Key result
Discontinuing pulmonary hypertension medication after balloon pulmonary angioplasty decreased cardiac output compared to no medication (difference -0.65; 95% CI -0.90 to -0.40).
Why the study?
Some patients with CTEPH experience exercise intolerance due to reduced cardiac output even after successful BPA, making medical therapy an option, but it is unclear which patients require it post-BPA.
Does discontinuation of pulmonary hypertension medications after balloon pulmonary angioplasty affect cardiac output in patients with CTEPH?
Cohort (n=286)
Does discontinuation of pulmonary hypertension medications after balloon pulmonary angioplasty affect cardiac output in patients with CTEPH?
Mean Difference: -0.65 (95% CI -0.9–-0.4)
Absolute Event Rate: -0.33% vs 0.32%
Discontinuation of pulmonary hypertension medication after successful balloon pulmonary angioplasty decreases cardiac output, suggesting medical therapy may still be necessary, particularly as increasing cardiac output with BPA alone is challenging with advancing age.
May identify CTEPH patients needing post-BPA medical therapy; hypothesis-generating, prospective trials required before practice change.
BACKGROUND: Some patients with chronic thromboembolic pulmonary hypertension (CTEPH) exhibit exercise intolerance due to reduced cardiac output (CO) even after successful balloon pulmonary angioplasty (BPA). Medical therapy is a potential option for such cases; however, it is unclear which patients necessitate it even after BPA. METHODS: This study included 286 patients with CTEPH who underwent BPA and right heart catheterization 1 year after the final BPA and classified them into no-medication and withdrawal groups. The no-medication group comprised patients without pulmonary hypertension (PH) medications before and after BPA, while the withdrawal group included patients who received PH medications before BPA and discontinued them after BPA. We assessed differences in the changes in CO after BPA from baseline (ΔCO) between the 2 groups. Additionally, we evaluated the ΔCO among different age categories within each group: younger (<60 years), middle-aged (60-70 years), and older adults (≥70 years). RESULTS: After adjusting baseline covariates, overall CO did not differ significantly. However, ΔCO was significantly positive in the no-medication group but negative in the withdrawal group (0.32 and -0.33, difference in ΔCO: -0.65, 95% confidence intervals: -0.90 to -0.40). A significantly positive effect on ΔCO was observed in younger and middle-aged individuals, with a significant interaction between age and ΔCO in no-medication groups. CONCLUSIONS: Increasing CO with BPA alone may be challenging with age in patients with CTEPH. Given that discontinuation of PH medication after BPA decreased CO more than the effect of BPA, medical therapy might be necessary even after successful BPA.
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Kanezawa et al. (2024) conducted a cohort in chronic thromboembolic pulmonary hypertension (CTEPH) (n=286). Discontinuation of pulmonary hypertension medications vs. No pulmonary hypertension medications before and after BPA was evaluated on Changes in cardiac output after BPA from baseline (ΔCO) (MD -0.65, 95% CI -0.90 to -0.40). Discontinuing pulmonary hypertension medication after balloon pulmonary angioplasty decreased cardiac output compared to no medication (difference -0.65; 95% CI -0.90 to -0.40).
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