Paradoxical rise in pulmonary pressures and BNP immediately after balloon pulmonary angioplasty for CTEPH

Abstract Purpose: Balloon Pulmonary Angioplasty (BPA) is a constantly improving technique option for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). To assess pulmonary artery pressures (PAP) and BNP changes immediately after Balloon Pulmonary Angioplasty (BPA) procedures.Methods: We implemented a rigorous protocol for measuring PAP just before, then immediately after, the BPA session and BNP before, then the following morning. In a sub-group of 16 procedures we also performed an endothelin-1 (ET-1) assay before and after each procedure.Results: out of 81 BPA (32 patients), sPAP before and after were 65 mmHg [59-74] versus 75 mmHg [64-80]: P=0.005; 38 mmHg [33-43] vs 43 mmHg [36-48] for mPAP: P <0.001, 23 mmHg [17-27] vs 24 mmHg [20-26] for dPAP: P=0.35. In all, PAP rose after 81% of the procedures. Likewise, BNP showed a significant increase the day after BPA: 127pg/mL [80-262] versus 116 pg/mL [58-215]: P <0.001. In all, BNP increased in 83% of the procedures. These modifications are not linked with a worst final BPA result. ET-1 decreased significantly: 1.5 pg /mL [1.39-3.64] vs 1.28 pg /mL [1.14-3.13]: P=0.021. Conclusion: PAP and BNP are very often transiently increased immediately after BPA. These paradoxical changes which may participate in common BPA procedure complications are not predictive of the long-term treatment benefits. Assessment of the BPA result should not be made within hours of a BPA session. The reason for the paradoxical increase in PAP and BNP is not established, but ET-1 secretion does not appear to be responsible.