Efficacy and prognosis of multimodal angiography-interventions for chronic pulmonary artery stenosis and pulmonary hypertension.

OBJECTIVE

To explore the effects of multimodal endoluminal interventional technology combined therapy on clinical efficacy, pulmonary vascular resistance (PVR), pulmonary microvessel density (MVD), and long-term prognosis in patients with chronic pulmonary artery stenotic pulmonary hypertension (CPAS-PH).

METHODS

This retrospective analysis included 117 CPAS-PH patients (January 2019 - December 2022) who received the combined therapy. They were divided into a control group (n=50) and an observation group (n=67). Baseline data, preoperative and 6-month postoperative PVR, MVD, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), 6-minute walking distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and complications were collected. Kaplan-Meier method was used to analyze 2-year survival, Cox regression to identify independent prognostic factors and nomogram and ROC curve to verify diagnostic efficacy.

RESULTS

The observation group had a lower 6-month postoperative PVR, LVEDD, NT-proBNP, adverse reaction rate, and 2-year mortality (all P<0.001), but higher MVD, LVEF, 6MWD, and follow-up duration (all P<0.001) than the control group. Multivariate Cox analysis showed PVR≥5.305 WU (HR=4.324, 95% CI: 1.666-11.221, P=0.003), LVEDD≥56.95 mm (HR=3.632, 95% CI: 1.110-11.887, P=0.033) were prognostic factors. Having MVD≥14.5 (HR=0.279, 95% CI: 0.113-0.685, P=0.005) and LVEF≥39.34% (HR=0.093, 95% CI: 0.024-0.354, P=0.001) were protective factors. The nomogram and ROC curve confirmed good diagnostic efficacy.

CONCLUSION

Multimodal endoluminal interventional combined therapy effectively reduces PVR, promotes pulmonary microvascular remodeling, and improves cardiac function and exercise tolerance, with favorable long-term prognosis. Postoperative 6-month PVR, MVD, LVEF, and LVEDD are important evaluation indicators.