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Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9108966/ https://www.ncbi.nlm.nih.gov/pubmed/35586450 http://dx.doi.org/10.1183/23120541.00564-2021 |
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author | Ruigrok, Dieuwertje Handoko, M. Louis Meijboom, Lilian J. Nossent, Esther J. Boonstra, Anco Braams, Natalia J. van Wezenbeek, Jessie Tepaske, Robert Tuinman, Pieter Roel Heunks, Leo M.A. Vonk Noordegraaf, Anton de Man, Frances S. Symersky, Petr Bogaard, Harm-Jan |
author_facet | Ruigrok, Dieuwertje Handoko, M. Louis Meijboom, Lilian J. Nossent, Esther J. Boonstra, Anco Braams, Natalia J. van Wezenbeek, Jessie Tepaske, Robert Tuinman, Pieter Roel Heunks, Leo M.A. Vonk Noordegraaf, Anton de Man, Frances S. Symersky, Petr Bogaard, Harm-Jan |
author_sort | Ruigrok, Dieuwertje |
collection | PubMed |
description | 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′(O(2))) <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. |
format | Online Article Text |
id | pubmed-9108966 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-91089662022-05-17 Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension Ruigrok, Dieuwertje Handoko, M. Louis Meijboom, Lilian J. Nossent, Esther J. Boonstra, Anco Braams, Natalia J. van Wezenbeek, Jessie Tepaske, Robert Tuinman, Pieter Roel Heunks, Leo M.A. Vonk Noordegraaf, Anton de Man, Frances S. Symersky, Petr Bogaard, Harm-Jan ERJ Open Res Original Research Articles 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′(O(2))) <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. European Respiratory Society 2022-05-16 /pmc/articles/PMC9108966/ /pubmed/35586450 http://dx.doi.org/10.1183/23120541.00564-2021 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Research Articles Ruigrok, Dieuwertje Handoko, M. Louis Meijboom, Lilian J. Nossent, Esther J. Boonstra, Anco Braams, Natalia J. van Wezenbeek, Jessie Tepaske, Robert Tuinman, Pieter Roel Heunks, Leo M.A. Vonk Noordegraaf, Anton de Man, Frances S. Symersky, Petr Bogaard, Harm-Jan Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
title | Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
title_full | Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
title_fullStr | Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
title_full_unstemmed | Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
title_short | Noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
title_sort | noninvasive follow-up strategy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9108966/ https://www.ncbi.nlm.nih.gov/pubmed/35586450 http://dx.doi.org/10.1183/23120541.00564-2021 |
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