Balloon pulmonary angioplasty improves haemodynamics but not oxygenation, desaturation in CTEPH

In patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), balloon pulmonary angioplasty (BPA) seems to improve haemodynamics, but has no effect on oxygenation and desaturation, leading to residual symptoms, a recent study has found.

Ninety-nine eligible patients underwent BPA and completed a battery of haemodynamic assessments: right heart catheterization, nocturnal oximetry, and arterial blood gas examinations. Exercise capacity and respiratory function tests were also performed, and participants’ New York Heart Association functional class (NYHA-FC) were determined.

After BPA, the researchers found that haemodynamics had nearly normalized in the patients, with mean pulmonary arterial pressure dropping from 37.5±10.0 to 20.6±4.9 mm Hg (p<0.01). Similarly, the pulmonary vascular resistance decreased from 744±383 to 261±92 dyne/s/cm^–5, along with an improvement in cardiac index from 2.27±0.71 to 2.43±0.62 L/min/m² (p=0.03).

NYHA-FC also improved significantly after BPA. Oxygenation likewise saw a significant but slight improvement, particularly in terms of arterial oxygen saturation and alveolar oxygen partial pressure. Nocturnal oximetry returned ambiguous results, with some parameters improving, some deteriorating, and others unchanged.

Desaturation parameters were also unaffected by BPA both during sleep (p=0.47) and during a 6-minute walk test (p=0.59).

“To improve clinical outcomes including residual symptoms, domiciliary or nocturnal oxygen therapy should be continued, if necessary,” the researchers said. “More work is required to develop further treatment for CTEPH patients.”