Balloon pulmonary angioplasty (BPA) improves the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricle (RV) is an important predictor of prognosis in CTEPH patients. 2D-speckle tracking echocardiography (2D-STE) can evaluate RV function. This study aimed to evaluate the effectiveness of BPA in CTEPH patients and to assess the value of 2D-STE in predicting outcomes of BPA. A total of 76 patients with CTEPH underwent 354 BPA sessions from January 2017 to October 2022. Responders were defined as those with mean pulmonary artery pressure (mPAP) ≤ 30 mmHg or those showing ≥ 30% decrease in pulmonary vascular resistance (PVR) after the last BPA session, compared to baseline. Logistic regression analysis was performed to identify predictors of BPA efficacy. BPA resulted in a significant decrease in mPAP (from 50.8 ± 10.4 mmHg to 35.5 ± 11.9 mmHg, p < 0.001), PVR (from 888.7 ± 363.5 dyn·s·cm−5 to 545.5 ± 383.8 dyn·s·cm−5, p < 0.001), and eccentricity index (from 1.3 to 1.1, p < 0.001), and a significant increase in RV free wall longitudinal strain (RVFWLS: from 15.7% to 21.0%, p < 0.001). Significant improvement was also observed in the 6-min walking distance (from 385.5 m to 454.5 m, p < 0.001). After adjusting for confounders, multivariate analysis showed that RVFWLS was the only independent predictor of BPA efficacy. The optimal RVFWLS cutoff value for predicting BPA responders was 12%. BPA was found to reduce pulmonary artery pressure, reverse RV remodeling, and improve exercise capacity. RVFWLS obtained by 2D-STE was an independent predictor of BPA outcomes. Our study may provide a meaningful reference for interventional therapy of CTEPH.

中文翻译：

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慢性血栓栓塞性肺动脉高压右心室重构对球囊肺血管成形术结果的影响：二维斑点追踪超声心动图研究

球囊肺血管成形术（BPA）可改善慢性血栓栓塞性肺动脉高压（CTEPH）的预后。右心室（RV）是 CTEPH 患者预后的重要预测指标。 2D 斑点追踪超声心动图 (2D-STE) 可以评估 RV 功能。本研究旨在评估 BPA 对 CTEPH 患者的有效性，并评估 2D-STE 在预测 BPA 结局中的价值。从 2017 年 1 月到 2022 年 10 月，共有 76 名 CTEPH 患者接受了 354 次 BPA 治疗。缓解者被定义为平均肺动脉压 (mPAP) ≤ 30 mmHg 或治疗后肺血管阻力 (PVR) 降低 ≥ 30% 的患者。上次 BPA 会话与基线相比。进行逻辑回归分析以确定 BPA 功效的预测因子。 BPA 导致 mPAP（从 50.8 ± 10.4 mmHg 降至 35.5 ± 11.9 mmHg，p < 0.001）、PVR（从 888.7 ± 363.5 dyn·s·cm−5 降至 545.5 ± 383.8 dyn·s·cm−5， p < 0.001）和偏心指数（从 1.3 到 1.1，p < 0.001），以及 RV 游离壁纵向应变显着增加（RVFWLS：从 15.7% 到 21.0%，p < 0.001）。 6 分钟步行距离也有显着改善（从 385.5 m 到 454.5 m，p < 0.001）。调整混杂因素后，多变量分析表明 RVFWLS 是 BPA 疗效的唯一独立预测因子。预测 BPA 反应者的最佳 RVFWLS 截止值为 12%。 BPA被发现可以降低肺动脉压力，逆转右心室重塑，并提高运动能力。通过 2D-STE 获得的 RVFWLS 是 BPA 结果的独立预测因子。本研究可为CTEPH的介入治疗提供有意义的参考。