) for baseline comparison, and pre-treatment baseline for evaluating intervention effects.

Outcome

Pulmonary artery blood flow dynamics (flow velocity, wall shear stress, oscillatory shear index, and blood stagnation volume) evaluated using computational fluid dynamics.surrogate

Computational fluid dynamics demonstrates that both pulmonary endarterectomy and balloon pulmonary angioplasty effectively improve abnormal pulmonary artery blood flow dynamics, including wall shear stress and blood stagnation, in patients with CTEPH.

Main Result

Absolute Event Rate: 3.97% vs 1.02%

p-value: p=<0.01

Limitations

Small sample size from only two institutes
Used simulation data and did not directly measure parameters
Did not consider biological changes in vascular properties due to aging or changes after PEA surgery
CFD analysis accuracy compromised due to incomplete 3D model reconstructions
Could not examine pulmonary artery endothelial cell function and NO production in vivo
Results do not reflect the causes of the disease

Abstract

Chronic thromboembolic pulmonary hypertension is caused by incomplete resolution and organization of thrombi. Blood flow dynamics are involved in thrombus formation; however, only a few studies have reported on pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension. Furthermore, the effects of treatment interventions on pulmonary artery blood flow dynamics are not fully understood. The aim of the study was to evaluate pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy and balloon pulmonary angioplasty, using computational fluid dynamics. We analyzed patient-specific pulmonary artery models of 10 patients with chronic thromboembolic pulmonary hypertension and three controls using computational fluid dynamics. In patients with chronic thromboembolic pulmonary hypertension, flow velocity and wall shear stress in the pulmonary arteries were significantly decreased, and the oscillatory shear index and blood stagnation volume were significantly increased than in controls. Pulmonary endarterectomy induced redistribution of pulmonary blood flow and improved blood flow dynamics in the pulmonary artery. Balloon pulmonary angioplasty improved pulmonary blood flow disturbance, decreased blood flow stagnation, and increased wall shear stress, leading to vasodilatation of the distal portion of the pulmonary artery following balloon pulmonary angioplasty treatment.

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