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Background <p>The effect of balloon pulmonary angioplasty (BPA) on hemodynamics in chronic thromboembolic pulmonary hypertension (CTEPH), assessed using time-resolved three-dimensional cine phase-contrast cardiac magnetic resonance (4D flow CMR), remains unclear. Therefore, the present study aimed to investigate the hemodynamic features of the pulmonary artery (PA) before and after BPA and the diagnostic performance of 4D flow CMR-derived hemodynamics before BPA to predict the achievement of mean pulmonary artery pressure (mPAP) &lt; 30 mmHg after BPA.</p> Methods <p>Twenty-one patients with CTEPH who underwent 4D flow CMR before and after BPA were retrospectively enrolled. Regarding 4D flow CMR, the analysis included peak flow volume and velocity at the main PA and peak systolic wall shear stress (WSS).</p> Results <p>Seventeen patients achieved a mPAP &lt; 30 mmHg after BPA. Peak flow velocity at the main PA (262.8 ± 52.3&#xa0;mm/s vs. 298.5 ± 68.3&#xa0;mm/s, <i>p</i> = 0.015) and peak WSS (0.97 ± 0.26&#xa0;Pa vs. 1.13 ± 0.37&#xa0;Pa, <i>p</i> = 0.044) both increased after BPA compared to their values before BPA. Receiver operating characteristic analysis was performed to predict mPAP ≥ 30 mmHg after BPA based on peak flow velocity and peak WSS before BPA. The analysis revealed an area under the curve of 0.926 (<i>p</i> &lt; 0.001) for peak flow velocity before BPA (sensitivity, 0.765; specificity, 0.750; cut-off, &lt; 251&#xa0;mm/s) and 0.971 (<i>p</i> &lt; 0.001) for peak WSS before BPA (sensitivity, 0.882; specificity, 1.00; cut-off, &lt; 0.89&#xa0;Pa).</p> Conclusions <p>Based on the study results, 4D flow CMR imaging showed improvement in hemodynamics after BPA. Furthermore, peak flow velocity and peak WSS were useful metrics for predicting the achievement of catheter-based BPA goal of mPAP &lt; 30 mmHg with a better prognosis.</p>

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Hemodynamics assessment using 4D flow CMR before and after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a retrospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月21日

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  • Kazuto Ohno,
  • Kenichiro Suwa,
  • Keitaro Akita,
  • Ryota Sato,
  • Terumori Satoh,
  • Yuichiro Maekawa

摘要

Background

The effect of balloon pulmonary angioplasty (BPA) on hemodynamics in chronic thromboembolic pulmonary hypertension (CTEPH), assessed using time-resolved three-dimensional cine phase-contrast cardiac magnetic resonance (4D flow CMR), remains unclear. Therefore, the present study aimed to investigate the hemodynamic features of the pulmonary artery (PA) before and after BPA and the diagnostic performance of 4D flow CMR-derived hemodynamics before BPA to predict the achievement of mean pulmonary artery pressure (mPAP) < 30 mmHg after BPA.

Methods

Twenty-one patients with CTEPH who underwent 4D flow CMR before and after BPA were retrospectively enrolled. Regarding 4D flow CMR, the analysis included peak flow volume and velocity at the main PA and peak systolic wall shear stress (WSS).

Results

Seventeen patients achieved a mPAP < 30 mmHg after BPA. Peak flow velocity at the main PA (262.8 ± 52.3 mm/s vs. 298.5 ± 68.3 mm/s, p = 0.015) and peak WSS (0.97 ± 0.26 Pa vs. 1.13 ± 0.37 Pa, p = 0.044) both increased after BPA compared to their values before BPA. Receiver operating characteristic analysis was performed to predict mPAP ≥ 30 mmHg after BPA based on peak flow velocity and peak WSS before BPA. The analysis revealed an area under the curve of 0.926 (p < 0.001) for peak flow velocity before BPA (sensitivity, 0.765; specificity, 0.750; cut-off, < 251 mm/s) and 0.971 (p < 0.001) for peak WSS before BPA (sensitivity, 0.882; specificity, 1.00; cut-off, < 0.89 Pa).

Conclusions

Based on the study results, 4D flow CMR imaging showed improvement in hemodynamics after BPA. Furthermore, peak flow velocity and peak WSS were useful metrics for predicting the achievement of catheter-based BPA goal of mPAP < 30 mmHg with a better prognosis.