PULMONARY VENTILATION AND GAS EXCHANGE EFFICIENCY IN RISK ASSESSMENT FOR CHRONIC POSTTHROMBOEMBOLIC PULMONARY HYPERTENSION

Aim. To evaluate prognostic significance of diffusion capacity of the lungs and efficacy of pulmonary gas exchange in risk assessment of perioperational and early postoperational complications in patients with chronic post-thromboembolic pulmonary hypertension (CPH).

Material and methods. Totally, 131 patient included, with CPH, who had undergone thrombo-endarterectomy from the branches of pulmonary artery. Before the surgery, together with standard investigation, the following methods were applied: body pletismography, lung diffusion capacity assessment, ventilation efficiency assessment. The relation was analyzed, of the parameters of pulmonary functional tests with the results of surgical treatment of CPH patients.

Results. CPH patients present with a low level of pulmonary diffusion capacity and ventilation efficiency. Among the parameters of pulmonary functional tests, diffusion ability of the lungs shows the highest prediction significance in surgical risk assessment for CPH treatment. The relation found, for diffusion ability of the lungs and risk of respiratory failure (ОR 0,94 (0,91-0,99), p=0,004), heart failure (ОR 0,93 (0,87-1,00), p=0,023), short term post-operaton mortality (ОR 0,95 (0,89-0,99), p=0,034) and long-term mortality (ОR 0,94 (0,79-0,99), p=0,030). Efficacy of pulmonary ventilation showed significant relation only with the development of respiratory failure (ОR 0,91 (0,82-1,00), p=0,038)

Conclusion. Decline of pulmonary diffusion ability to 45% and lower from expected level increases the risk of respiratory and heart failure development in early postoperation period, as the risk of in-hospital death and mortality throughout 1 year follow-up after thrombo-endarterectomy from the branches of pulmonary artery.

1. Jenkins DP, Madani M, Mayer E et al. Surgical treatment of chronic thromboembolic pulmonary hypertension. European Respiratory Journal. 2013; 41(3): 735-742. https://doi.org/10.1183/09031936.00058112

2. Delcroix M, Lang I, Pepke-Zaba J et al. Long-term outcome of patients with chronic thromboembolic pulmonary hypertension CLINICAL PERSPECTIVE. Circulation 2016; 133(9): 859-871. https://doi.org/10.1161/circulationaha.115.016522

3. Giuliani L, Piccinino C, D’Armini MA et al. Prevalence of undiagnosed chronic thromboembolic pulmonary hypertension after pulmonary embolism. Blood Coagulation & Fibrinolysis 2014; 25(7): 649–53. http://dx.doi.org/10.1097/mbc.0000000000000084

4. Gurevich MA. Pulmonary embolism: issues of clinical manifestation, diagnostics and therapy. Almanac of Clinical Medicine. 2015; 38: 90-94. Russian (Гуревич М. А. Тромбоэмболия легочной артерии (вопросы клиники, диагностики и терапии). Альманах клинической медицины 2015; 38: 90-94.)

5. Duplyakov D.V., Pavlova T.V., Mullova T.V. et al. Clinical presentation and patient management differences in confirmed and non-confirmed pulmonary thromboembolism. Russian Journal of Cardiology 2015; 3: 18-24. Russian (Дупляков Д. В., Павлова Т. В., Муллова И. С. И др. Различия в клинической картине и ведении пациентов с подтвержденной и неподтвержденной тромбоэмболией легочной артерии. Российский кардиологический журнал 2015; 3: 18-24.) http://dx.doi.org/10.15829/1560-4071-2015-3-18-24

6. Morsolini M, Nicolardi S, Milanesi E et al. Evolving surgical techniques for pulmonary endarterectomy according to the changing features of chronic thromboembolic pulmonary hypertension patients during 17-year single-center experience. The Journal of Thoracic and Cardiovascular Surgery 2012; 144(1): 100-107.

7. O’Boyle F, Mediratta N, Chalmers J et al. Long-term survival of patients with pulmonary disease undergoing coronary artery bypass surgery. European Journal of Cardio-Thoracic Surgery 2012; 43(4): 697-703.

8. Ponomarev DN, Kamenskaya OV, Klinkova AS et al. Influence of bronchial obstruction syndrome on perioperative characteristics in patients with aortocoronary bypass: intermediate results of prospective cohort study. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery 2015; 19(4): 72-78. Russian (Пономарев Д. Н., Каменская О. В., Клинкова А. С. и др. Влияние синдрома бронхиальной обструкции на периоперационные характеристики у пациентов при аортокоронарном шунтировании: промежуточные результаты проспективного когортного исследования. Патология кровообращения и кардиохирургия 2015; 19(4): 72-78.)

9. Miller MR, Crapo R, Hankinson J et al. General considerations for lung function testing. Eur Respir J. 2005; 26: 153-161. https://doi.org/10.1183/09031936.05.00034505

10. Pellegrino R, Viegi G, Brusasco V et al. Interpretative strategies for lung function tests. European Respiratory Journal. 2005; 26(5): 948-968. https://doi.org/10.1183/09031936.05.00035205

11. Bazdyrev ED, Polikutina OM, Kalichenko NA et al. Complex assessment of the respiratory status of patients with coronary heart disease before the scheduled coronary bypass surgery. Pul'monologiya 2015; 25(6): 704-712. Russian (Баздырев Е. Д., Поликутина О. М., Каличенко Н. А. и др. Комплексная оценка респираторного статуса пациентов с ишемической болезнью сердца перед проведением планового коронарного шунтирования. Пульмонология 2015; 25(6): 704-712.)

12. Savushkina OI, Chernyak AV. Clinical application of the bodipletismography method. Atmosfera. Pul'monologiya i allergologiya 2013; 2: 38-41. Russian (Савушкина О. И., Черняк А. В. Клиническое применение метода бодиплетизмографии. Атмосфера. Пульмонология и аллергология 2013; 2: 38-41.)

13. Chapman HA. Epithelial-mesenchymal interactions in pulmonary fibrosis. Annual Review of Physiology 2011; 73(1): 413-435.

14. Hoeper MM, Meyer K, Rademacher J et al. Diffusion Capacity and Mortality in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction. JACC: Heart Failure 2016; 4(6): 441-449. https://doi.org/10.1016/j.jchf.2015.12.016

15. Neas LM, Schwartz J. Pulmonary Function Levels as Predictors of Mortality in a National Sample of US Adults. American Journal of Epidemiology 1998, 147(11): 1011-1018. http://dx.doi.org/10.1093/oxfordjournals.aje.a009394