{
  "abstract": "Background Balloon pulmonary angioplasty (BPA) improves haemodynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies on BPA have set the treatment objective to achieve a mean pulmonary arterial pressure (mPAP) of <30 mm Hg. However, the clinical impact of mPAP after BPA remains unclear. This study aimed to stratify patients according to their mPAP after BPA and evaluate its association with clinical status and long-term outcomes.Methods We retrospectively reviewed 304 patients with inoperable CTEPH (median age, 72 (61 to 79) years) who underwent BPA and follow-up right heart catheterisation. Patients were categorised by mPAP after BPA: ≤20, >20–<30 and ≥30 mm Hg groups.Results The WHO functional classification, 6 min walk distance and right ventricular ejection fraction were significantly better in the group with a lower mPAP (trend test p=0.007, p<0.001 and p=0.002, respectively). Additionally, the proportions of patients who required pulmonary vasodilators or oxygen therapy were significantly lower in the group with a lower mPAP (trend test p<0.001 and p<0.001, respectively). Across all multivariable models, the mPAP ≥30 mm Hg group had a significantly poorer prognosis compared with the mPAP ≤20 mm Hg group. In contrast, no significant difference was observed between the mPAP ≤20 mm Hg and >20–<30 mm Hg groups.Conclusions In patients with CTEPH after BPA, an mPAP of <30 mm Hg was associated with a favourable prognosis, and patients with an mPAP of ≤20 mm Hg presented with better symptoms, exercise capacity, right ventricular function and more withdrawal from oxygen therapy and pulmonary vasodilators. The BPA treatment goal may require individual adaptation.",
  "authors": [
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan",
        "Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"
      ],
      "name": "Ryo Takano"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Tatsuo Aoki"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan",
        "Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"
      ],
      "name": "Shinya Fujisaki"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Mitsumasa Akao"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan",
        "Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"
      ],
      "name": "Hiroyuki Endo"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Naruhiro Nishi"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Hiroya Hayashi"
    },
    {
      "affiliations": [
        "Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Akiyuki Kotoku"
    },
    {
      "affiliations": [
        "Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Hiroki Horinouchi"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Takatoyo Kiko"
    },
    {
      "affiliations": [
        "Department of Vascular Physiology, National Cerebral and Cardiovascular Center, Suita, Japan"
      ],
      "name": "Ryotaro Asano"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Jin Ueda"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Akihiro Tsuji"
    },
    {
      "affiliations": [
        "Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan"
      ],
      "name": "Kenichi Tsujita"
    },
    {
      "affiliations": [
        "Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan",
        "Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Teruo Noguchi"
    },
    {
      "affiliations": [
        "Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Tetsuya Fukuda"
    },
    {
      "affiliations": [
        "Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Takeshi Ogo"
    }
  ],
  "title": "Clinical impact of mean pulmonary arterial pressure after balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension",
  "uid": "ff14ce5b-fd3d-5368-8fc1-f301108b4ce3"
}