Central versus Peripheral CTEPH—Clinical and Hemodynamic Specifications
Monika Kaldararova,
Iveta Simkova,
Marcela Bohacekova,
Adriana Reptova,
Tereza Hlavata,
Jozef Pacak,
Jaroslav Lindner,
Pavel Jansa
Affiliations
Monika Kaldararova
Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia
Iveta Simkova
Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia
Marcela Bohacekova
Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia
Adriana Reptova
Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia
Tereza Hlavata
Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia
Jozef Pacak
Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia
Jaroslav Lindner
2nd Department of Surgery—Department of Cardiovascular Surgery, 1st Faculty of Medicine, General University Hospital, Charles University, U nemocnice 2, 128 02 Prague, Czech Republic
Pavel Jansa
Center for Pulmonary Hypertension, 1st Faculty of Medicine, General University Hospital, Charles University, U nemocnice 2, 128 02 Prague, Czech Republic
Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic progressive disease, resulting from persistent arterial obstruction combined with small-vessel remodeling. Central and peripheral CTEPH are distinguished, according to the dominant lesion’s location. This is important for surgical or percutaneous interventional assessment or for medical treatment. Material and Methods: Eighty-one patients (51 male/30 female) with confirmed CTEPH were analyzed, while the CENTRAL type included 51 patients (63%) and the PERIPHERAL type 30 patients (37%). Results: A significant difference in CENTRAL type vs. PERIPHERAL type was determined in gender (male 72.5% vs. 46.7%; p = 0.0198). No difference was found in age, functional status, or echocardiographic parameters. Invasive hemodynamic parameters showed a significant difference in mean pulmonary arterial pressure (46 vs. 58 mmHg; p = 0.0002), transpulmonary gradient (34 vs. 47 mmHg; p = 0.0005), and cardiac index (2.04 vs. 2.5 L.min.m2; p = 0.02) but not in pulmonary vascular resistance. Risk factors showed a significant difference only in acute pulmonary embolism (93.8% vs. 60%; p = 0.0002) and malignancy (2% vs. 13.3%; p = 0.0426). Conclusions: Our study showed hemodynamic differences between CENTRAL type vs. PERIPHERAL type CTEPH with a worse hemodynamic picture in CENTRAL form. This may indicate a different pathophysiological response and/or possible additional influences contributing especially to the peripheral pulmonary bed affection.
