Heart-Rate Recovery at 1 Min After Exercise Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension

Frontiers in Cardiovascular Medicine

article

Yi Zhang¹  Xin Li¹  Qin Luo¹  Qing Zhao¹  Qixian Zeng¹  Tao Yang¹  Qi Jin¹  Lu Yan¹  Anqi Duan¹  Xiuping Ma¹  Chenhong An¹  Changming Xiong¹  Zhihui Zhao¹  Zhihong Liu¹ 

[1] Center for Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College;Department of Cardiology, Zhongshan Hospital, Fudan University

关键词: chronic thromboembolic pulmonary hypertension;    balloon pulmonary angioplasty;    heart-rate recovery at 1 min;    cardiac autonomic function;    prognosis;   

DOI  :  10.3389/fcvm.2022.795420

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Dysfunction of autonomic nervous system plays an important role in the development of pulmonary hypertension. The present study aimed to investigate the interaction between balloon pulmonary angioplasty (BPA) and cardiac autonomic function by using heart-rate recovery at 1 min (HRR1) after exercise as a surrogate marker. Methods and Results We retrospectively enrolled 89 consecutive patients with inoperable chronic thromboembolic pulmonary hypertension who underwent BPA from May, 2018 to Jan, 2021. According to hemodynamics at follow-up, patients were categorized as BPA responders if they met one or both of the following criteria: (1) mean pulmonary arterial pressure ≤ 30 mmHg and (2) a reduction of pulmonary vascular resistance ≥ 30%. Compared with baseline, HRR1 tended to increase within 7 days after the first BPA session, and this improvement persisted at follow-up. HRR1 at baseline and at follow-up were associated with well-validated markers of CTEPH severity, including N-terminal pro-brain natriuretic peptide, mean pulmonary arterial pressure and pulmonary vascular resistance. Furthermore, the change of HRR1 from baseline to follow-up was also associated with the change of those variables. After adjustment for confounders, baseline HRR1 was still a strong independent predictor of BPA outcome. Receiver operator characteristic curve analysis showed that the cutoff value for HRR1 in predicting BPA outcome was 19 beats. Conclusions BPA could significantly improve HRR1, suggesting the alleviation of sympathovagal imbalance. Easily available and non-invasive HRR1 seems to be a useful tool in predicting outcome of BPA and dynamically monitoring the efficacy of BPA.

【 授权许可】

CC BY