Sex Differences Among Patients Treated With Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Studies have shown sex differences in the outcomes of chronic thromboembolic pulmonary hypertension (CTEPH) and in patients who have undergone pulmonary endarterectomy. Limited data exist regarding outcomes of balloon pulmonary angioplasty (BPA) for female versus male subjects. In this analysis cohort, a total of 767 sessions of BPA were performed on 144 patients of which 83 (58%) were female. There were no differences in age, body mass index and comorbidities between males and females. However, females had worse baseline functional class, higher median N‐terminal pro‐brain natriuretic peptide and a shorter 6‐min walk test. At baseline, males were more likely to be on pulmonary hypertension (PH) medical treatment before BPA (92% vs 76%, p = 0.008), and females had significantly higher pulmonary vascular resistance (PVR) (5.5 ± 3.0 wu vs 3.9 ± 1.9 wu, p < 0.001). After BPA, the improvements in mean pulmonary artery pressure and PVR from baseline were comparable in both groups. The requirement for PH medical therapy significantly reduced after BPA for males (92% vs. 80%, p = 0.008) but not for females. Functional class improved in both groups after BPA. There were no significant differences in complication rates per BPA session between male and female patients (9% and 12%, p = 0.104). Female CTEPH patients had a worse baseline clinical profile including higher PVR. Female patients were also more likely to remain on PH medical therapy after BPA. There were no significant differences observed in hemodynamic response to BPA and in complication rates between male and female patients.