Date Published: September 25, 2018
Publisher: Public Library of Science
Author(s): Steffen D. Kriechbaum, Christoph B. Wiedenroth, Till Keller, Jan Sebastian Wolter, Ruth Ajnwojner, Karina Peters, Moritz A. Haas, Fritz C. Roller, Andreas Breithecker, Andreas J. Rieth, Stefan Guth, Andreas Rolf, Dirk Bandorski, Christian W. Hamm, Eckhard Mayer, Christoph Liebetrau, Marc W. Merx.
Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress.
This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU.
Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.
Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in about 0.1 to 9% of all patients surviving acute pulmonary embolism . Due to a distinct impairment of pulmonary hemodynamics and secondary right heart dysfunction, the prognosis of CTEPH is poor without therapy.  Pulmonary endarterectomy is the treatment of choice, offering a potential curative approach.  For patients deemed to be inoperable, targeted medication and a consecutive balloon pulmonary angioplasty (BPA) as an interventional treatment option is recommended. [1, 3–7]
The principles of the clinical and scientific work-up of patients who undergo treatment for CTEPH at our center have been recently published by our group.  The study population and the respective methods are described in brief as follows.
BPA is a promising treatment option for inoperable CTEPH patients.  Over the last decade, data about the beneficial effects accumulated and procedural improvements led to a high level of periprocedural safety. [3, 5, 6, 11, 14, 17, 18] In CTEPH, intravascular thrombotic obstruction compounded by vascular remodeling leads to an increased PVR and meanPAP. [1, 19, 20] The pathological changes of pulmonary hemodynamics trigger an impairment of cardiac, particularly right ventricular, function. [21, 22] Right ventricular afterload elevation causes increased wall tension and leads to myofibrillar damage.  Natriuretic peptide levels correlate with myocardial wall stress and proved to indicate right ventricular remodeling and cardiac troponins are highly sensitive for the detection of myocardial injury. [9, 24–26] Accordingly, the aim of the present study was to characterize the time course of hs-cTnT mirroring myocardial damage in CTEPH patients undergoing BPA and to determine the relation to NT-proBNP levels as an indicator for cardiac wall stress.