PMID- 29730328
OWN - NLM
STAT- In-Process
LR  - 20190912
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 154
IP  - 3
DP  - 2018 Sep
TI  - Poor Subpleural Perfusion Predicts Failure After Balloon Pulmonary Angioplasty
      for Nonoperable Chronic Thromboembolic Pulmonary Hypertension.
PG  - 521-531
LID - S0012-3692(18)30659-7 [pii]
LID - 10.1016/j.chest.2018.03.059 [doi]
AB  - BACKGROUND: Poor subpleural perfusion (PSP) in the capillary phase of pulmonary
      angiography predicts worse outcomes following pulmonary endarterectomy in
      operable chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary
      angioplasty (BPA) has emerged as a treatment for nonoperable CTEPH. The goal of
      the present article was to assess the association between PSP and BPA failure.
      METHODS: Subpleural perfusion was classified as poor (defined as subpleural
      spaces either not perfused or minimally perfused in all segments) or normal. We
      retrospectively reviewed PSP and hemodynamic variables of 101 consecutive
      patients who underwent BPA from February 2014 to August 2016. The total
      cross-sectional area of bronchial arteries was also measured by using CT
      scanning. Patients were categorized according to hemodynamic results after the
      last BPA: a failure group (defined as mean pulmonary arterial pressure > 30 mm Hg
      and a decrease in pulmonary vascular resistance < 30% [n = 15]) or a success
      group (n = 86). RESULTS: Although baseline hemodynamic variables were similar
      between the two groups, PSP was observed in 46.7% of patients in the failure
      group vs 13.9% in the success group (P = .003). Multivariate analysis revealed
      that PSP was the only predictor of BPA failure (OR, 4.02 [95% CI, 1.17-13.89]; P 
      = .028). Patients with PSP exhibited poorly developed bronchial arteries compared
      with patients with normal perfusion (7.0 [5.8-9.6] mm(2) vs 8.7 [6.9-11.3] mm(2);
      P = .032). CONCLUSIONS: PSP in the capillary phase, suggesting the presence of
      small vessel disease with diffuse distal thrombosis, is a predictor of BPA
      failure. PSP was also associated with less developed bronchial arteries, which
      suggests a key role of bronchial-pulmonary anastomoses in maintaining the
      pulmonary capillary bed open downstream of the pulmonary arterial obstruction.
      PSP affected approximately 15% of patients with nonoperable CTEPH who underwent
      BPA.
CI  - Copyright (c) 2018 American College of Chest Physicians. Published by Elsevier
      Inc. All rights reserved.
FAU - Taniguchi, Yu
AU  - Taniguchi Y
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; AP-HP, Service de Pneumologie, Centre de Reference de
      l'Hypertension Pulmonaire, Hopital Bicetre, Le Kremlin-Bicetre, France; Inserm
      UMR_S 999, Hopital Marie Lannelongue, Le Plessis Robinson, France.
FAU - Brenot, Philippe
AU  - Brenot P
AD  - Inserm UMR_S 999, Hopital Marie Lannelongue, Le Plessis Robinson, France; Service
      de Radiologie, Hopital Marie Lannelongue, Le Plessis Robinson, France.
FAU - Jais, Xavier
AU  - Jais X
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; AP-HP, Service de Pneumologie, Centre de Reference de
      l'Hypertension Pulmonaire, Hopital Bicetre, Le Kremlin-Bicetre, France; Inserm
      UMR_S 999, Hopital Marie Lannelongue, Le Plessis Robinson, France.
FAU - Garcia, Carlos
AU  - Garcia C
AD  - Inserm UMR_S 999, Hopital Marie Lannelongue, Le Plessis Robinson, France; Service
      de Radiologie, Hopital Marie Lannelongue, Le Plessis Robinson, France.
FAU - Weatherald, Jason
AU  - Weatherald J
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; AP-HP, Service de Pneumologie, Centre de Reference de
      l'Hypertension Pulmonaire, Hopital Bicetre, Le Kremlin-Bicetre, France;
      Department of Medicine, Division of Respirology, University of Calgary, Calgary, 
      AB, Canada; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.
FAU - Planche, Olivier
AU  - Planche O
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; Inserm UMR_S 999, Hopital Marie Lannelongue, Le Plessis 
      Robinson, France; AP-HP, Service de Radiologie, Hopital Bicetre, Le
      Kremlin-Bicetre, France.
FAU - Fadel, Elie
AU  - Fadel E
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; Inserm UMR_S 999, Hopital Marie Lannelongue, Le Plessis 
      Robinson, France; Service de Chirurgie Thoracique, Hopital Marie Lannelongue, Le 
      Plessis Robinson, France.
FAU - Humbert, Marc
AU  - Humbert M
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; AP-HP, Service de Pneumologie, Centre de Reference de
      l'Hypertension Pulmonaire, Hopital Bicetre, Le Kremlin-Bicetre, France; Inserm
      UMR_S 999, Hopital Marie Lannelongue, Le Plessis Robinson, France.
FAU - Simonneau, Gerald
AU  - Simonneau G
AD  - Universite Paris-Sud, Faculte de Medecine, Universite Paris-Saclay, Le
      Kremlin-Bicetre, France; AP-HP, Service de Pneumologie, Centre de Reference de
      l'Hypertension Pulmonaire, Hopital Bicetre, Le Kremlin-Bicetre, France; Inserm
      UMR_S 999, Hopital Marie Lannelongue, Le Plessis Robinson, France. Electronic
      address: gerald.simonneau@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20180503
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - AIM
SB  - IM
PMC - PMC6169450
OTO - NOTNLM
OT  - *balloon pulmonary angioplasty
OT  - *chronic thromboembolic pulmonary hypertension
OT  - *poor subpleural perfusion
OT  - *predictive factor
EDAT- 2018/05/08 06:00
MHDA- 2018/05/08 06:00
CRDT- 2018/05/07 06:00
PHST- 2017/11/08 00:00 [received]
PHST- 2018/01/24 00:00 [revised]
PHST- 2018/03/30 00:00 [accepted]
PHST- 2018/05/08 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
PHST- 2018/05/07 06:00 [entrez]
AID - S0012-3692(18)30659-7 [pii]
AID - 10.1016/j.chest.2018.03.059 [doi]
PST - ppublish
SO  - Chest. 2018 Sep;154(3):521-531. doi: 10.1016/j.chest.2018.03.059. Epub 2018 May
      3.