Published online May 28, 2023. doi: 10.4329/wjr.v15.i5.146
Peer-review started: November 26, 2022
First decision: March 15, 2023
Revised: April 4, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: May 28, 2023
Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension (CTEPH), approximately 20%-29% of patients exhibit a restrictive pattern on pulmonary function testing.
To quantify longitudinal changes in lung volume and cardiac cross-sectional area (CSA) in patients with CTEPH.
In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019, we evaluated 15 patients with CTEPH who had chest computed tomography (CT) performed at baseline and after at least 6 mo of therapy. We matched the CTEPH cohort with 45 control patients by age, sex, and observation period. CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.
Total, right lung, and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline (total, P = 0.004; right lung, P = 0.003; right lower lobe; P = 0.01). In the CTEPH group, the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group (total, P = 0.01; right lung, P = 0.007; right lower lobe, P = 0.01; CSA, P = 0.0002). There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.
After at least 6 mo of treatment, CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.
Core Tip: The total lung volume, right lower lobe volume, and cardiac cross-sectional area were reduced after at least 6 mo of follow-up after treatment in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This finding suggests that structural lung changes have occurred in CTEPH, possibly from continued infarction with secondary volume loss from fibrosis or bronchoconstriction. The loss of lung volume may prove to be an important clinical consideration in CTEPH treatment because pulmonary function may continue to deteriorate despite improved right heart function in patients with CTEPH.