Loading ...

TOPLINE:

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) pretreated with dual therapy for PH before balloon pulmonary angioplasty (BPA) had fewer thoracic complications and greater improvements in clinical and hemodynamic measures after BPA than those pretreated with PH-targeted monotherapy.

METHODOLOGY:

• Researchers conducted a retrospective study to compare the effects of PH-targeted monotherapy and dual therapy before BPA on complication rates and clinical outcomes in patients with CTEPH.
• They included 169 patients with CTEPH (mean age, 66 years; 53% women) treated at two expert centers in Netherlands between June 2015 and April 2024, using data from the Dutch BPA registry.
• Before the first BPA session, 93 patients received PH-targeted monotherapy (commonly riociguat, an endothelin receptor antagonist [ERA], or a phosphodiesterase-5 inhibitor) and 76 received dual therapy (an ERA plus either of the other two drugs used in monotherapy).
• Thoracic and nonthoracic periprocedural complications were recorded. Clinical parameters, including World Health Organization functional class, 6-minute walking distance, and logarithmic N-terminal-prohormone brain natriuretic peptide (log NT-proBNP) levels, as well as pulmonary hemodynamic parameters were also evaluated.
• Patients underwent a mean of 4.9 BPA sessions and had clinical and hemodynamic outcomes assessed approximately 6 months after their final procedure. Periprocedural complication was defined as a complication that occurred within 24 hours of the procedure or led to hospital readmission within 1 week.

TAKEAWAY:

• On a per-BPA session basis, patients pretreated with dual therapy experienced fewer thoracic complications than those pretreated with monotherapy (8.4% vs 19.6%; P < .001).
• Monotherapy was independently associated with 3.33-fold higher odds of thoracic complications than dual PH-targeted therapy in an adjusted analysis (P = .005). Higher levels of log NT-proBNP and higher right atrial pressure were also independent predictors of thoracic complications (P = .01 for both).
• At the time of the first BPA, patients pretreated with monotherapy had higher pulmonary vascular resistance (PVR) than those pretreated with dual therapy (PVR; 5.8 vs 3.7 Wood units [WU]) and had a lower cardiac index (2.6 L/min/m² vs 3.1 L/min/m²; P < .01 for both).
• At the 6-month follow-up assessment, patients pretreated with dual therapy vs monotherapy demonstrated greater improvement in the 6-minute walking distance (+86 m vs +30 m), the cardiac index (+1.2 L/min/m² vs +0.4 L/min/m²), and PVR (-6.1 WU vs -4.0 WU; P < .05 for all).

IN PRACTICE:

“[The study] outcomes suggest that pretreatment with dual PH-targeted medical therapy may be more effective in lowering the patient’s clinical and hemodynamic parameters in comparison to monotherapy before initiating BPA treatment,” the researchers of the study wrote.

SOURCE:

The study was led by D.P. Staal, St. Antonius Hospital in Nieuwegein/Utrecht, Netherlands. It was published online on May 11, 2026, in Chest.

LIMITATIONS:

The study was retrospective and observational; thus, residual confounding from center-driven treatment choices may have existed. Neither center routinely performed chest CT after BPA, which may have underestimated lung injury. Local differences in protocols for PVR measurement may have affected the analyses.

DISCLOSURES:

The research received support from an unrestricted research grant provided by Janssen-Cilag B.V. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.