Abstract
Background: We have recently shown that balloon pulmonary angioplasty (BPA) safely improves pulmonary haemodynamics, exercise capacity, and right ventricular (RV) function in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, exercise intolerance and symptoms on effort persist even after a series of BPA, despite remarkably restored resting haemodynamics, that would be hard to restore with BPA alone.
Methods: We tested multi-step therapy of riociguat as a pre-treatment, a series of BPA, and cardiac rehabilitation (CR) as a post-treatment, especially on pulmonary haemodynamics, exercise capacity, and RV function evaluated with brain natriuretic peptide (BNP) and cardiovascular magnetic resonance.
Results: First, a pre-BPA treatment with riociguat significantly ameliorated mean pulmonary arterial pressure (mPAP) (40.4±5.9 to 32.6±5.6 mmHg) and BNP (153±203 to 60±60 pg/mL) before the first BPA (n=18, all P<0.05). Second, a series of BPA further ameliorated mPAP (35.4±10.7 to 23.7±6.2 mmHg) and exercise intolerance (normalised peak oxygen uptake [VO<2], 63±12 to 72±12%) (n=48, all P<0.05). Finally, CR initiated immediately following BPA improved exercise capacity to near-normal levels (normalised peak VO<2, 71±9 to 78±13%) and accelerated RV reverse remodelling after BPA (RV end-diastolic volume index, 84±22 to 78±16 mL/m2) (n=17, all P<0.05), without worsening of haemodynamics (mPAP, 24.5±6.4 to 24.8±4.1 mmHg).
Conclusions: Multi-step therapy consisting of riociguat, BPA, and CR is useful to effectively improve haemodynamics, exercise capacity, and RV function in patients with inoperable CTEPH.
- Copyright ©the authors 2017
