BMC Pulmonary Medicine (Dec 2021)

Vascular involvement in chronic thromboembolic pulmonary hypertension is associated with spirometry obstructive impairment

  • Asako Yanagisawa,
  • Akira Naito,
  • Takayuki Jujo-Sanada,
  • Nobuhiro Tanabe,
  • Keiichi Ishida,
  • Goro Matsumiya,
  • Rika Suda,
  • Hajime Kasai,
  • Ayumi Sekine,
  • Toshihiko Sugiura,
  • Ayako Shigeta,
  • Seiichiro Sakao,
  • Koichiro Tatsumi,
  • Takuji Suzuki

DOI
https://doi.org/10.1186/s12890-021-01779-x
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 9

Abstract

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Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension caused by persistent thromboembolism of the pulmonary arteries. In clinical practice, CTEPH patients often show obstructive ventilatory impairment, even in the absence of a smoking history. Recent reports imply a tendency for CTEPH patients to have a lower FEV1.0; however, the mechanism underlying obstructive impairment remains unknown. Methods We retrospectively analyzed CTEPH patients who underwent a pulmonary function test and respiratory impedance test to evaluate their exertional dyspnea during admission for right heart catheterization from January 2000 to December 2019. We excluded patients with a smoking history to rule out the effect of smoking on obstructive impairment. Results A total of 135 CTEPH patients were analyzed. The median FEV1.0/FVC was 76.0%, %FEV 1.0 had a negative correlation with the mean pulmonary artery pressure and pulmonary vascular resistance and the CT Angiogram (CTA) obstruction score. A multivariate regression analysis revealed that the CTA obstruction score was an independent factor of a lower %FEV1.0. In the 54 patients who underwent pulmonary endarterectomy, %FEV1.0 was improved in some cases and was not in some. Mean PAP largely decreased after PEA in the better %FEV1.0 improved cases, suggesting that vascular involvement in CTEPH could be associated with spirometry obstructive impairment. Conclusion %FEV1.0 had a significant correlation with the CTA obstruction score. Obstructive impairment might have an etiological relationship with vascular involvement. Further investigations could shed new light on the etiology of CTEPH.

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