RT Journal Article
SR Electronic
T1 Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00564-2021
DO 10.1183/23120541.00564-2021
VO 8
IS 2
A1 Dieuwertje Ruigrok
A1 M. Louis Handoko
A1 Lilian J. Meijboom
A1 Esther J. Nossent
A1 Anco Boonstra
A1 Natalia J. Braams
A1 Jessie van Wezenbeek
A1 Robert Tepaske
A1 Pieter Roel Tuinman
A1 Leo M.A. Heunks
A1 Anton Vonk Noordegraaf
A1 Frances S. de Man
A1 Petr Symersky
A1 Harm-Jan Bogaard
YR 2022
UL http://openres.ersjournals.com/content/8/2/00564-2021.abstract
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