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Heart and Vessels

, Volume 34, Issue 4, pp 688–697 | Cite as

Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

  • Sarasa Isobe
  • Yuji ItabashiEmail author
  • Takashi Kawakami
  • Masaharu Kataoka
  • Shun Kohsaka
  • Toshimitsu Tsugu
  • Mai Kimura
  • Mitsuaki Sawano
  • Toshiomi Katsuki
  • Takashi Kohno
  • Jin Endo
  • Mitsushige Murata
  • Keiichi Fukuda
Original Article

Abstract

Balloon pulmonary angioplasty (BPA) has emerged as an effective treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Renal function has been identified as a prognostic marker in patients with pulmonary hypertension in previous studies. We, therefore, aimed to investigate the clinical parameters associated with improvements in renal function in patients with CTEPH. A total of 45 consecutive patients with inoperable CTEPH undergoing BPA (mean age 62.2 ± 15.1 years) were included in the study. We evaluated the patients’ clinical characteristics at baseline and at 1-year post-BPA, and investigated the association between renal function and hemodynamic parameters, including right heart function. Hemodynamics and renal function showed sustained improvements at 1 year after BPA in 64.4% of patients. Improved estimated glomerular filtration rate (eGFR) was significantly correlated with increased cardiac index (r = 0.433, p = 0.003) and mixed venous oxygen saturation (SvO2; r = 0.459, p = 0.002), and with decreased mean pulmonary arterial pressure (r = − 0.420, p = 0.004) and pulmonary vascular resistance (r = -− 0.465, p = 0.001). Multivariate analysis revealed that an increase in SvO2 immediately after the final BPA was associated with improved eGFR after the 1st year (odds ratio 1.041; 95% confidence interval 1.004–1.078; P = 0.027). The cut-off value for predicting improved eGFR was an increase in SvO2 after the final BPA of >125.4% over the baseline value (specificity 100%, sensitivity 24.1%). In conclusion, BPA improved symptoms, right heart function, hemodynamics, and renal function up to the chronic phase. Increasing SvO2 by >125.4% above baseline in the acute phase is important for improving renal function at 1 year after BPA in CTEPH patients.

Keywords

Balloon pulmonary angioplasty Chronic thromboembolic pulmonary hypertension Renal function Mixed venous oxygen saturation Cardiac index 

Notes

Acknowledgements

We thank Jane Charbonneau, DVM, and Susan Furness, PhD, from Edanz Group (https://www.edanzediting.com/ac) for editing drafts of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Sarasa Isobe
    • 1
  • Yuji Itabashi
    • 1
    Email author
  • Takashi Kawakami
    • 1
  • Masaharu Kataoka
    • 1
  • Shun Kohsaka
    • 1
  • Toshimitsu Tsugu
    • 1
  • Mai Kimura
    • 1
  • Mitsuaki Sawano
    • 1
  • Toshiomi Katsuki
    • 1
  • Takashi Kohno
    • 1
  • Jin Endo
    • 1
  • Mitsushige Murata
    • 2
  • Keiichi Fukuda
    • 1
  1. 1.Department of CardiologyKeio University School of MedicineTokyoJapan
  2. 2.Department of Laboratory MedicineKeio University School of MedicineTokyoJapan

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