TY  - JOUR
AB  - We present a 30-year-old man with pulmonary hypertension after pulmonary embolism. Pulmonary angiography showed multiple stenosis in the pulmonary vascular tree. We treated four of these stenoses by balloon angioplasty in three sessions. Pulmonary artery pressure was reduced from 90/25 mm Hg (mean 46) to 78/13 mm Hg (mean 35) with concomitant increase of aortic pressure from 105/60 mm Hg (mean 75) to 134/68 mm Hg (mean 90). Pulmonary perfusion scintigraphy showed increase of perfusion in the treated segments. Two procedures were followed by transient segmental pulmonary edema, but no other complications were noted. We conclude that balloon angioplasty is a promising method of lowering pulmonary artery pressure and improving pulmonary perfusion in suitable cases of pulmonary hypertension secondary to pulmonary embolism.
AU  - Voorburg, J. A.I.
AU  - Manger Cats, V.
AU  - Buis, B.
AU  - Bruschke, A. V.G.
DO  - 10.1378/chest.94.6.1249
IS  - 6
PB  - The American College of Chest Physicians
PY  - 1988
SP  - 1249
EP  - 1253
TI  - Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism
T2  - Chest
UR  - http://dx.doi.org/10.1378/chest.94.6.1249
VL  - 94
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension, a rare complication of acute pulmonary embolism, is characterized by fibrothrombotic obstructions of large pulmonary arteries combined with small-vessel arteriopathy. It can be cured by pulmonary endarterectomy, and can be clinically improved by medical therapy in inoperable patients. A European registry was set up in 27 centers to evaluate long-term outcome and outcome correlates in 2 distinct populations of operated and not-operated patients who have chronic thromboembolic pulmonary hypertension. Methods and Results-A total of 679 patients newly diagnosed with chronic thromboembolic pulmonary hypertension were prospectively included over a 24-month period. Estimated survival at 1, 2, and 3 years was 93% (95% confidence interval [CI], 90-95), 91% (95% CI, 87-93), and 89% (95% CI, 86-92) in operated patients (n=404), and only 88% (95% CI, 83-91), 79% (95% CI, 74-83), and 70% (95% CI, 64-76) in not-operated patients (n=275). In both operated and not-operated patients, pulmonary arterial hypertension-targeted therapy did not affect survival estimates significantly. Mortality was associated with New York Heart Association functional class IV (hazard ratio [HR], 4.16; 95% CI, 1.49-11.62; P=0.0065 and HR, 4.76; 95% CI, 1.76-12.88; P=0.0021), increased right atrial pressure (HR, 1.34; 95% CI, 0.95-1.90; P=0.0992 and HR, 1.50; 95% CI, 1.20-1.88; P=0.0004), and a history of cancer (HR, 3.02; 95% CI, 1.36-6.69; P=0.0065 and HR, 2.15; 95% CI, 1.18-3.94; P=0.0129) in operated and not-operated patients, respectively. Additional correlates of mortality were bridging therapy with pulmonary arterial hypertension-targeted drugs, postoperative pulmonary hypertension, surgical complications, and additional cardiac procedures in operated patients, and comorbidities such as coronary disease, left heart failure, and chronic obstructive pulmonary disease in not-operated patients. Conclusions-The long-term prognosis of operated patients currently is excellent and better than the outcome of notoperated patients.
AU  - Delcroix, Marion
AU  - Lang, Irene
AU  - Pepke-Zaba, Joanna
AU  - Jansa, Pavel
AU  - D'Armini, Andrea M.
AU  - Snijder, Repke
AU  - Bresser, Paul
AU  - Torbicki, Adam
AU  - Mellemkjaer, Sören
AU  - Lewczuk, Jerzy
AU  - Simkova, Iveta
AU  - Barberà, Joan A.
AU  - De Perrot, Marc
AU  - Hoeper, Marius M.
AU  - Gaine, Sean
AU  - Speich, Rudolf
AU  - Gomez-Sanchez, Miguel A.
AU  - Kovacs, Gabor
AU  - Jais, Xavier
AU  - Ambroz, David
AU  - Treacy, Carmen
AU  - Morsolini, Marco
AU  - Jenkins, David
AU  - Lindner, Jaroslav
AU  - Dartevelle, Philippe
AU  - Mayer, Eckhard
AU  - Simonneau, Gérald
DO  - 10.1161/CIRCULATIONAHA.115.016522
IS  - 9
KW  - Endarterectomy
KW  - hypertension, pulmonary
KW  - pulmonary embolism
KW  - survival
KW  - thromboembolism
PY  - 2016
SP  - 859
EP  - 871
TI  - Long-Term Outcome of Patients with Chronic Thromboembolic Pulmonary Hypertension : Results from an International Prospective Registry
T2  - Circulation
VL  - 133
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension is an underdiagnosed condition. Patients typically present with the symptoms of right heart failure. Diagnosis is usually done by radionuclide ventilation/perfusion (VQ) scan, high-quality multidetector computed tomography (CT) or pulmonary angiography at expert centers. Pulmonary endarterectomy remains the corner stone in management of chronic thromboembolic pulmonary hypertension. Deep hypothermic circulatory arrest is commonly used for the operation at most centers. In-hospital mortality ranges from 1.7 to 14.2%. Pulmonary hemorrhage, reperfusion lung injury, and right ventricular failure remain major early post-operative concerns. Five-year survival is reported to be 76 to 89%. Long-term outcome depends on residual pulmonary hypertension. Balloon pulmonary angioplasty and medical management play an adjunctive role. Here, we provide a comprehensive review on surgical management of chronic thromboembolic pulmonary hypertension.
AU  - Mangukia, Chirantan
AU  - Rali, Parth
AU  - Desai, Parag
AU  - Ku, Tse Shuen Jade
AU  - Brann, Stacey
AU  - Patel, Shrey
AU  - Sunagawa, Gengo
AU  - Minakata, Kenji
AU  - Kehara, Hiromu
AU  - Toyoda, Yoshiya
DO  - 10.1007/s12055-021-01208-y
KW  - Chronic thromboembolic pulmonary hypertension
KW  - Pulmonary endarterectomy
KW  - Pulmonary thromboendarterectomy
PB  - Indian Journal of Thoracic and Cardiovascular Surgery
PY  - 2021
SP  - 14
EP  - 20
TI  - Pulmonary endarterectomy
T2  - Indian Journal of Thoracic and Cardiovascular Surgery
ER  -
TY  - GEN
AB  - Riociguat is a first-in-class soluble guanylate cyclase stimulator, approved for the treatment of adults with pulmonary arterial hypertension (PAH), inoperable chronic thromboembolic pulmonary hypertension (CTEPH), or persistent or recurrent CTEPH after pulmonary endarterectomy. Approval was based on the results of the phase III PATENT-1 (PAH) and CHEST-1 (CTEPH) studies, with significant improvements in the primary endpoint of 6-minute walk distance vs placebo of +36 m and +46 m, respectively, as well as improvements in secondary endpoints such as pulmonary vascular resistance and World Health Organization functional class. Riociguat acts as a stimulator of cyclic guanosine monophosphate synthesis rather than as an inhibitor of cGMP metabolism. As with other approved therapies for PAH, riociguat has antifibrotic, antiproliferative and anti-inflammatory effects, in addition to vasodilatory properties. This has led to further clinical studies in patients who do not achieve a satisfactory clinical response with phosphodiesterase type-5 inhibitors. Riociguat has also been evaluated in patients with World Health Organization group 2 and 3 pulmonary hypertension, and other conditions including diffuse cutaneous systemic sclerosis, Raynaud's phenomenon and cystic fibrosis. This review evaluates the results of the original clinical trials of riociguat for the treatment of PAH and CTEPH, and summarises the body of work that has examined the safety and efficacy of riociguat for the treatment of other types of pulmonary hypertension.
AU  - Klinger, James R.
AU  - Chakinala, Murali M.
AU  - Langleben, David
AU  - Rosenkranz, Stephan
AU  - Sitbon, Olivier
DA  - 2021/7//
DO  - 10.1111/bcp.14676
IS  - 7
KW  - drug information
KW  - pharmacotherapy
KW  - therapeutics
PB  - John Wiley and Sons Inc
PY  - 2021
SP  - 2645
EP  - 2662
TI  - Riociguat: Clinical research and evolving role in therapy
T2  - British Journal of Clinical Pharmacology
VL  - 87
ER  -
TY  - JOUR
AU  - Galiè, Nazzareno
AU  - Humbert, Marc
AU  - Vachiery, Jean Luc
AU  - Gibbs, Simon
AU  - Lang, Irene
AU  - Torbicki, Adam
AU  - Simonneau, Gérald
AU  - Peacock, Andrew
AU  - Noordegraaf, Anton Vonk
AU  - Beghetti, Maurice
AU  - Ghofrani, Ardeschir
AU  - Sanchez, Miguel Angel Gomez
AU  - Hansmann, Georg
AU  - Klepetko, Walter
AU  - Lancellotti, Patrizio
AU  - Matucci, Marco
AU  - McDonagh, Theresa
AU  - Pierard, Luc A.
AU  - Trindade, Pedro T.
AU  - Zompatori, Maurizio
AU  - Hoeper, Marius
DO  - 10.1183/13993003.01032-2015
IS  - 4
PY  - 2015
SP  - 903
EP  - 975
TI  - 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
T2  - European Respiratory Journal
UR  - http://dx.doi.org/10.1183/13993003.01032-2015
VL  - 46
ER  -
TY  - GEN
AB  - Objective: To evaluate clinical literature for direct oral anticoagulants (DOACs) therapy for non–Food and Drug Administration approved indications. Data Sources: Articles from MEDLINE, Cochrane Library, Google Scholar, and OVID databases were reviewed from 1946 through September 4, 2020. Study Selection and Data Extraction: Fully published studies assessing DOACs for atrial fibrillation (AF) with valvular heart disease (VHD), heart failure (HF), left ventricular thrombus (LVT), superficial vein thrombosis (SVT), or pulmonary hypertension (PH) were evaluated. Data Synthesis: Our review showed that DOACs are safe to use in patients with AF and VHD except for mitral stenosis or mechanical heart valve. Rivaroxaban 2.5 mg twice daily should be used with caution in patients with HF with reduced ejection fraction until further evaluation is performed. Four retrospective studies for DOAC use in patients with LVT showed conflicting results. One phase 3 randomized controlled trial showed noninferiority of rivaroxaban to fondaparinux for SVT treatment. The use of DOACs for pulmonary arterial hypertension was not evaluated in any clinical study, but 2 retrospective studies for the use of DOACs in patients with chronic thromboembolic PH (CTEPH) showed similar efficacy between DOACs and warfarin. Relevance to Patient Care and Clinical Practice: This review provides clinicians with a comprehensive literature review surrounding DOAC use in common off-label indications. Conclusion: DOACs can be considered for AF complicated by VHD except for mitral stenosis or mechanical valve replacement. DOACs (especially rivaroxaban) are considered as an alternative therapy for SVT and CTEPH. Further prospective studies for DOAC uses are needed for HF or LVT.
AU  - Brokmeier, Hannah
AU  - Kido, Kazuhiko
DA  - 2021/8//
DO  - 10.1177/1060028020970618
IS  - 8
KW  - atrial fibrillation
KW  - direct oral anticoagulants
KW  - heart failure
KW  - left ventricular thrombus
KW  - pulmonary hypertension
KW  - superficial vein thrombosis
PB  - SAGE Publications Inc.
PY  - 2021
SP  - 995
EP  - 1009
TI  - Off-label Use for Direct Oral Anticoagulants: Valvular Atrial Fibrillation, Heart Failure, Left Ventricular Thrombus, Superficial Vein Thrombosis, Pulmonary Hypertension—a Systematic Review
T2  - Annals of Pharmacotherapy
VL  - 55
ER  -
TY  - JOUR
AU  - Hoole, Stephen P.
AU  - Jenkins, David P.
DO  - 10.1136/heartjnl-2019-316291
IS  - 19
KW  - pulmonary vascular disease
KW  - thromboembolic pulmonary vascular disease
PY  - 2020
SP  - 1525
EP  - 1531
TI  - Chronic thromboembolic pulmonary hypertension: Interventional approaches
T2  - Heart
VL  - 106
ER  -
TY  - JOUR
AB  - Background Macitentan is beneficial for long-term treatment of pulmonary arterial hypertension. The microvasculopathy of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension are similar. Methods The phase 2, double-blind, randomised, placebo-controlled MERIT-1 trial assessed macitentan in 80 patients with CTEPH adjudicated as inoperable. Patients identified as WHO functional class II–IV with a pulmonary vascular resistance (PVR) of at least 400 dyn·s/cm5 and a walk distance of 150–450 m in 6 min were randomly assigned (1:1), via an interactive voice/web response system, to receive oral macitentan (10 mg once a day) or placebo. Treatment with phosphodiesterase type-5 inhibitors and oral or inhaled prostanoids was permitted for WHO functional class III/IV patients. The primary endpoint was resting PVR at week 16, expressed as percentage of PVR measured at baseline. Analyses were done in all patients who were randomly assigned to treatment; safety analyses were done in all patients who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT02021292. Findings Between April 3, 2014, and March 17, 2016, we screened 186 patients for eligibility at 48 hospitals across 20 countries. Of these, 80 patients in 36 hospitals were randomly assigned to treatment (40 patients to macitentan, 40 patients to placebo). At week 16, geometric mean PVR decreased to 73·0% of baseline in the macitentan group and to 87·2% in the placebo group (geometric means ratio 0·84, 95% CI 0·70–0·99, p=0·041). The most common adverse events in the macitentan group were peripheral oedema (9 [23%] of 40 patients) and decreased haemoglobin (6 [15%]). Interpretation In MERIT-1, macitentan significantly improved PVR in patients with inoperable CTEPH and was well tolerated. Funding Actelion Pharmaceuticals Ltd.
AU  - Ghofrani, Hossein Ardeschir
AU  - Simonneau, Gérald
AU  - D'Armini, Andrea M.
AU  - Fedullo, Peter
AU  - Howard, Luke S.
AU  - Jaïs, Xavier
AU  - Jenkins, David P.
AU  - Jing, Zhi Cheng
AU  - Madani, Michael M.
AU  - Martin, Nicolas
AU  - Mayer, Eckhard
AU  - Papadakis, Kelly
AU  - Richard, Dominik
AU  - Kim, Nick H.
AU  - Lang, Irene
AU  - Kähler, Christian
AU  - Delcroix, Marion
AU  - Bshouty, Zoheir
AU  - Varela, Pablo Sepulveda
AU  - Jing, Zhi Cheng
AU  - Yang, Yuanhua
AU  - Liu, Jinming
AU  - Zhang, Gangcheng
AU  - Zhang, Nuofu
AU  - Mi, Yuhong
AU  - Zhu, Xianyang
AU  - Jansa, Pavel
AU  - Jaïs, Xavier
AU  - Prévot, Grégoire
AU  - Bouvaist, Hélène
AU  - Sanchez, Olivier
AU  - Grimminger, Friedrich
AU  - Held, Matthias
AU  - Wilkens, Heinrike
AU  - Rosenkranz, Stephan
AU  - Grünig, Ekkehard
AU  - Karlócai, Kristóf
AU  - Temesvári, András
AU  - Edes, Istvan
AU  - Aidietienė, Sigita
AU  - Miliauskas, Skaidrius
AU  - Zamudio, Tomas Rene Pulido
AU  - Sanchez, Carlos Jerjes
AU  - Noordegraaf, Anton Vonk
AU  - Lewczuk, Jerzy
AU  - Podolec, Piotr
AU  - Kasprzak, Jarosław
AU  - Mularek-Kubzdela, Tatiana
AU  - Grzywna, Ryszard
AU  - Dheda, Keertan
AU  - Moiseeva, Olga
AU  - Chernyavskiy, Alexander
AU  - Shipulin, Vladimir
AU  - Barbarash, Olga
AU  - Martynyuk, Tamila
AU  - Kim, Hyung Kwan
AU  - Park, Jun Bean
AU  - Lee, Jae Seung
AU  - Speich, Rudolf
AU  - Ulrich, Silvia
AU  - Aubert, John David
AU  - Phrommintikul, Arintaya
AU  - Jaimchariyatam, Nattapong
AU  - Sompradeekul, Suree
AU  - Onen, Zeynep Pinar
AU  - Okumus, Gulfer
AU  - Solovey, Lyubomyr
AU  - Gavrysyuk, Volodymyr
AU  - Howard, Luke
AU  - Pepke-Zaba, Joanna
AU  - Condliffe, Robin
AU  - McConnell, John
AU  - Kerr, Kim
AU  - Nguyen, Lan Hieu
AU  - Pham, Nguyen Vinh
DA  - 2017/10//
DO  - 10.1016/S2213-2600(17)30305-3
IS  - 10
PB  - Lancet Publishing Group
PY  - 2017
SP  - 785
EP  - 794
TI  - Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study
T2  - The Lancet Respiratory Medicine
VL  - 5
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the leading causes of severe pulmonary hypertension (PH). The disease is still underdiagnosed, and the true prevalence is unknown. CTEPH is characterized by intraluminal non-resolving thrombus organization and fibrous stenosis, or complete obliteration of pulmonary arteries, promoted by progressive remodeling of the pulmonary vasculature. One consequence of this is an increase in pulmonary vascular resistance and pressure, resulting in PH and progressive right heart failure, leading to death if left untreated. Endovascular disobliteration by pulmonary endarterectomy (PEA) is the preferred treatment for CTEPH patients. PEA surgery is the only technique that can potentially cure CTEPH disease, especially in patients with fresh or organized thrombi of the proximal branches of pulmonary arteries. However, not all patients are eligible for PEA surgery. Recent research has provided evidence suggesting balloon pulmonary angioplasty (BPA) and targeted medical therapy as additional promising available treatments options for inoperable CTEPH and recurrent/persistent PH after PEA surgery. Studies on BPA have shown it to improve pulmonary hemodynamics, symptoms, exercise capacity and RV function in inoperable CTEPH. Subsequently, BPA has developed into an essential component of the modern era of CTEPH treatment. Large randomized controlled trials have demonstrated varying significant improvements with targeted medical therapy in technically inoperable CTEPH patients. Thus, treatment of CTEPH requires a comprehensive multidisciplinary assessment, including an experienced PEA surgeon, PH specialist, BPA interventionist and CTEPH-trained radiologist at expert centers. In this comprehensive review, we address the latest developments in the fast-evolving field of CTEPH. These include advancements in imaging modalities and developments in operative and interventional techniques, which have widened the range of patients who may benefit from these procedures. The efficacy and safety of targeted medical therapies in CTEPH patients are also discussed. As the treatment options for CTEPH improve, hybrid management involving multiple treatments in the same patient may become a viable option in the near future.
AU  - Gerges, Mario
AU  - Yacoub, Magdi
DO  - 10.21542/GCSP.2020.11
IS  - 1
PY  - 2020
TI  - Chronic thromboembolic pulmonary hypertension - Still evolving
T2  - Global Cardiology Science and Practice
VL  - 2020
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic PH leading to right heart failure and death. Lung ventilation/perfusion scintigraphy is the screening test of choice; a normal scan rules out CTEPH. In the case of an abnormal perfusion scan, a high-quality pulmonary angiogram is necessary to confirm and define the pulmonary vascular involvement and prior to making a treatment decision. PH is confirmed with right heart catheterisation, which is also necessary for treatment determination. In addition to chronic anticoagulation therapy, each patient with CTEPH should receive treatment assessment starting with evaluation for pulmonary endarterectomy, which is the guideline recommended treatment. For technically inoperable cases, PH-targeted medical therapy is recommended (currently riociguat based on the CHEST studies), and balloon pulmonary angioplasty should be considered at a centre experienced with this challenging but potentially effective and complementary intervention.
AU  - Kim, Nick H.
AU  - Delcroix, Marion
AU  - Jais, Xavier
AU  - Madani, Michael M.
AU  - Matsubara, Hiromi
AU  - Mayer, Eckhard
AU  - Ogo, Takeshi
AU  - Tapson, Victor F.
AU  - Ghofrani, Hossein Ardeschir
AU  - Jenkins, David P.
DO  - 10.1183/13993003.01915-2018
IS  - 1
PY  - 2019
TI  - Chronic thromboembolic pulmonary hypertension
T2  - European Respiratory Journal
UR  - http://dx.doi.org/10.1183/13993003.01915-2018
VL  - 53
ER  -
TY  - JOUR
AB  - Objective: To estimate the prevalence and incidence of pulmonary hypertension (PH) in Colombia between the period between 2010 and 2014. Methodology: Cross-sectional study using the Data Warehouse of the Social Protection Information System (SISPRO) of the Ministry of Health and Social Protection (MSPS). We included all the nationwide patients who had registered the diagnoses of Primary Pulmonary Hypertension (ICD-10 I270) during the period established for the study. Results: It was estimated that the prevalence and incidence of PH is approximately 52 and 20 cases per million inhabitants, respectively. It predominates in the female sex and in the age groups over 60 years. Conclusion: Epidemiological estimates of PH in Colombia are consistent with the definition of orphan or rare diseases.
AU  - Miranda, Pablo A.M.
AU  - Guzmán Sáenz, Roberto C.
AU  - Ivan, Baños A.
AU  - Álvaro, Alvarez B.
DO  - 10.14482/sun.34.3.614.4
IS  - 3
KW  - Epidemiology
KW  - Incidence
KW  - Prevalence
KW  - Pulmonary hypertension
PY  - 2018
SP  - 607
EP  - 624
TI  - Epidemiology of pulmonary hypertension in Colombia
T2  - Salud Uninorte
VL  - 34
ER  -
TY  - JOUR
AB  - El presente documento resume el marco de colaboración denominado “Red Colombiana de Hipertensión Pulmonar” entre miembros de diversas instituciones y especialidades médicas y paramédicas que tienen intereses académicos y científicos en el diagnóstico, tratamiento y/o investigación en áreas diversas de la Hipertensión Pulmonar. Esta iniciativa denominada con el acrónimo “HAPredco”, se justifica ampliamente por la relevancia científica de viabilizar un intercambio gremial, transdisciplinar y continuo mediante una Plataforma de Acción Continuada (PAC) de gestión de la información, experiencias, bases de datos y experticias alrededor de la hipertensión pulmonar.
AU  - Orozco-Levi, Mauricio
AU  - Conde Camacho, Rafael
AU  - Conrado Pacheco, Manuel
AU  - Londoño Villegas, Alejandro
DO  - 10.30789/rcneumologia.v33.n1.2021.545
IS  - 1
PY  - 2021
SP  - 43
EP  - 49
TI  - La Red Colombiana de Hipertensión Pulmonar: Elementos de Gestión y Gobernanza Científica
T2  - Revista Colombiana de Neumología
VL  - 33
ER  -
TY  - JOUR
AB  - This systematic review of literature and online reports critically appraised incidence and prevalence estimates of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension to identify the most accurate estimates. Medline® and Embase® databases were searched for articles published between 1 January 2003 and 31 August 2020. Studies were grouped according to whether they were registries (population-based estimates), clinical databases (hospital-based estimates) or claims/administrative databases. Registries were classified into systematic and non-systematic registries, according to whether every national centre participated. Of 7309 publications identified, 5414 were screened after removal of duplicates and 33 were included. Inclusion was based on study type, availability of a clear numerator (diagnosed population) and a population- or hospital-based denominator, or all primary data required to calculate estimates. Only the most recent publication from a database was included. Most studies were based on European data and very few included children. In adults, the range of estimates per million was approximately 20-fold for pulmonary arterial hypertension incidence (1.5–32) and prevalence (12.4–268) and of similar magnitude for chronic thromboembolic pulmonary hypertension incidence (0.9–39) and prevalence (14.5–144). Recent (≤5 years) national systematic registry data from centralised healthcare systems provided the following ranges in adult estimates per million: approximately 5.8 for pulmonary arterial hypertension incidence, 47.6–54.7 for pulmonary arterial hypertension prevalence, 3.1–6.0 for chronic thromboembolic pulmonary hypertension incidence and 25.8–38.4 for chronic thromboembolic pulmonary hypertension prevalence. These estimates were considered the most reliable and consistent for the scientific community to plan for resource allocation and improve detection rates.
AU  - Leber, Laurence
AU  - Beaudet, Amélie
AU  - Muller, Audrey
DO  - 10.1177/2045894020977300
IS  - 1
KW  - epidemiology
KW  - pulmonary arterial hypertension
KW  - pulmonary hypertension
KW  - registries
PB  - SAGE Publications Ltd
PY  - 2021
TI  - Epidemiology of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: identification of the most accurate estimates from a systematic literature review
T2  - Pulmonary Circulation
VL  - 11
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of pulmonary embolism. As for most rare diseases, epidemiologic data are scarce, but recent registries suggest an incidence of at least 5 per million inhabitants per year. A history of massive or recurrent acute pulmonary embolismis observed inmost patientswith CTEPH, but the proportion of patients who develop CTEPH after acute pulmonary embolism is a matter of debate, further complicated by the possiblemisdiagnosis ofCTEPHas acute pulmonaryembolism. A complete resolution of thrombi is usually not achieved after acute pulmonary embolism, and the clinical relevance of a "postpulmonary embolism syndrome" with persistent perfusion defects and exercise intolerance is discussed. Risk factors most consistently associated with CTEPH are circulating anti-phospholipid antibodies or lupus anticoagulant, increased factorVIII, non-Oblood groups, and chronic inflammatory diseases. There is no female predominance, and it is a disease of older age. Survival in the absence of specific surgical or medical treatment is poor and depends on the hemodynamic severity.
AU  - Delcroix, Marion
AU  - Kerr, Kim
AU  - Fedullo, Peter
DO  - 10.1513/AnnalsATS.201509-621AS
KW  - Epidemiology
KW  - Pulmonary Embolism
KW  - Pulmonary Hypertension
KW  - Risk Factors
PY  - 2016
SN  - 0000000183949
SP  - S201
EP  - S206
TI  - Chronic thromboembolic pulmonary hypertension: Epidemiology and risk factors
T2  - Annals of the American Thoracic Society
VL  - 13
ER  -
TY  - JOUR
AB  - The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown. We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as "all comers", "survivors" or "survivors without major comorbidities". CTEPH incidences were calculated using random effects models. We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1-1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0-4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5-4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7-5.9) and 4.1 (95% CI 2.1-8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1-8.4). The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ∼3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.
AU  - Ende-Verhaar, Yvonne M.
AU  - Cannegieter, Suzanne C.
AU  - Noordegraaf, Anton Vonk
AU  - Delcroix, Marion
AU  - Pruszczyk, Piotr
AU  - Mairuhu, Albert T.A.
AU  - Huisman, Menno V.
AU  - Klok, Frederikus A.
DO  - 10.1183/13993003.01792-2016
IS  - 2
PY  - 2017
TI  - Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: A contemporary view of the published literature
T2  - European Respiratory Journal
UR  - http://dx.doi.org/10.1183/13993003.01792-2016
VL  - 49
ER  -
TY  - JOUR
AB  - BACKGROUND Chronic thromboembolic pulmonary hypertension (CTPH) is associated with considerable morbidity and mortality. Its incidence after pulmonary embolism and associated risk factors are not well documented. METHODS We conducted a prospective, long-term, follow-up study to assess the incidence of symptomatic CTPH in consecutive patients with an acute episode of pulmonary embolism but without prior venous thromboembolism. Patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography and, if supportive findings were present, ventilation-perfusion lung scanning and pulmonary angiography. CTPH was considered to be present if systolic and mean pulmonary-artery pressures exceeded 40 mm Hg and 25 mm Hg, respectively; pulmonary-capillary wedge pressure was normal; and there was angiographic evidence of disease. RESULTS The cumulative incidence of symptomatic CTPH was 1.0 percent (95 percent confidence interval, 0.0 to 2.4) at six months, 3.1 percent (95 percent confidence interval, 0.7 to 5.5) at one year, and 3.8 percent (95 percent confidence interval, 1.1 to 6.5) at two years. No cases occurred after two years among the patients with more than two years of follow-up data. The following increased the risk of CTPH: a previous pulmonary embolism (odds ratio, 19.0), younger age (odds ratio, 1.79 per decade), a larger perfusion defect (odds ratio, 2.22 per decile decrement in perfusion), and idiopathic pulmonary embolism at presentation (odds ratio, 5.70). CONCLUSIONS CTPH is a relatively common, serious complication of pulmonary embolism. Diagnostic and therapeutic strategies for the early identification and prevention of CTPH are needed.
AU  - Pengo, Vittorio
AU  - Lensing, Anthonie W.A.
AU  - Prins, Martin H.
AU  - Marchiori, Antonio
AU  - Davidson, Bruce L.
AU  - Tiozzo, Francesca
AU  - Albanese, Paolo
AU  - Biasiolo, Alessandra
AU  - Pegoraro, Cinzia
AU  - Iliceto, Sabino
AU  - Prandoni, Paolo
DO  - 10.1056/nejmoa032274
IS  - 22
PY  - 2004
SP  - 2257
EP  - 2264
TI  - Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism
T2  - New England Journal of Medicine
VL  - 350
ER  -
TY  - JOUR
AB  - BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is often a sequel of venous thromboembolism with fatal natural history; however, many cases can be cured by pulmonary endarterectomy. The clinical characteristics and current management of patients enrolled in an international CTEPH registry was investigated. METHODS AND RESULTS-: The international registry included 679 newly diagnosed (≤6 months) consecutive patients with CTEPH, from February 2007 until January 2009. Diagnosis was confirmed by right heart catheterization, ventilation-perfusion lung scintigraphy, computerized tomography, and/or pulmonary angiography. At diagnosis, a median of 14.1 months had passed since first symptoms; 427 patients (62.9%) were considered operable, 247 (36.4%) nonoperable, and 5 (0.7%) had no operability data; 386 patients (56.8%, ranging from 12.0%- 60.9% across countries) underwent surgery. Operable patients did not differ from nonoperable patients relative to symptoms, New York Heart Association class, and hemodynamics. A history of acute pulmonary embolism was reported for 74.8% of patients (77.5% operable, 70.0% nonoperable). Associated conditions included thrombophilic disorder in 31.9% (37.1% operable, 23.5% nonoperable) and splenectomy in 3.4% of patients (1.9% operable, 5.7% nonoperable). At the time of CTEPH diagnosis, 37.7% of patients initiated at least 1 pulmonary arterial hypertension-targeted therapy (28.3% operable, 53.8% nonoperable). Pulmonary endarterectomy was performed with a 4.7% documented mortality rate. CONCLUSIONS-: Despite similarities in clinical presentation, operable and nonoperable CTEPH patients may have distinct associated medical conditions. Operability rates vary considerably across countries, and a substantial number of patients (operable and nonoperable) receive off-label pulmonary arterial hypertension-targeted treatments. © 2011 American Heart Association, Inc.
AU  - Pepke-Zaba, Joanna
AU  - Delcroix, Marion
AU  - Lang, Irene
AU  - Mayer, Eckhard
AU  - Jansa, Pavel
AU  - Ambroz, David
AU  - Treacy, Carmen
AU  - D'Armini, Andrea M.
AU  - Morsolini, Marco
AU  - Snijder, Repke
AU  - Bresser, Paul
AU  - Torbicki, Adam
AU  - Kristensen, Bent
AU  - Lewczuk, Jerzy
AU  - Simkova, Iveta
AU  - Barberà, Joan A.
AU  - De Perrot, Marc
AU  - Hoeper, Marius M.
AU  - Gaine, Sean
AU  - Speich, Rudolf
AU  - Gomez-Sanchez, Miguel A.
AU  - Kovacs, Gabor
AU  - Hamid, Abdul Monem
AU  - Jaïs, Xavier
AU  - Simonneau, Gérald
DO  - 10.1161/CIRCULATIONAHA.110.015008
IS  - 18
KW  - chronic disease
KW  - endarterectomy
KW  - hypertension
KW  - pulmonary
PY  - 2011
SP  - 1973
EP  - 1981
TI  - Chronic thromboembolic pulmonary hypertension (CTEPH): Results from an international prospective registry
T2  - Circulation
VL  - 124
ER  -
TY  - JOUR
AB  - Objectives: To describe the characteristics of patients who undergo balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) and report the mid-term outcomes. Background: BPA has been recently introduced in Latin America. Mid-term results have not been published. Methods: Prospective Chilean Registry of inoperable CTEPH patients who underwent BPA. Clinical variables were analyzed at baseline, after each procedure and at follow-up. Hemodynamic variables were recorded before and after the last BPA. Results: Between August 2016 and September 2019, 22 patients (17 women), 59 ± 12.7 years, underwent 81 BPA and were followed for as long as 33.1 months (mean 17.3 ± 7.5). Mean pulmonary artery pressure decreased by 17.4% (51.1 ± 12 vs. 42.2 ± 13 mmHg, p =.001), pulmonary vascular resistance by 23.9% (766.7 ± 351 vs. 583 ± 346 dynes/s/cm−5, p =.001), cardiac index increased by 8% (2.3 ± 0.54 vs. 2.5 ± 0.54 L/min/m2, p =.012), N-terminal pro-B-type natriuretic peptide decreased by 73.8% (1,685 ± 1,045 vs. 441.8 ± 276 pg/dl, p =.006), and 6-min walk distance improved by 135 m (316.7 ± 94 vs. 451.1 ± 113 m, p =.001). One patient (4.5%) developed lung reperfusion injury and four patients (18.2%) had minor bleeding (hemoptysis), after the procedure. There was no mortality associated with BPA. Conclusions: Our results confirm that BPA for inoperable CTEPH is a relatively safe procedure that improves clinical and hemodynamic parameters in the mid-term. This therapy should be considered as an alternative, mainly in places where access to PAH therapy or surgery is restricted.
AU  - Sepúlveda, Pablo
AU  - Hameau, René
AU  - Backhouse, Christian
AU  - Charme, Gustavo
AU  - Pacheco, Francisco
AU  - Ramírez, Pablo A.
AU  - Fuensalida, Alberto J.
AU  - Quitral, Jorge
AU  - Martínez, Gonzalo
AU  - Martínez, José A.
DO  - 10.1002/ccd.29322
IS  - 6
KW  - angioplasty
KW  - chronic thromboembolic pulmonary hypertension
KW  - pulmonary hypertension
KW  - registry
PY  - 2021
SP  - E748
EP  - E757
TI  - Mid-term follow-up of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: An experience in Latin America
T2  - Catheterization and Cardiovascular Interventions
VL  - 97
ER  -
TY  - JOUR
AU  - Mahmud, Ehtisham
AU  - Maolo, Alessandro
AU  - Poch, David
AU  - Ang, Lawrence
AU  - Patel, Mitul
AU  - Kim, Nick
DO  - 10.1016/j.jacc.2018.08.1145
IS  - 13
PB  - Elsevier
PY  - 2018
SP  - B25
EP  - B26
TI  - TCT-57 Hemodynamic and Functional Improvement Following Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Experience at a High Volume Pulmonary Thromboendarterectomy Center
T2  - Journal of the American College of Cardiology
UR  - http://dx.doi.org/10.1016/j.jacc.2018.08.1145
VL  - 72
ER  -
TY  - JOUR
AB  - Background-Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. Methods and Results-A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent followup right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. Conclusions-This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
AU  - Ogawa, Aiko
AU  - Satoh, Toru
AU  - Fukuda, Tetsuya
AU  - Sugimura, Koichiro
AU  - Fukumoto, Yoshihiro
AU  - Emoto, Noriaki
AU  - Yamada, Norikazu
AU  - Yao, Atsushi
AU  - Ando, Motomi
AU  - Ogino, Hitoshi
AU  - Tanabe, Nobuhiro
AU  - Tsujino, Ichizo
AU  - Hanaoka, Masayuki
AU  - Minatoya, Kenji
AU  - Ito, Hiroshi
AU  - Matsubara, Hiromi
DO  - 10.1161/CIRCOUTCOMES.117.004029
IS  - 11
KW  - Angioplasty
KW  - Hypertension
KW  - Lung injury
KW  - Pulmonary
KW  - Survival
PY  - 2017
SP  - 1
EP  - 7
TI  - Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension results of a multicenter registry
T2  - Circulation: Cardiovascular Quality and Outcomes
VL  - 10
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension, resulting from fibrotic transformation of pulmonary artery clots causing chronic obstruction in macroscopic pulmonary arteries and associated vascular remodelling in the microvasculature. Pulmonary endarterectomy (PEA) offers the best chance of symptomatic and prognostic improvement in eligible patients; in expert centres, it has excellent results. Current in-hospital mortality rates are <5% and survival is >90% at 1 year and >70% at 10 years. However, PEA, is a complex procedure and relies on a multidisciplinary CTEPH team led by an experienced surgeon to decide on an individual’s operability, which is determined primarily by lesion location and the haemodynamic parameters. Therefore, treatment of patients with CTEPH depends largely on subjective judgements of eligibility for surgery by the CTEPH team. Other controversies discussed in this article include eligibility for PEA versus balloon pulmonary angioplasty, the new treatment algorithm in the European Society of Cardiology/European Respiratory Society guidelines and the definition of an “expert centre” for the management of this condition.
AU  - Jenkins, David
AU  - Madani, Michael
AU  - Fadel, Elie
AU  - D’Armini, Andrea Maria
AU  - Mayer, Eckhard
DO  - 10.1183/16000617.0111-2016
IS  - 143
PY  - 2017
TI  - Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension
T2  - European Respiratory Review
UR  - http://dx.doi.org/10.1183/16000617.0111-2016
VL  - 26
ER  -
TY  - JOUR
AB  - Chronic thromboembolic disease (CTEPH) is one of the causes for developing pulmonary hypertension (PH). PH is characterized by an increase in pulmonary vascular pressure and resistance, ultimately leading to chronic overload. This study describes the clinical, functional, and hemodynamic characteristics as well as the established treatment strategy for a cohort of patients diagnosed with CTEPH in Bucaramanga, Colombia. In Colombia, PH is considered as an orphan disease with limited epidemiological data. We aim to provide useful information in order to help guide future clinical decisions for PH treatment and prevention. We conducted a cross-sectional study, obtaining clinical data from patients under follow-up, over 18 years of age, with hemodynamic confirmation of CTEPH in two pulmonary outpatient centers in Bucaramanga, Colombia between 2012 and 2018. 35 patients with diagnosis of CTEPH were included. Mean age was 52.3 ± 17.9 years. The mean time between the onset of symptoms to diagnosis was 14 months. 71% had a previous thrombotic event and 69% had functional class III and IV according to the world health organization (WHO) criteria. Most of the patients were classified as at high risk of mortality according to the European Society of Cardiology (ESC) and the European Respiratory Society (ERS/ESC) criteria and 60% were referred to undergo thromboendarterectomy. Most of the patients were under monotherapy treatment with Bosentan, the most prescribed medication in both monotherapy and dual therapy. This study identified a high number of patients in advanced stages of CETPH due to late diagnosis, related to health care limitations. This resulted in worse prognosis and quality of life. In addition, low adherence to non-pharmacological interventions was evidenced in patients who were not candidates for thromboendarterectomy despite the onset of pharmacological therapy.
AU  - Fajardo-Rivero, Javier Enrique
AU  - Mogollón, Melissa
AU  - García-Bohórquez, Diego Fernando
AU  - Villabona-Rueda, Andrés
AU  - Mendoza-Herrera, Tania
AU  - Ramírez-Sarmiento, Alba
AU  - Bolívar-Grimaldos, Fabio
AU  - Orozco-Levi, Mauricio
DO  - 10.3390/jor1020012
IS  - 2
PY  - 2021
SP  - 105
EP  - 113
TI  - Characterization of a Cohort of Patients with Chronic Thromboembolic Pulmonary Hypertension from Northeastern Colombia (REHINO Study)
T2  - Journal of Respiration
VL  - 1
ER  -
TY  - JOUR
AU  - Payares, Carlos
DO  - http://dx.doi.org/10.1016/j.rccar.2017.08.008
IS  - 1
PY  - 2017
SP  - 48
EP  - 54
TI  - Diagnóstico y tratamiento de la hipertensión pulmonar tromboembólica crónica
T2  - Revista Colombiana de Cardiología
VL  - 24
ER  -
TY  - JOUR
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially fatal and frequently undiagnosed form of pulmonary hypertension (PH), classified within group 4 by the World Health Organization (WHO). It is a type of precapillary PH, which uncommonly develops as a peculiar sequel of acute pulmonary embolism due to the partial resolution of the mechanically obstructing thrombus with a coexisting inflammatory response from pulmonary vessels. CTEPH is one of the potentially treatable forms of PH whose current standard of care is surgical pulmonary endarterectomy. Medical therapy with few drugs in non-operable disease is approved and has shown improvement in patients' hemodynamic condition and functional ability. Recently, balloon pulmonary angioplasty (BPA) has shown promising results as a treatment option for technically inoperable patients, those with unacceptable risk-to-benefit ratio and in a case of residual PH after endarterectomy. Lack of meticulous CTEPH screening programs in post-pulmonary embolism patients leading to underdiagnosis of this condition, complex operability assessment, and diversity in BPA techniques among different institutions are still the issues that need to be addressed. In this paper, we review the recent achievements in the management of non-operable CTEPH, their outcome and safety, based on available data.
AU  - Rotzinger, David C.
AU  - Rezaei-Kalantari, Kiara
AU  - Aubert, John David
AU  - Qanadli, Salah D.
DO  - 10.1016/j.ejrad.2021.109562
IS  - January
KW  - Chronic thromboembolic pulmonary hypertension
KW  - Endovascular procedure
KW  - Pulmonary angioplasty
KW  - Pulmonary embolism
PB  - Elsevier B.V.
PY  - 2021
SP  - 109562
EP  - 109562
TI  - Pulmonary angioplasty: A step further in the continuously changing landscape of chronic thromboembolic pulmonary hypertension management
T2  - European Journal of Radiology
UR  - https://doi.org/10.1016/j.ejrad.2021.109562
VL  - 136
ER  -
TY  - JOUR
AB  - Balloon pulmonary angioplasty (BPA) is an emerging treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We report on a prospective series of 56 consecutive patients who underwent 266 BPA interventions (median, five per patient) at two German institutions. All patients underwent a comprehensive diagnostic work-up including right heart catheterisation at baseline and 24 weeks after their last intervention. BPA resulted in improvements in WHO functional class, 6 min walk distance (mean change, +33 m), right ventricular function and haemodynamics, including a decline in mean pulmonary artery pressure by 18% and in pulmonary vascular resistance by 26%. Procedure-related adverse events occurred in 9.4% of the interventions. The most common complications were related to pulmonary vascular injury and consecutive pulmonary bleeding. Most of these events were asymptomatic and self-limiting, but one patient died from pulmonary bleeding, resulting in a mortality rate of 1.8%. BPA resulted in haemodynamic and clinical improvements but was also associated with a considerable number of complications, including one fatal pulmonary bleeding. As the effects of BPA on survival are unknown, randomised controlled outcome trials comparing BPA with approved medical therapies in patients with inoperable CTEPH are required to allow for appropriate risk-benefit assessments.
AU  - Olsson, Karen M.
AU  - Wiedenroth, Christoph B.
AU  - Kamp, Jan Christopher
AU  - Breithecker, Andreas
AU  - Fuge, Jan
AU  - Krombach, Gabriele A.
AU  - Haas, Moritz
AU  - Hamm, Christian
AU  - Kramm, Thorsten
AU  - Guth, Stefan
AU  - Ghofrani, Hossein Ardeschir
AU  - Hinrichs, Jan B.
AU  - Cebotari, Serghei
AU  - Meyer, Katrin
AU  - Hoeper, Marius M.
AU  - Mayer, Eckhard
AU  - Liebetrau, Christoph
AU  - Meyer, Bernhard C.
DO  - 10.1183/13993003.02409-2016
IS  - 6
PY  - 2017
TI  - Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: The initial German experience
T2  - European Respiratory Journal
UR  - http://dx.doi.org/10.1183/13993003.02409-2016
VL  - 49
ER  -
TY  - JOUR
AB  - Background —Although pulmonary thromboendarterectomy is increasingly successful for the definitive treatment of chronic thromboembolic pulmonary hypertension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness. Therefore, for selected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA).
AU  - Feinstein, Jeffrey A.
AU  - Goldhaber, Samuel Z
AU  - Lock, James E
AU  - Ferndandes, Susan M
AU  - Landzberg, Michael J
DA  - 2001/1//
DO  - 10.1161/01.CIR.103.1.10
IS  - 1
KW  - balloon ⅲ angioplasty ⅲ
KW  - cteph
KW  - definitive treatment of chronic
KW  - embolism ⅲ thrombus ⅲ
KW  - increas-
KW  - ingly successful for the
KW  - lthough pulmonary thromboendarterectomy is
KW  - not all
KW  - pulmonary heart disease
KW  - thromboembolic pulmonary hypertension
PY  - 2001
SP  - 10
EP  - 13
TI  - Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension
T2  - Circulation
UR  - https://www.ahajournals.org/doi/10.1161/01.CIR.103.1.10
VL  - 103
ER  -
TY  - JOUR
AB  - Background-Although balloon pulmonary angioplasty (BPA) for inoperable patients with chronic thromboembolic pulmonary hypertension was first reported over a decade ago, its clinical application has been restricted because of limited efficacy and complications. We have refined the procedure of BPA to maximize its clinical efficacy. Methods and Results-Sixty-eight consecutive patients with inoperable chronic thromboembolic pulmonary hypertension underwent BPA. We evaluated pulmonary artery diameters and determined the appropriate balloon size by using intravascular ultrasound. We performed BPA in a staged fashion over multiple, separate procedures to maximize efficacy and reduce the risk of reperfusion pulmonary injury. A total of 4 (2-8) sessions were performed in each patient, and the number of vessels dilated per session was 3 (1-14). The World Health Organization functional class improved from 3 to 2 (P<0.01), and mean pulmonary arterial pressure was decreased from 45.4±9.6 to 24.0±6.4 mm Hg (P<0.01). One patient died because of right heart failure 28 days after BPA. During follow-up for 2.2±1.4 years after the final BPA, another patient died of pneumonia, and the remaining 66 patients are alive. In 57 patients who underwent right heart catheterization at follow-up, improvement of mean pulmonary arterial pressure was maintained (24.0±5.8 mm Hg at 1.0±0.9 years). Forty-one patients (60%) developed reperfusion pulmonary injury after BPA, but mechanical ventilation was required in only 4 patients. Conclusions-Our refined BPA procedure improves clinical status and hemodynamics of inoperable patients with chronic thromboembolic pulmonary hypertension, with a low mortality. A refined BPA procedure could be considered as a therapeutic approach for patients with inoperable chronic thromboembolic pulmonary hypertension. © 2012 American Heart Association, Inc.
AU  - Mizoguchi, Hiroki
AU  - Ogawa, Aiko
AU  - Munemasa, Mitsuru
AU  - Mikouchi, Hiroshi
AU  - Ito, Hiroshi
AU  - Matsubara, Hiromi
DO  - 10.1161/CIRCINTERVENTIONS.112.971077
IS  - 6
KW  - Peripheral vascular disease
KW  - Pulmonary hypertension
KW  - Reperfusion
KW  - Revascularization
PY  - 2012
SP  - 748
EP  - 755
TI  - Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension
T2  - Circulation: Cardiovascular Interventions
VL  - 5
ER  -
TY  - JOUR
AU  - Galiè, Nazzareno
AU  - Humbert, Marc
AU  - Vachiery, Jean Luc
AU  - Gibbs, Simon
AU  - Lang, Irene
AU  - Torbicki, Adam
AU  - Simonneau, Gérald
AU  - Peacock, Andrew
AU  - Vonk Noordegraaf, Anton
AU  - Beghetti, Maurice
AU  - Ghofrani, Ardeschir
AU  - Gomez Sanchez, Miguel Angel
AU  - Hansmann, Georg
AU  - Klepetko, Walter
AU  - Lancellotti, Patrizio
AU  - Matucci, Marco
AU  - McDonagh, Theresa
AU  - Pierard, Luc A.
AU  - Trindade, Pedro T.
AU  - Zompatori, Maurizio
AU  - Hoeper, Marius
AU  - Aboyans, Victor
AU  - Vaz Carneiro, Antonio
AU  - Achenbach, Stephan
AU  - Agewall, Stefan
AU  - Allanore, Yannick
AU  - Asteggiano, Riccardo
AU  - Paolo Badano, Luigi
AU  - Albert Barberà, Joan
AU  - Bouvaist, Hélène
AU  - Bueno, Héctor
AU  - Byrne, Robert A.
AU  - Carerj, Scipione
AU  - Castro, Graça
AU  - Erol, Çetin
AU  - Falk, Volkmar
AU  - Funck-Brentano, Christian
AU  - Gorenflo, Matthias
AU  - Granton, John
AU  - Iung, Bernard
AU  - Kiely, David G.
AU  - Kirchhof, Paulus
AU  - Kjellstrom, Barbro
AU  - Landmesser, Ulf
AU  - Lekakis, John
AU  - Lionis, Christos
AU  - Lip, Gregory Y.H.
AU  - Orfanos, Stylianos E.
AU  - Park, Myung H.
AU  - Piepoli, Massimo F.
AU  - Ponikowski, Piotr
AU  - Revel, Marie Pierre
AU  - Rigau, David
AU  - Rosenkranz, Stephan
AU  - Völler, Heinz
AU  - Luis Zamorano, Jose
AU  - Myftiu, Sokol
AU  - Bonderman, Diana
AU  - Firdovsi, Ibrahimov
AU  - Lazareva, Irina
AU  - De Pauw, Michel
AU  - Sokolović, Šekib
AU  - Velchev, Vasil
AU  - Čikeš, Maja
AU  - Moutiris, Josef Antoniou
AU  - Jansa, Pavel
AU  - Nielsen-Kudsk, Jens Erik
AU  - Anton, Ly
AU  - Jääskeläinen, Pertti
AU  - Bauer, Fabrice
AU  - Chukhrukidze, Archil
AU  - Opitz, Christian
AU  - Giannakoulas, George
AU  - Karlócai, Kristóf
AU  - Oddsson, Hjörtur
AU  - Gaine, Sean
AU  - Menachemi, Doron
AU  - Emdin, Michele
AU  - Sooronbaev, Talant
AU  - Rudzītis, Ainars
AU  - Gumbiene, Lina
AU  - Lebrun, Frederic
AU  - Micallef, Josef
AU  - Botnaru, Victor
AU  - Oukerraj, Latifa
AU  - Andreassen, Arne K.
AU  - Kurzyna, Marcin
AU  - Leite Baptista, Maria João Ribeiro
AU  - Coman, Ioan Mircea
AU  - Moiseeva, Olga
AU  - Stefanović, Branislav S.
AU  - Šimková, Iveta
AU  - Wikström, Gerhard
AU  - Schwerzmann, Markus
AU  - Srbinovska-Kostovska, Elizabeta
AU  - van Dijk, Arie P.J.
AU  - Mahdhaoui, Abdallah
AU  - Kaymaz, Cihangir
AU  - Coghlan, Gerry
AU  - Sirenko, Yuriy
DO  - 10.1093/eurheartj/ehv317
IS  - 1
KW  - Chronic thromboembolic pulmonary hypertension
KW  - Congenital heart disease
KW  - Connective tissue disease
KW  - Endothelin receptor antagonists
KW  - Guidelines
KW  - Heart failure
KW  - Left heart disease
KW  - Lung disease
KW  - Phosphodiesterase type 5 inhibitors
KW  - Prostacyclin analogues
KW  - Pulmonary arterial hypertension
KW  - Pulmonary hypertension
KW  - Respiratory failure
PY  - 2016
SP  - 67
EP  - 119
TI  - 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
T2  - European Heart Journal
VL  - 37
ER  -
TY  - JOUR
AB  - Background: The potential role of new oral anticoagulants in antiphospholipid antibody syndrome (APS) remains uncertain. Objective: To determine whether rivaroxaban is noninferior to dose-adjusted vitamin K antagonists (VKAs) for thrombotic APS. Design: 3-year, open-label, randomized noninferiority trial. (EU Clinical Trials Register: EUDRA [European Union Drug Regulatory Authorities] code 2010-019764-36) Setting: 6 university hospitals in Spain. Participants: 190 adults (aged 18 to 75 years) with thrombotic APS. Intervention: Rivaroxaban (20 mg/d or 15 mg/d, according to renal function) versus dose-adjusted VKAs (target international normalized ratio, 2.0 to 3.0, or 3.1 to 4.0 in patients with a history of recurrent thrombosis). Measurements: The primary efficacy outcome was the proportion of patients with new thrombotic events; the primary safety outcome was major bleeding. The prespecified noninferiority margin for risk ratio (RR) was 1.40. Secondary outcomes included time to thrombosis, type of thrombosis, changes in biomarker levels, cardiovascular death, and nonmajor bleeding. Results: After 3 years of follow-up, recurrent thrombosis occurred in 11 patients (11.6%) in the rivaroxaban group and 6 (6.3%) in the VKA group (RR in the rivaroxaban group, 1.83 [95% CI, 0.71 to 4.76]). Stroke occurred more commonly in patients receiving rivaroxaban (9 events) than in those receiving VKAs (0 events) (corrected RR, 19.00 [CI, 1.12 to 321.9]). Major bleeding occurred in 6 patients (6.3%) in the rivaroxaban group and 7 (7.4%) in the VKA group (RR, 0.86 [CI, 0.30 to 2.46]). Post hoc analysis suggested an increased risk for recurrent thrombosis in rivaroxaban-treated patients with previous arterial thrombosis, livedo racemosa, or APS-related cardiac valvular disease. Limitation: Anticoagulation intensity was not measured in the rivaroxaban group. Conclusion: Rivaroxaban did not show noninferiority to dose-adjusted VKAs for thrombotic APS and, in fact, showed a non-statistically significant near doubling of the risk for recurrent thrombosis.
AU  - Ordi-Ros, Josep
AU  - Sáez-Comet, Luis
AU  - Pérez-Conesa, Mercedes
AU  - Vidal, Xavier
AU  - Riera-Mestre, Antoni
AU  - Castro-Salomó, Antoni
AU  - Cuquet-Pedragosa, Jordi
AU  - Ortiz-Santamaria, Vera
AU  - Mauri-Plana, Montserrat
AU  - Solé, Cristina
AU  - Cortés-Hernández, Josefina
DA  - 2019/11//
DO  - 10.7326/M19-0291
IS  - 10
PB  - American College of Physicians
PY  - 2019
SP  - 685
EP  - 694
TI  - Rivaroxaban versus Vitamin K antagonist in antiphospholipid syndrome a randomized noninferiority trial
T2  - Annals of Internal Medicine
VL  - 171
ER  -
TY  - JOUR
AB  - Objectives: Our goal was to investigate the effect of treatment with the oral dual endothelin receptor antagonist bosentan on the hemodynamics and exercise capacity of patients with chronic thromboembolic pulmonary hypertension (CTEPH). Background: CTEPH is characterized by vascular obstruction and remodeling, leading to increased pulmonary vascular resistance (PVR). Although pulmonary endarterectomy (PEA) is potentially curative, medical therapy is needed in patients with inoperable disease or persistent/recurrent pulmonary hypertension after PEA. Methods: The BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension) study was a double-blind, randomized, placebo-controlled study in CTEPH including patients with either inoperable CTEPH or persistent/recurrent pulmonary hypertension after PEA (>6 months after PEA). Independent coprimary end points were change in PVR as a percentage of baseline and change from baseline in 6-min walk distance after 16 weeks of treatment with bosentan or placebo. Secondary end points included change from baseline in World Health Organization functional class and other hemodynamic parameters. Results: One hundred fifty-seven patients were enrolled and randomized: 80 to placebo, 77 to bosentan. A statistically significant treatment effect (TE) of bosentan over placebo on PVR was demonstrated: -24.1% of baseline (95% confidence interval [CI]: -31.5% to -16.0%; p < 0.0001). Total pulmonary resistance (TE: -193 dyn·s·cm-5; 95% CI: -283 to -104 dyn·s·cm-5; p < 0.0001) and cardiac index (TE: 0.3 l·min-1·m-2; 95% CI: 0.14 to 0.46 l·min-1·m-2; p = 0.0007) improved. Mean TE on 6-min walk distance was +2.2 m (95% CI: -22.5 to 26.8 m; p = 0.5449). Bosentan treatment was well tolerated. Conclusions: This study demonstrated a positive TE of bosentan on hemodynamics in this patient population. No improvement was observed in exercise capacity. Further trials are needed to define the role of medical therapy in patients with CTEPH (Bosentan Effects in Inoperable Forms of Chronic Thromboembolic Pulmonary Hypertension; NCT00313222). © 2008 American College of Cardiology Foundation.
AU  - Jaïs, Xavier
AU  - D'Armini, Andrea M.
AU  - Jansa, Pavel
AU  - Torbicki, Adam
AU  - Delcroix, Marion
AU  - Ghofrani, Hossein A.
AU  - Hoeper, Marius M.
AU  - Lang, Irene M.
AU  - Mayer, Eckhard
AU  - Pepke-Zaba, Joanna
AU  - Perchenet, Loïc
AU  - Morganti, Adele
AU  - Simonneau, Gérald
AU  - Rubin, Lewis J.
DO  - 10.1016/j.jacc.2008.08.059
IS  - 25
KW  - bosentan
KW  - hemodynamics
KW  - operability
KW  - pulmonary endarterectomy
PY  - 2008
SP  - 2127
EP  - 2134
TI  - Bosentan for Treatment of Inoperable Chronic Thromboembolic Pulmonary Hypertension. BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a Randomized, Placebo-Controlled Trial
T2  - Journal of the American College of Cardiology
VL  - 52
ER  -
TY  - JOUR
AB  - BACKGROUND Riociguat, a member of a new class of compounds (soluble guanylate cyclase stimulators), has been shown in previous clinical studies to be beneficial in the treatment of chronic thromboembolic pulmonary hypertension. METHODS In this phase 3, multicenter, randomized, double-blind, placebo-controlled study, we randomly assigned 261 patients with inoperable chronic thromboembolic pulmonary hypertension or persistent or recurrent pulmonary hypertension after pulmonary endarterectomy to receive placebo or riociguat. The primary end point was the change from baseline to the end of week 16 in the distance walked in 6 minutes. Secondary end points included changes from baseline in pulmonary vascular resistance, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, World Health Organization (WHO) functional class, time to clinical worsening, Borg dyspnea score, quality-of-life variables, and safety. RESULTS By week 16, the 6-minute walk distance had increased by a mean of 39 m in the riociguat group, as compared with a mean decrease of 6 m in the placebo group (least-squares mean difference, 46 m; 95% confidence interval [CI], 25 to 67; P<0.001). Pulmonary vascular resistance decreased by 226 dyn·sec·cm(-5) in the riociguat group and increased by 23 dyn·sec·cm(-5) in the placebo group (least-squares mean difference, -246 dyn·sec·cm(-5); 95% CI, -303 to -190; P<0.001). Riociguat was also associated with significant improvements in the NT-proBNP level (P<0.001) and WHO functional class (P=0.003). The most common serious adverse events were right ventricular failure (in 3% of patients in each group) and syncope (in 2% of the riociguat group and in 3% of the placebo group). CONCLUSIONS Riociguat significantly improved exercise capacity and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. (Funded by Bayer HealthCare; CHEST-1 and CHEST-2 ClinicalTrials.gov numbers, NCT00855465 and NCT00910429, respectively.)
AU  - Ghofrani, Hossein-Ardeschir
AU  - D'Armini, Andrea M.
AU  - Grimminger, Friedrich
AU  - Hoeper, Marius M.
AU  - Jansa, Pavel
AU  - Kim, Nick H.
AU  - Mayer, Eckhard
AU  - Simonneau, Gerald
AU  - Wilkins, Martin R.
AU  - Fritsch, Arno
AU  - Neuser, Dieter
AU  - Weimann, Gerrit
AU  - Wang, Chen
DA  - 2013/7//
DO  - 10.1056/nejmoa1209657
IS  - 4
PB  - New England Journal of Medicine (NEJM/MMS)
PY  - 2013
SP  - 319
EP  - 329
TI  - Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension
T2  - New England Journal of Medicine
VL  - 369
ER  -
TY  - JOUR
AB  - Balloon pulmonary angioplasty (BPA) is an emerging treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We report on a prospective series of 56 consecutive patients who underwent 266 BPA interventions (median, five per patient) at two German institutions. All patients underwent a comprehensive diagnostic work-up including right heart catheterisation at baseline and 24 weeks after their last intervention. BPA resulted in improvements in WHO functional class, 6 min walk distance (mean change, +33 m), right ventricular function and haemodynamics, including a decline in mean pulmonary artery pressure by 18% and in pulmonary vascular resistance by 26%. Procedure-related adverse events occurred in 9.4% of the interventions. The most common complications were related to pulmonary vascular injury and consecutive pulmonary bleeding. Most of these events were asymptomatic and self-limiting, but one patient died from pulmonary bleeding, resulting in a mortality rate of 1.8%. BPA resulted in haemodynamic and clinical improvements but was also associated with a considerable number of complications, including one fatal pulmonary bleeding. As the effects of BPA on survival are unknown, randomised controlled outcome trials comparing BPA with approved medical therapies in patients with inoperable CTEPH are required to allow for appropriate risk-benefit assessments.
AU  - Olsson, Karen M.
AU  - Wiedenroth, Christoph B.
AU  - Kamp, Jan Christopher
AU  - Breithecker, Andreas
AU  - Fuge, Jan
AU  - Krombach, Gabriele A.
AU  - Haas, Moritz
AU  - Hamm, Christian
AU  - Kramm, Thorsten
AU  - Guth, Stefan
AU  - Ghofrani, Hossein Ardeschir
AU  - Hinrichs, Jan B.
AU  - Cebotari, Serghei
AU  - Meyer, Katrin
AU  - Hoeper, Marius M.
AU  - Mayer, Eckhard
AU  - Liebetrau, Christoph
AU  - Meyer, Bernhard C.
DO  - 10.1183/13993003.02409-2016
IS  - 6
PY  - 2017
TI  - Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: The initial German experience
T2  - European Respiratory Journal
UR  - http://dx.doi.org/10.1183/13993003.02409-2016
VL  - 49
ER  -
TY  - JOUR
AB  - BACKGROUND: Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy. AIMS: The present study aimed to evaluate the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country. METHODS: Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a prospective, multicentre registry of adult and paediatric pulmonary arterial hypertension (PAH) and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1,056 BPA procedures at eight institutions in Poland. RESULTS: In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR: 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (p<0.001) and pulmonary vascular resistance from 642±341 to 324±183 dynes (p<0.001), and the six-minute walking test (6MWT) improved from 341±129 to 423±136 m (p<0.001). Pulmonary injury related to the BPA procedure occurred in 6.4% of all sessions. Eighteen patients (7.6%) died during follow-up, including 4 (1.7%) who died within 30 days after BPA. Overall survival was 92.4% (95% confidence interval [CI]: 87.6%-94.9%) three years after the initial BPA procedure. CONCLUSIONS: This multicentre registry confirmed significant improvement of haemodynamic, functional, and biochemical parameters after BPA. Complication rates were low and overall survival comparable to the results of another registry. Therefore, BPA may be an important therapeutic option in patients with CTEPH in Poland.
AU  - Darocha, Szymon
AU  - Roik, Marek
AU  - Kopeć, Grzegorz
AU  - Araszkiewicz, Aleksander
AU  - Furdal, Michał
AU  - Lewandowski, Maciej
AU  - Jacheć, Wojciech
AU  - Grabka, Marek
AU  - Banaszkiewicz, Marta
AU  - Piertrasik, Arkadiusz
AU  - Pietura, Radosław
AU  - Stępniewski, Jakub
AU  - Waligóra, Marcin
AU  - Magoń, Wojciech
AU  - Jonas, Kamil
AU  - Łabyk, Andrzej
AU  - Potępa, Michał
AU  - Fudryna, Aleksandra
AU  - Jankiewicz, Stanislaw
AU  - Sławek-Szmyt, Sylwia
AU  - Mularek-Kubzdela, Tatiana
AU  - Lesiak, Maciej
AU  - Mroczek, Ewa
AU  - Orłowska, Joanna
AU  - Peregud-Pogorzelska, Małgorzata
AU  - Tomasik, Andrzej
AU  - Mizia-Stec, Katarzyna
AU  - Przybylski, Roman
AU  - Podolec, Piotr
AU  - Zieliński, Dariusz
AU  - Biederman, Andrzej
AU  - Torbicki, Adam
AU  - Pruszczyk, Piotr
AU  - Kurzyna, Marcin
DO  - 10.4244/EIJ-D-21-00230
PY  - 2021
TI  - Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: A Multicenter Registry.
T2  - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
ER  -
TY  - JOUR
AB  - Purpose: Right ventricular (RV) function is an important factor in the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH) in patients. In our study, we aimed to evaluate the timing and magnitude of regional RV function before and after balloon pulmonary angioplasty (BPA) using speckle tracking echocardiography (STE) and their relation to clinical and hemodynamic parameters in patients with CTEPH. Material and Method: We enrolled 20 CTEPH patients and 19 healthy subjects in our study. Enrolled patients underwent echocardiography, right heart catheterization (RHC), and 6-minute walk distance (6MWD) test at baseline and after the BPA. Results: In hemodynamic RHC measurements and clinical evaluations, mean pulmonary artery pressure (median: 53.5 mm Hg vs 37.0 mm Hg, P =.001) and pulmonary vascular resistance (median: 12 Wood units [WU] vs 7 WU, P =.001) and pro-brain natriuretic peptide level decreased and 6MWD increased after BPA sessions. There was no statistically significant difference between before and after the BPA sessions in conventional echocardiographic measurements. In STE analysis, the electromechanical delay (EMD) between RV free wall (RVF) and LV lateral wall (LVL) (median: 65 ms vs 47.5 ms, P =.01) and RV peak systolic strain dispersion index (52 ms vs 29 ms, P =.001) were higher in patients with CTEPH than healthy controls before the BPA. Both these parameters decreased significantly after BPA. Conclusion: Chronic thromboembolic pulmonary hypertension was associated with RV electromechanical delay and dispersion based on the STE analysis. Balloon pulmonary angioplasty might have an important impact on the improvement of both RV function and hemodynamics.
AU  - Kanar, Batur Gonenc
AU  - Mutlu, Bülent
AU  - Atas, Halil
AU  - Akaslan, Dursun
AU  - Yıldızeli, Bedrettin
DA  - 2019/11//
DO  - 10.1111/echo.14503
IS  - 11
KW  - balloon pulmonary angioplasty
KW  - chronic thromboembolic pulmonary hypertension
KW  - echocardiography
KW  - electromechanical delay
KW  - strain
PB  - Blackwell Publishing Inc.
PY  - 2019
SP  - 2050
EP  - 2056
TI  - Improvements of right ventricular function and hemodynamics after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension
T2  - Echocardiography
VL  - 36
ER  -
TY  - JOUR
AB  - Objective: To examine the interpretation of the verbal anchors used in the Borg rating of perceived exertion (RPE) scales in different clinical groups and a healthy control group. Design: Prospective experimental study. Setting: Rehabilitation center. Participants: Nineteen subjects with brain injury, 16 with chronic low back pain (CLBP), and 20 healthy controls. Interventions: Not applicable. Main Outcome Measures: Subjects used a visual analog scale (VAS) to rate their interpretation of the verbal anchors from the Borg RPE 6-20 and the newer 10-point category ratio scale. Results: All groups placed the verbal anchors in the order that they occur on the scales. There were significant within-group differences (P>.05) between VAS scores for 4 verbal anchors in the control group, 8 in the CLBP group, and 2 in the brain injury group. There was no significant difference in rating of each verbal anchor between the groups (P>.05). Conclusions: All subjects rated the verbal anchors in the order they occur on the scales, but there was less agreement in rating of each verbal anchor among subjects in the brain injury group. Clinicians should consider the possibility of small discrepancies in the meaning of the verbal anchors to subjects, particularly those recovering from brain injury, when they evaluate exercise perceptions. © 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.
AU  - Dawes, Helen N.
AU  - Barker, Karen L.
AU  - Cockburn, Janet
AU  - Roach, Neil
AU  - Scott, Oona
AU  - Wade, Derick
DA  - 2005/5//
DO  - 10.1016/j.apmr.2004.10.043
IS  - 5
KW  - Exercise
KW  - Exertion
KW  - Perception
KW  - Rehabilitation
KW  - Semantics
PY  - 2005
SP  - 912
EP  - 916
TI  - Borg's rating of perceived exertion scales: Do the verbal anchors mean the same for different clinical groups?
T2  - Archives of Physical Medicine and Rehabilitation
VL  - 86
ER  -
TY  - JOUR
AB  - Background-Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. Methods and Results-A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent followup right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. Conclusions-This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
AU  - Ogawa, Aiko
AU  - Satoh, Toru
AU  - Fukuda, Tetsuya
AU  - Sugimura, Koichiro
AU  - Fukumoto, Yoshihiro
AU  - Emoto, Noriaki
AU  - Yamada, Norikazu
AU  - Yao, Atsushi
AU  - Ando, Motomi
AU  - Ogino, Hitoshi
AU  - Tanabe, Nobuhiro
AU  - Tsujino, Ichizo
AU  - Hanaoka, Masayuki
AU  - Minatoya, Kenji
AU  - Ito, Hiroshi
AU  - Matsubara, Hiromi
DO  - 10.1161/CIRCOUTCOMES.117.004029
IS  - 11
KW  - Angioplasty
KW  - Hypertension
KW  - Lung injury
KW  - Pulmonary
KW  - Survival
PY  - 2017
SP  - 1
EP  - 7
TI  - Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension results of a multicenter registry
T2  - Circulation: Cardiovascular Quality and Outcomes
VL  - 10
ER  -