Chest
Original ResearchPulmonary Vascular DiseaseSubpleural Perfusion as a Predictor for a Poor Surgical Outcome in Chronic Thromboembolic Pulmonary Hypertension
Section snippets
Design and Subjects
This was a retrospective single-center cohort study involving consecutive patients. Between July 2000 and December 2009, 110 patients were diagnosed with CTEPH at Chiba University Hospital. CTEPH was defined as mean PAP ≥ 25 mm Hg with a normal wedge pressure in patients who had dyspnea on exertion for > 6 months. Additionally, lung perfusion scans were required to demonstrate segmental or larger defects concomitant with a normal ventilation scan. Helical CT scan angiography also was performed
Results
Seventy-five patients comprised the well-perfused group, and 29 patients comprised the poorly perfused group. The poorly perfused group had a significantly higher mean PAP (49.5 ± 10.5 mm Hg vs 42.7 ± 11.9 mm Hg, P = .008) and PVR (969 ± 428 dyne/s/cm5 vs 754 ± 367 dyne/s/cm5, P = .013) and a lower central disease score compared with the well-perfused group, resulting in fewer patients meeting the operative criteria (27.6% vs 49.3%, P = .04) (Table 1). The overall hospital mortality after
Discussion
Poor subpleural perfusion was found to be associated with surgical mortality as well as with a higher postoperative PVR. Even in a multivariate analysis, poor subpleural perfusion was associated with poor surgical outcome, although the poorly perfused group showed significantly more severe disease and more distal thrombi compared with the well-perfused group at baseline. To our knowledge, this report is the first to show poor subpleural perfusion to be associated with poor surgical outcome of
Acknowledgments
Author contributions: Dr Tanabe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Tanabe: contributed to the design of the study, data analysis and interpretation, and writing and review of the entire manuscript.
Dr Sugiura: contributed to the data analysis and critical review of the manuscript.
Dr Jujo: contributed to the data analysis and critical review of the manuscript.
Dr Sakao: contributed to the
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
Funding/Support: The present study was supported in part by a grant to the Respiratory Failure Research Group from the Ministry of Health, Labor and Welfare of Japan [No. 23162501 to Dr Tatsumi] and a research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan [No. 22590849 to Dr Tanabe].