PMID- 28291667
OWN - NLM
STAT- MEDLINE
DCOM- 20180716
LR  - 20181202
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 27
IP  - 1
DP  - 2018 Jan
TI  - Medical Therapy Versus Balloon Angioplasty for CTEPH: A Systematic Review and 
      Meta-Analysis.
PG  - 89-98
LID - S1443-9506(17)30081-1 [pii]
LID - 10.1016/j.hlc.2017.01.016 [doi]
AB  - BACKGROUND: A significant number of chronic thromboembolic pulmonary hypertension 
      (CTEPH) patients will have an inoperable disease. Medical therapy and balloon 
      pulmonary angioplasty (BPA) have provided alternate therapeutic options for 
      patients with inoperable CTEPH, although there are a limited number of published 
      studies examining the outcomes. Thus, our study aims to evaluate and compare the 
      efficacy of medical therapy and BPA in patients with inoperable CTEPH. METHODS: 
      An electronic search of six databases was performed and the search results were 
      screened against established criteria for inclusion into this study. Data was 
      extracted and meta-analytical techniques were used to analyse the data. RESULTS: 
      Pooled data from RCTs revealed that medical therapy, compared with a placebo, was 
      associated with a significant improvement of at least one functional class 
      (p=0.038). With regards to pulmonary haemodynamics, medical therapy also resulted 
      in a significant reduction in both mean pulmonary arterial pressure (mPAP) 
      (p=0.002) and pulmonary vascular resistance (PVR) (p<0.001). From the included 
      observational studies, the 6-minute walk distance (6MWD) significantly increased 
      following medical therapy by an average of 22.8% (p<0.001). The pooled 
      improvement in 6MWD was found to be significantly higher in the BPA group when 
      compared to medical therapy for CTEPH (p=0.001). Pooled data from available 
      observational studies of medical therapy or BPA all demonstrated significant 
      improvements in mPAP and PVR for pre versus post intervention comparisons. The 
      improvement in mPAP (p=0.002) and PVR (p=0.002) were significantly greater for 
      BPA intervention when compared to medical therapy. CONCLUSIONS: High-quality 
      evidence supports the use of targeted medical therapy in improving haemodynamics 
      in patients with inoperable CTEPH. There is only moderate-quality evidence from 
      observational studies supporting the efficacy of BPA in improving both 
      haemodynamics and exercise capacity. Further RCTs and prospective observational 
      studies comparing medical therapy and BPA in patients with inoperable CTEPH are 
      required.
CI  - Copyright (c) 2017 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      Published by Elsevier B.V. All rights reserved.
FAU - Phan, Kevin
AU  - Phan K
AD  - Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department 
      of Respiratory Medicine and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, 
      NSW, Australia. Electronic address: kphan.vc@gmail.com.
FAU - Jo, Helen E
AU  - Jo HE
AD  - Department of Respiratory Medicine and Sleep Medicine, Royal Prince Alfred 
      Hospital, Sydney, NSW, Australia.
FAU - Xu, Joshua
AU  - Xu J
AD  - Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
FAU - Lau, Edmund M
AU  - Lau EM
AD  - Department of Respiratory Medicine and Sleep Medicine, Royal Prince Alfred 
      Hospital, Sydney, NSW, Australia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170301
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Angioplasty, Balloon/*methods
MH  - Chronic Disease
MH  - Fibrinolytic Agents/*therapeutic use
MH  - *Hemodynamics
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/physiopathology/*therapy
MH  - Pulmonary Artery/*physiopathology
MH  - Pulmonary Embolism/complications/physiopathology/*therapy
MH  - Thrombolytic Therapy/*methods
OTO - NOTNLM
OT  - Balloon pulmonary angioplasty: Medical therapy
OT  - Haemodynamics
OT  - Hypertension
OT  - Inoperable
OT  - Meta analysis
OT  - Systematic review
EDAT- 2017/03/16 06:00
MHDA- 2018/07/17 06:00
CRDT- 2017/03/15 06:00
PHST- 2016/09/13 00:00 [received]
PHST- 2017/01/16 00:00 [revised]
PHST- 2017/01/18 00:00 [accepted]
PHST- 2017/03/16 06:00 [pubmed]
PHST- 2018/07/17 06:00 [medline]
PHST- 2017/03/15 06:00 [entrez]
AID - S1443-9506(17)30081-1 [pii]
AID - 10.1016/j.hlc.2017.01.016 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2018 Jan;27(1):89-98. doi: 10.1016/j.hlc.2017.01.016. Epub 2017 
      Mar 1.