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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2022
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.
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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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