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Impact of Discontinuation of Pulmonary Hypertension-Targeted Drugs in Chronic Thromboembolic Pulmonary Hypertension Patients After Balloon Pulmonary Angioplasty
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A6341 - Impact of Discontinuation of Pulmonary Hypertension-Targeted Drugs in Chronic Thromboembolic Pulmonary Hypertension Patients After Balloon Pulmonary Angioplasty
Author Block: Y. Shintani1, J. Ueda1, T. Ogo2; 1National Cerebral and Cardiovascular Center, Osaka, Japan, 2National Cerebral and Cardiovascular Center, Suita, Japan.
Background: Pulmonary hypertension (PH)-targeted drugs is a therapeutic options for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) beside balloon pulmonary angioplasty (BPA). It remains uncertain whether PH-targeted drugs should be continued after the amelioration of hemodynamics by BPA. Objectives: The purpose of the present study was to investigate the influence of discontinuation of PH-targeted drugs in CTEPH patients who had achieved near-normal value of mean pulmonary arterial pressure (mPAP) by BPA. Methods: We retrospectively analyzed consecutive 36 consecutive CTEPH patients who were treated with combination of BPA and PH-targeted drugs and whose mPAP was 24 mmHg or less in three month after BPA. Total of 12 patients (33%) discontinued PH-targeted drugs three months after the BPA (Discontinuation Group: n=12), and the remaining twenty-four patients were continued (Continuation Group: n=24). We compared the changes of hemodynamic parameters, World Health Organization functional class (WHO-FC), plasma brain natriuretic peptide (BNP) levels, right ventricular (RV) function estimated by cardiovascular magnetic resonance and exercise tolerability estimated by 6-minute walk test and cardiopulmonary exercise testing between three month and one year after BPA in both groups. Results: There was no difference in baseline characteristics and hemodynamics between both groups. Patients in discontinuation group showed equivalent value of hemodynamics such as mPAP (19.8 mmHg vs. 21.2 mmHg, P=0.29), PVR (313mmHg vs. 336mmHg, P=0.65), RA (2.3 mmHg vs.1.7 mmHg, P=0.14), and CI (2.7 mmHg vs.2.5 mmHg, P=0.39) at one year after BPA compared with Continuation Group. There was no significant difference in WHO-FC, plasma BNP levels, RV volume, RV ejection fraction and the parameters of exercise tolerability from 3-month to 1-year after BPA in both groups. No patients experienced adverse events after discontinuation of PH-targeted drugs. Conclusions: Discontinuation of PH-targeted drugs after the achievement of near-normal value of mPAP by BPA showed no adverse effect on hemodynamics in CTEPH patients. PH-targeted drugs can be withdrawn safely in CTEPH patients improved by the BPA.
Author Block: Y. Shintani1, J. Ueda1, T. Ogo2; 1National Cerebral and Cardiovascular Center, Osaka, Japan, 2National Cerebral and Cardiovascular Center, Suita, Japan.
Background: Pulmonary hypertension (PH)-targeted drugs is a therapeutic options for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) beside balloon pulmonary angioplasty (BPA). It remains uncertain whether PH-targeted drugs should be continued after the amelioration of hemodynamics by BPA. Objectives: The purpose of the present study was to investigate the influence of discontinuation of PH-targeted drugs in CTEPH patients who had achieved near-normal value of mean pulmonary arterial pressure (mPAP) by BPA. Methods: We retrospectively analyzed consecutive 36 consecutive CTEPH patients who were treated with combination of BPA and PH-targeted drugs and whose mPAP was 24 mmHg or less in three month after BPA. Total of 12 patients (33%) discontinued PH-targeted drugs three months after the BPA (Discontinuation Group: n=12), and the remaining twenty-four patients were continued (Continuation Group: n=24). We compared the changes of hemodynamic parameters, World Health Organization functional class (WHO-FC), plasma brain natriuretic peptide (BNP) levels, right ventricular (RV) function estimated by cardiovascular magnetic resonance and exercise tolerability estimated by 6-minute walk test and cardiopulmonary exercise testing between three month and one year after BPA in both groups. Results: There was no difference in baseline characteristics and hemodynamics between both groups. Patients in discontinuation group showed equivalent value of hemodynamics such as mPAP (19.8 mmHg vs. 21.2 mmHg, P=0.29), PVR (313mmHg vs. 336mmHg, P=0.65), RA (2.3 mmHg vs.1.7 mmHg, P=0.14), and CI (2.7 mmHg vs.2.5 mmHg, P=0.39) at one year after BPA compared with Continuation Group. There was no significant difference in WHO-FC, plasma BNP levels, RV volume, RV ejection fraction and the parameters of exercise tolerability from 3-month to 1-year after BPA in both groups. No patients experienced adverse events after discontinuation of PH-targeted drugs. Conclusions: Discontinuation of PH-targeted drugs after the achievement of near-normal value of mPAP by BPA showed no adverse effect on hemodynamics in CTEPH patients. PH-targeted drugs can be withdrawn safely in CTEPH patients improved by the BPA.
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