Predictors of the development of residual pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension

Introduction. After pulmonary endarterectomy (PEA), a third of patients with chronic thromboembolic pulmonary hypertension (CTEPH) develop residual pulmonary hypertension (PH) in the postoperative period, which plays a decisive role in the formation of long-term mortality, but in modern clinical practice there are no tools for predicting its probability. Objective. of the study was to determine predictors of residual pulmonary hypertension after pulmonary endarterectomy. Methods. The retrospective cohort observational study included 353 patients aged 19 to 77 years with CTEPH who underwent PEA at the Federal State Budgetary Institution "National Medical Research Center named after Academician E.N. Meshalkin" from 2004 to 2019. The patients underwent clinical and instrumental examination before PEA, after PEA during the hospital period and in the late period (12 months) after PEA. An analysis of the obtained factors was carried out, non-modifiable and modifiable predictors of residual PH were determined. Results. According to the regression analysis, independent non-modifiable predictors of residual PH after PEA were identified: history of cancer; blood group AB (IV); reperfusion syndrome after PEA; pulmonary vascular resistance >1000 dyn×s×cm–5 according to pulmonary circulation tensiometry data before PEA; the ratio of the systolic excursion of the tricuspid valve annulus to the systolic pressure in the pulmonary artery -0,154 mm/mmHg before and after PEA and systolic pressure in the right ventricle >50 mmHg after PEA, measured by transthoracic echocardiography during the hospital period; thrombus calcification in the biopsy material of thrombotic masses. In addition, modifiable predictors were identified - delay in diagnosis and treatment of 6 months or more; obesity; smoking; anemia; irregular warfarin intake; failure to achieve target INR values; thrombosis of veins of any localization after LEE in dynamics. Conclusion. For the first time in Russia, modifiable and non-modifiable predictors of residual PH after PEA in patients with CTEPH were identified. An optimization algorithm for early diagnosis and treatment of CTEPH was proposed.