Similar quality of life after balloon pulmonary angioplasty or pulmonary endarterectomy for CTEPH

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is most commonly treated with pulmonary endarterectomy (PEA) or with a combination of pulmonary vasodilators and balloon pulmonary angioplasty (BPA). Quality of life (QoL) after treatment is one of many factors used to determine which procedure is most suitable for each patient. Studies evaluating QoL after these interventions have not compared QoL between both procedures in a randomized cohort. In this prospective registry study, we explored QoL as an outcome in patients treated with PEA or BPA treatment and which factors correlated to QoL. Methods: CTEPH patients treated in Amsterdam University Medical Center and Aarhus University Hospital, the living with pulmonary hypertension questionnaire (LPHQ) was recorded to assess QoL before treatment and 6 months after treatment. Multiple pulmonary and hemodynamic parameters were recorded as part of standard clinical care. Results: At baseline 99 LPHQ questionnaires were answered and 67 at 6 months. Baseline parameters did not differ significantly between patients undergoing PEA vs BPA. QoL was similar at baseline in both treatment groups, and both groups experienced a similar improvement in QoL after treatment. The New York Heart Association (NYHA) score and Borg score after the six-minute walking distance (6MWD) were most strongly correlated to QoL at all time points. Baseline carbon monoxide diffusion capacity (DLCO) was inversely correlated to QoL after treatment. Presence of residual PH was not associated with significantly decreased QoL. Conclusions: We did not find evidence that QoL differed in 2 separate groups of patients who underwent either BPA or PEA. Multiple parameters pertaining to dyspnea and basic functionality were moderately correlated to QoL, this was not the case for hemodynamic parameters. These results indicate that when determining invasive treatment in CTEPH, QoL can be expected to improve with both treatments.