Impact of disease location and laterality on hemodynamic response following pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension
Bryan O. Pérez Martínez, MD,
Gabriella V. Rubick, MD,
Avi Toiv, MD,
Sidney Perkins, MD,
Jorge Vinales,
Victor M. Moles, MD,
Vallerie V. McLaughlin, MD,
Thomas M. Cascino, MD MSc,
Bryan Kelly, DO,
Gillian Grafton, DO,
Rana Awdish, MD,
Jonathan W. Haft, MD,
Vikas Aggarwal, MD MPH
Affiliations
Bryan O. Pérez Martínez, MD
Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Division of Cardiology, Department of Internal Medicine, University of Connecticut Health, Farmington, CT
Gabriella V. Rubick, MD
Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Avi Toiv, MD
Department of Internal Medicine, Henry Ford Health System, Detroit, MI
Sidney Perkins, MD
Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Jorge Vinales
University of Michigan Medical School, Ann Arbor, MI
Victor M. Moles, MD
Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Vallerie V. McLaughlin, MD
Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Thomas M. Cascino, MD MSc
Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Bryan Kelly, DO
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Health System, Detroit, MI; Department of Osteopathic Medical Specialties, MIchigan State University College of Osteopathic Medicine, East Lansing, MI
Gillian Grafton, DO
Division of Cardiology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
Rana Awdish, MD
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Health System, Detroit, MI; Michigan State College of Human Medicine, Lansing, MI
Jonathan W. Haft, MD
Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
Vikas Aggarwal, MD MPH
Division of Cardiology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI; Corresponding author: Vikas Aggarwal, MD, MPH, K2 Cardiac Cath Administrative Suite, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202. Telephone: (313)353-9538.
Background: In patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary thromboendarterectomy (PTE), obstructive disease burden predicts positive hemodynamic responsiveness. However, the effect of disease location (upper, middle, or lower lobes) and lung laterality (right or left) has not been studied. Objectives: Examine the effect of obstructive disease location and laterality on hemodynamic response following PTE. Methods: This analysis is a retrospective cohort study of 56 consecutive patients diagnosed with CTEPH who underwent PTE at the University of Michigan Hospital between August 2019 and July 2022. Disease burden, location, and laterality were assessed on invasive pulmonary angiography (IPA), and lobar segments were assigned a score based on these features and correlated with an absolute change in pulmonary vascular resistance (PVR) following PTE. The relationship between disease burden and hemodynamic responsiveness was modeled using linear regressions with R2 reported as a measure of correlation. Results: Most patients were World Health Organization (WHO) class III or IV (n = 47; 83.9%) and had a history of acute pulmonary embolism (n = 51; 91.1%). A modest correlation between patients’ overall disease burden and absolute change in PVR was noted, with the strongest contributions from the right lower lobe (RLL), right middle lobe (RML), and left lower lobe (LLL) (R2 = 0.16, 0.10, and 0.03, respectively). Conclusion: Disease location in the RLL, RML, and LLL may predict hemodynamic improvement in patients with CTEPH undergoing PTE.
