{
  "abstract": "Introduction Patients with chronic thromboembolic pulmonary hypertension (CTEPH) may undergo balloon pulmonary angioplasty (BPA) if pulmonary endarterectomy is unsuitable. Medical therapies including phosphodiesterase-5 inhibitors (PDE5i), endothelin receptor antagonists (ERA) and riociguat are commonly used as bridging therapies to BPA, but data comparing these therapies are limited. We compared the impact of bridging therapies on serially measured haemodynamic and physiological parameters.Methods We conducted a secondary analysis of the prospective UK CURATE registry. Consecutive patients awaiting BPA at Royal Papworth Hospital between 1 October 2015 and 1 October 2024 were recruited. Baseline haemodynamic and physiological parameters at CTEPH diagnosis (first right heart catheter) and immediately prior to starting BPA therapy (second right heart catheter) were collected. Differences in parameters were assessed using Kruskal-Wallis to compare the impact of medical therapies used in the intervening period. Propensity score matching was performed to account for baseline differences.Results 158 patients (median age 66 and 54% male) with CTEPH taking bridging therapy before their 1st BPA were included. 42 received PDE5i monotherapy, 67 received PDE5i and ERA dual therapy, and 49 received riociguat monotherapy. Patients with more severe baseline haemodynamic data were preferentially treated with dual therapy. All bridging therapy approaches were associated with improved haemodynamic parameters including mean pulmonary arterial pressure (mPAP), cardiac output (CO) and pulmonary vascular resistance (PVR), and NT-proBNP. Dual therapy was associated with a greater increase in CO ( p=0.002), reduction in PVR (p<0.001) and reduction in NT-proBNP (p<0.001) versus monotherapies (figure 1). Comparison of percentage change, correcting for baseline differences, yielded similar results, with dual therapy associated with greater increase in CO (p<0.001), reduction in PVR (p<0.001) and reduction in NT-proBNP (p=0.004) versus monotherapies. Propensity score matching further supported these findings.Abstract S83 Figure 1Absolute change in haemodynamic parameters and NT-proBNP from diagnosis (baseline) to immediately before BPA for (A) mPAP; (B) CO; (C) PVR; (D) NT-proBNPConclusion Patients with CTEPH awaiting BPA had greater improvements in haemodynamic parameters and NT-proBNP with PDE5i and ERA dual bridging therapy versus monotherapies, with no differences between PDE5i and riociguat monotherapies. These differences persisted following correction for baseline differences. As improvements in haemodynamic parameters are associated with improved BPA safety profile, bridging with dual therapy may enhance BPA safety, although more work is needed to validate this hypothesis.",
  "authors": [
    {
      "affiliations": [
        "School of Clinical Medicine, University of Cambridge, Cambridge, UK"
      ],
      "name": "O Li"
    },
    {
      "affiliations": [
        "Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "H Ghani"
    },
    {
      "affiliations": [
        "Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "J Pepke-Zaba"
    },
    {
      "affiliations": [
        "Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "S Hoole"
    }
  ],
  "title": "S83 Comparing bridging therapies prior to balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension",
  "uid": "18a4073b-0cc1-5df4-b00c-5268dc2a5026"
}