Open AccessSequential treatment with riociguat and balloon pulmonary angioplasty for patients with inoperable chronic thromboembolic pulmonary hypertension
Author(s) -
Wiedenroth Christoph B.,
Ghofrani H. Ardeschir,
Adameit Miriam S.D.,
Breithecker Andreas,
Haas Moritz,
Kriechbaum Steffen,
Rieth Andreas,
Hamm Christian W.,
Mayer Eckhard,
Guth Stefan,
Liebetrau Christoph
Publication year - 2018
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1177/2045894018783996
Subject(s) - riociguat , medicine , hemodynamics , angioplasty , pulmonary hypertension , chronic thromboembolic pulmonary hypertension , cardiology , balloon
Riociguat is the treatment of choice for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). We addressed here whether additional balloon pulmonary angioplasty (BPA) provides further benefits. A prospective series of 36 consecutive patients with inoperable CTEPH were treated with riociguat at least three months before BPA. All patients underwent diagnostic workup at baseline, before BPA treatments, and six months after final intervention. The main outcome measures were pulmonary hemodynamic parameters and World Health Organization (WHO) functional class (FC). Significant improvements in pulmonary hemodynamics and physical capacity were observed for riociguat treatment, and subsequent BPA interventions yielded further benefits. With targeted medication, WHO FC improved by at least one class in 13 (36.1%) patients ( P = 0.01). Hemodynamic assessment showed significant improvements in mean pulmonary arterial pressure (mPAP) (49 ± 12 mmHg vs. 43 ± 12 mmHg; P = 0.003) and PVR (956 ± 501 dyn·s·cm –5 vs. 517 ± 279 dyn·s·cm –5 ; P = 0.0001). Treatment with a combination of targeted medication and BPA resulted in WHO FC improvement in 34 (94.4%) patients. Hemodynamic assessment showed significant improvement in mPAP (43 ± 12 mmHg vs. 34 ± 14 mmHg; P = 0.0001) and PVR (517 ± 279 dyn·s·cm –5 vs. 360 ± 175 dyn·s·cm –5 ; P = 0.0001). These findings provide, for the first time, support for the therapeutic strategy recommended by current guidelines.