PT  - JOURNAL ARTICLE
AU  - Ruigrok, Dieuwertje
AU  - Handoko, M. Louis
AU  - Meijboom, Lilian J.
AU  - Nossent, Esther J.
AU  - Boonstra, Anco
AU  - Braams, Natalia J.
AU  - van Wezenbeek, Jessie
AU  - Tepaske, Robert
AU  - Tuinman, Pieter Roel
AU  - Heunks, Leo M.A.
AU  - Vonk Noordegraaf, Anton
AU  - de Man, Frances S.
AU  - Symersky, Petr
AU  - Bogaard, Harm-Jan
TI  - Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
AID  - 10.1183/23120541.00564-2021
DP  - 2022 Apr 01
TA  - ERJ Open Research
PG  - 00564-2021
VI  - 8
IP  - 2
4099  - https://publications.ersnet.org//content/8/2/00564-2021.short
4100  - https://publications.ersnet.org//content/8/2/00564-2021.full
SO  - erjor2022 Apr 01; 8
AB  - Background The success of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is usually evaluated by performing a right heart catheterisation (RHC). Here, we investigate whether residual pulmonary hypertension (PH) can be sufficiently excluded without the need for a RHC, by making use of early post-operative haemodynamics, or N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) 6 months after PEA.Methods In an observational analysis, residual PH after PEA measured by RHC was related to haemodynamic data from the post-operative intensive care unit time and data from a 6-month follow-up assessment including NT-proBNP, TTE and CPET. After dichotomisation and univariate analysis, sensitivity, specificity, positive predictive value, negative predictive value (NPV) and likelihood ratios were calculated.Results Thirty-six out of 92 included patients had residual PH 6 months after PEA (39%). Correlation between early post-operative and 6-month follow-up mean pulmonary artery pressure was moderate (Spearman rho 0.465, p<0.001). Early haemodynamics did not predict late success. NT-proBNP >300 ng·L−1 had insufficient NPV (0.71) to exclude residual PH. Probability for PH on TTE had a moderate NPV (0.74) for residual PH. Peak oxygen consumption (V′O2) <80% predicted had the highest sensitivity (0.85) and NPV (0.84) for residual PH.Conclusions CPET 6 months after PEA, and to a lesser extent TTE, can be used to exclude residual CTEPH, thereby safely reducing the number of patients needing to undergo re-RHC after PEA.In approximately one-third to one-half of CTEPH patients, residual pulmonary hypertension after pulmonary endarterectomy can be excluded based on cardiopulmonary exercise testing or echocardiography, without the need for right heart catheterisation https://bit.ly/3pbj2Ge