Assessment of perfusion on ventilation/perfusion scan after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Expert opinion versus guidance by reference chart

Objective Balloon pulmonary angioplasty (BPA) is frequently used in chronic thromboembolic pulmonary hypertension (CTEPH)/chronic thromboembolic pulmonary disease (CTED). Nevertheless, noninvasive pulmonary perfusion imaging after BPA is scarce. In this study, change in perfusion on ventilation/perfusion (V/Q) scan after BPA was assessed and correlated with clinical outcomes. Methods Retrospectively, all consecutive patients with CTEPH/CTED patients who completed BPA and received planar V/Q scans baseline and 6 months follow-up were included. Perfusion was evaluated using gestalt interpretation and semiquantitative calculation of the pulmonary vascular obstruction (PVO) index, with obligatory use of the lung segment reference chart. Interobserver variability was assessed for both methods, and the correlation between PVO index and clinical parameters was tested. Results Thirty-three patients with CTEPH/CTED (mean age: 60.4 ± 14.7 years, 70% female) underwent 127 BPA procedures. Gestalt interpretation showed improved perfusion in 79% of all patients, and PVO index decreased significantly compared with baseline (45 ± 15-35 ± 15%; P < 0.001). The gestalt method showed a weak level of agreement (k = 0.32; P = 0.06), and the PVO method showed a moderate to strong reliability (R2 : 0.71, P < 0.001). The PVO index showed a significant (P < 0.001) but weak correlation with log N-terminal probrain natriuretic peptide, mean pulmonary artery pressure, and pulmonary vascular resistance (R2 : 0.26, 0.24, and 0.18, respectively). Conclusion Perfusion on V/Q scan significantly improved after BPA in patients with CTEPH/CTED. Semiquantitative calculation of PVO was more reliable in comparison to gestalt interpretation, however, clinical parameters showed only a weak correlation with the PVO index.