Skip to main content
Download PDF
  • Correspondence
  • Open access
  • Published:

Impact of psychiatric disorders on the hemodynamic and quality of life outcome of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a retrospective study

Respiratory Research volume 24, Article number: 274 (2023) Cite this article

Abstract

Background

Balloon pulmonary angioplasty (BPA) has beneficial effects on pulmonary hemodynamics, exercise capacity, and quality of life (QOL) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Recently, emerging evidence suggests a relationship between CTEPH and psychiatric disorders (PD). However, data on the clinical efficacy of BPA in CTEPH patients with PD are lacking.

Methods

We retrospectively analyzed 75 patients with inoperable/residual CTEPH who underwent BPA and right-sided heart catheterization before the initial BPA and within 1 year after the last procedure. QOL was evaluated using the European Quality of Life Five Dimension (EQ-5D) scale in 27 patients before and after BPA sessions. Baseline and post-procedural hemodynamic, functional, and QOL parameters were compared between the patients with and without PD.

Results

Among the 75 participants, 22 (29.3%) patients were categorized in the PD group. Although PD group had a similar mean pulmonary artery pressure level compared with non-PD group (40 ± 7 vs. 41 ± 9 mmHg, p = 0.477), they tended to have unfavorable QOL status (0.63 ± 0.22 vs. 0.77 ± 0.19, p = 0.102). BPA significantly improved pulmonary hemodynamics, laboratory parameters and exercise tolerance in both groups. BPA also significantly improved EQ-5D scores in the non-PD group (from 0.77 ± 0.19 to 0.88 ± 0.13, p < 0.001), but the scores remained unchanged in the PD group (from 0.63 ± 0.22 to 0.67 ± 0.22, p = 0.770). During the long-term period [1,848 (1,055–2,565) days], both groups experienced similar mortality rates (PD 4.6% vs. non-PD 5.7%, p = 1.000).

Conclusions

BPA improved hemodynamic and functional parameters irrespective of PD, but its effect on QOL was limited in patients with PD.

Background

Balloon pulmonary angioplasty (BPA) has beneficial effects on pulmonary hemodynamics, exercise capacity, and further quality of life (QOL) in patients with inoperable/residual chronic thromboembolic pulmonary hypertension (CTEPH) [1,2,3,4]. Chronic unresolved pulmonary embolism is a key manifestation of CTEPH [5, 6], and psychiatric disorders (PD) is a significant risk factor for venous thromboembolism (VTE) [7, 8]. In fact, patients with CTEPH exhibited a higher prevalence of concomitant PD than patients with pulmonary arterial hypertension or the general population [9], indicating a relationship between CTEPH and PD. Recent studies also demonstrated that patients with co-existing PD had reduced QOL and higher mortality rate after pulmonary endarterectomy (PEA) compared with those without PD [10, 11]. Despite the favorable impact of BPA on hemodynamic and QOL status [12, 13], data on the clinical efficacy of BPA in CTEPH patients with PD are lacking. The present study therefore aimed to investigate the hemodynamic, functional, and prognostic effects of BPA in patients with CTEPH, focusing on concomitant PD.

Methods

Study population

We retrospectively analyzed 80 consecutive patients with CTEPH undergoing BPA who were inoperable or had residual pulmonary hypertension (PH) after PEA at the University of Tokyo Hospital between April 2008 and March 2023. Five patients were excluded because of a lack of hemodynamic data before or after the BPA procedure. Patients were diagnosed with CTEPH based on co-existing PH assessed by right-sided heart catheterization (RHC), defined as mean pulmonary artery pressure (mPAP) > 20 mmHg with a normal mean pulmonary capillary wedge pressure ≤ 15 mmHg and pulmonary vascular resistance (PVR) > 2 Wood Units [14], and the demonstration of organic pulmonary thromboembolism using contrast lung computed tomography, pulmonary perfusion scintigraphy, and pulmonary angiography. Patients were considered as psychotic according to a previous diagnosis by a psychiatrist, but patients treated for insomnia alone were not defined as having a PD. The end date of the study was March 31, 2023. The investigation conformed to the principles outlined in the Declaration of Helsinki. The need for written informed consent was waived because of the retrospective nature of the study design and minimal risk to patients. This study was approved by the Institutional Review Boards of the University of Tokyo (No 2650).

Examinations

RHC was performed before the initial BPA (pre-BPA) and within one year after the last BPA (post-BPA). Right atrial pressure, PAP, and pulmonary capillary wedge pressure were measured using a Swan-Gantz catheter (Edwards Life Science, Irvine, CA, USA). Cardiac output was determined with the thermodilution method, and PVR was then calculated. World Health Organization functional score, brain natriuretic peptide (BNP) levels, respiratory function, and 6-min walk test were also assessed at the time of hospitalization for RHC.

BPA procedure

The BPA procedure has been described previously [15]. Briefly, we introduced a 6-Fr long sheath into the main pulmonary artery with a 0.035-inch guidewire through an 8-Fr sheath inserted in the femoral or internal jugular vein, and selected an individual segmental pulmonary artery using a 6-Fr guiding catheter. The target lesion was visualized by injecting contrast medium during inspiration, and a 0.014-inch guidewire was crossed through the lesion and an optimal-sized balloon (2.0–8.0 mm), determined by angiographic or intravascular ultrasound findings, was inflated. We treated ring-like, web, subtotal, and total lesions. We used a smaller balloon at the first session for each lung, to avoid reperfusion pulmonary edema, followed by a larger balloon from the second session, because of dilated vessels with increased blood flow through the first session. The initial goal of BPA was to achieve an mPAP < 30 mmHg on the basis of the previous studies [2, 16], and additional BPA was performed in patients with residual PH symptoms.

QOL evaluation

We evaluated QOL using the European Quality of Life Five Dimension (EQ-5D) scale [17], as an established tool for the quantitative assessment of QOL in various clinical settings including psychiatric disorders [18, 19]. The scale consists of five questionnaires (mobility, self-care, usual activities, pain discomfort, and anxiety depression) with five responses (no problems, slight problems, moderate problems, serious problems, and extreme problems) represented by scores of 1–5, respectively, for the individual questions (i.e., no problems = 1, slight problems = 2, moderate problems = 3, serious problems = 4, and extreme problems = 5). The final EQ-5D score was then calculated from the combined scores. The EQ-5D score in Japan ranges from − 0.025 to 1.000, with a higher score indicating a more-favorable health status [17]. We assessed the EQ-5D scores at the time of RHC before and after a series of BPA sessions.

Statistical analysis

Continuous variables were expressed as mean ± standard deviation or median (interquartile range) and compared between the PD and non-PD groups using unpaired Student’s t-tests or Wilcoxon’s rank sum tests, depending on the distribution of the data. Categorical variables were described as number (percentage) and analyzed by χ2 or Fisher’s exact tests. Paired t-tests or Wilcoxon’s signed-rank tests were used to compare hemodynamic, laboratory, functional, and QOL-related parameters as appropriate. All analyses were carried out using JMP Pro 17 statistical software (SAS Institute, Inc., Cary, NC, USA) and p < 0.05 was considered statistically significant.

Results

Seventy-five patients with CTEPH who underwent BPA and follow-up RHC were categorized into the PD group (n = 22) or non-PD group (n = 53) (Fig. 1). The mean age of the overall study population was 62 ± 14 years and 50 (66.7%) patients were women. Thirty-seven (49.3%) patients had a previous history of acute VTE, and 41 (54.7%) patients were diagnosed with CTEPH within 1 year from the onset of symptoms. During the median follow-up period of 1,848 (1,055–2,565) days, the median number of BPA sessions was six (4–8) and four (5.3%) patients died (2 right-sided heart failure, 1 lung cancer, and 1 respiratory infection), with no significant difference in mortality between the PD and non-PD groups (4.6% vs. 5.7%, p = 1.000).

Fig. 1
figure 1

Flow chart of the study. BPA, balloon pulmonary angioplasty; CTEPH, chronic thromboembolic pulmonary hypertension; PD, psychiatric disorder; QOL, quality of life; RHC, right-sided heart catheterization

Full size image

Prevalence and characteristics of PD in patients with CTEPH treated with BPA

Twenty-two of the 75 patients (29.3%) had PD (Fig. 1). The mean age at diagnosis of PD was 35 ± 13 years. The PD group included seven cases (31.8%) of schizophrenia, six (27.3%) of depression, six (27.3%) of bipolar disorder, ten (45.5%) others, and seven patients (31.8%) with overlap disease concomitant with multiple mental disorders. Most PD patients received antipsychotic agents, while nine patients in the non-PD group received prescribed sleeping pills [21 (95.5%) vs. 9 (17.0%), p < 0.001]. Most patients with PD received a combination of antipsychotic agents [median number of antipsychotic agents: 5 (3–6)] (Table 1). Patients with PD tended to be younger (58 ± 12 vs. 64 ± 15 years, p = 0.060) and had a higher body mass index (25.7 ± 4.4 vs. 22.3 ± 4.5 kg/m2, p = 0.002) than those without PD, while both groups had similar smoking status (p > 0.10) (Table 1). The prevalence of acute VTE was comparable between PD and non-PD groups (54.6% vs. 47.2%, p = 0.561), showing similar adherence to anticoagulants in both groups (Table 1). The baseline functional parameters, laboratory examinations, hemodynamic data, and respiratory functions are presented in Table 2. Functional parameters and exercise capacity were comparable between the two groups, but BNP was lower in the PD group [32 (13–105) vs. 117 (54–373) pg/ml, p = 0.001]. Regarding hemodynamic measurements, RHC showed similar mPAP between the two groups (40 ± 7 vs. 41 ± 9 mmHg, p = 0.477), whereas patients with PD tended to have a lower PVR [491 (376–654) vs. 667 (435–792) dyne·s·cm− 5, p = 0.066] and mean blood pressure (82 ± 13 vs. 89 ± 16 mmHg, p = 0.086) (Table 2). As for respiratory function, arterial oxygen saturation was significantly lower in the PD group (SaO2, 87.9 ± 4.9 vs. 90.9 ± 4.1%, p = 0.009), and patients in the PD group were likely to have lower percent diffusing capacity for carbon monoxide (%DLCO, 75.1 ± 13.1 vs. 82.5 ± 16.4%, p = 0.074) and higher alveolar-arterial oxygen gradient (A-aDO2, 46 ± 9 vs. 42 ± 10 mmHg, p = 0.103) (Table 2).

Table 1 Baseline characteristics of patients with and without PD
Full size table
Table 2 Baseline functional, laboratory, hemodynamic, and respiratory parameters
Full size table

Functional and hemodynamic effects of BPA in PD patients

Patients with and without PD underwent comparable numbers of BPA sessions [5 (4–9) vs. 6 (4–7) sessions, respectively, p = 0.409], with no significant difference in median follow-up duration from the last BPA session to RHC [177 (76–213) vs. 101 (59–203) days, respectively, p = 0.277]. Both groups experienced significant improvements in BNP, World Health Organization functional class, 6-min walk distance, SaO2, and A-aDO2 after BPA, whereas BNP remained higher in the non-PD group [12 (9–21) vs. 26 (15–55) pg/ml, p < 0.05] (Table 3). Follow-up RHC also demonstrated significant reductions in mPAP and PVR regardless of concomitant PD (Table 3), with similar numbers of patients achieving mPAP < 30 mmHg in the two groups [19 (86.4%) in PD vs. 46 (86.8%) in non-PD, p = 0.960].

Table 3 Functional, laboratory, and hemodynamic parameters before and after BPA
Full size table

Impact of BPA on QOL score in PD patients

The EQ-5D score was calculated in 27 patients (10 PD, 17 non-PD) before and after BPA. Before BPA, patients with PD tended to have lower EQ-5D score compared with patients without PD (0.63 ± 0.22 vs. 0.77 ± 0.19, p = 0.102) (Fig. 2a), which was explained by significantly poorer self-care and greater anxiety (Fig. 2b-f). The EQ-5D score after BPA sessions improved significantly in the non-PD group (from 0.77 ± 0.19 to 0.88 ± 0.13, p < 0.001) but remained unchanged in the PD group (from 0.63 ± 0.22 to 0.67 ± 0.22, p = 0.770), with a significantly higher post-BPA EQ-5D score in the non-PD group (0.88 ± 0.13 vs. 0.67 ± 0.22, p = 0.012) (Fig. 2a). This discrepancy was mainly attributable to lack of improvements in mobility, usual activities and anxiety depression following BPA in the PD group compared with the non-PD group (Fig. 2b-f).

Fig. 2
figure 2

EQ-5D scores and components in PD and non-PD groups before and after BPA. Bar graphs show EQ-5D score (a) and its components, including mobility (b), self-care (c), usual activities (d), pain discomfort (e), and anxiety depression (f) according to PD status before initial BPA and after last BPA procedure. Bars of EQ-5D score demonstrate mean values with standard error. Bars of each component of EQ-5D score represent median values with interquartile range. Left-side bars correspond to pre-BPA QOL status and right-side bars correspond to post-BPA QOL status. * p < 0.05 vs. PD group before BPA. ** p < 0.05 vs. PD group after BPA. † p < 0.05 vs. non-PD group before BPA. BPA, balloon pulmonary angioplasty; EQ-5D, European Quality of Life Five Dimension; PD, psychiatric disorder; QOL, quality of life

Full size image

Discussion

This study showed that 29.3% of patients with inoperable CTEPH who underwent BPA had concomitant PD. Before BPA, although PD group had a similar PH severity and exercise capacity, they tended to have unfavorable QOL status. BPA improved pulmonary hemodynamics, laboratory parameters, exercise tolerance, and A-aDO2 irrespective of co-existing PD, but did not improve QOL profiles in patients with PD.

The present study demonstrated that 29.3% of patients with inoperable CTEPH treated with BPA had concomitant PD. A previous single-center cohort study by Tajima et al. reported that approximately 10% of patients with CTEPH were complicated by PD [10], and Dering et al. also demonstrated that almost one-third of patients with CTEPH had concurrent psychological disorders [20, 21]. Furthermore, Suzuki et al. found that the prevalence of schizophrenia in patients with CTEPH (7.3%) was 11-fold higher than in the general population [9]. The higher prevalence of psychosis in patients with CTEPH relative to the general population indicates a certain association between CTEPH and PD [22].

There are several possible mechanisms for the relationship between CTEPH and PD. First, enhanced venous stasis due to immobilization related to the disease conditions (e.g., depression) or sedation, and obesity mediated by poor physical activity and drug-induced metabolic abnormalities, could lead to the development of VTE in patients with PD [8, 23]. A population-based cohort study accordingly found that schizophrenia carried a two-fold independent risk for VTE [24]. Second, some antipsychotics, including phenothiazines, clozapine, and risperidone, were shown to be related to serotonin-induced platelet aggregation and elevated antiphospholipid antibodies, contributing to increased thrombogenesis [8, 25]. Indeed, a large primary care cohort in the United Kingdom demonstrated that a prescription of antipsychotic drugs was associated with a 1.3-fold increased risk of VTE [23]. Furthermore, atypical symptoms in patients with PD might result in an underestimation and delayed diagnosis of acute VTE, leading to the subsequent development of CTEPH [26]. In fact, despite an enhanced risk of VTE in patients with PD, the prevalence of acute VTE was comparable between PD and non-PD groups in the present study.

The current results showed that patients with CTEPH and PD tended to be younger than those without PD, in accordance with a recent study in 107 patients with CTEPH [20]. Pre-procedural mPAP was similar between PD and non-PD groups, as shown in the previous studies [10, 27]. In contrast, although statistically insignificant, PD patients tended to have lower PVR compared with their non-PD counterparts, which was different from the previous studies [10, 27]. This discrepancy might be explained by the relatively small study population in the present work. After a series of BPA sessions, mPAP was significantly improved to a comparable level in both groups, suggesting that BPA could have favorable effects on pulmonary hemodynamics, irrespective of concomitant PD.

Recent strategic and procedural advancements of BPA contribute to an improvement in QOL [13, 28,29,30] beyond prognostic benefit [12, 31, 32]. Daroncha et al. showed a prominent improvement in the 36-item Short Form questionnaire after BPA [28], and Hoole et al. also demonstrated that the Cambridge Pulmonary Hypertension Outcome Review QOL questionnaire was ameliorated in 30 patients with CTEPH treated with BPA [29]. Moreover, Miura et al. found a favorable effect of extensive BPA after achieving mPAP < 30 mmHg on QOL score, beyond hemodynamic improvement [30]. In contrast to these studies however, the current results revealed that BPA was less effective in terms of QOL status in patients with PD, regardless of hemodynamic and functional restoration. Depression and anxiety were also associated with poor QOL in a previous study in patients with PH, including CTEPH [11]. The anxiety-depression score was more impaired in the PD group before and after BPA, which could partially explain the differences in QOL scores between the two groups. Furthermore, patients with PD had poorer scores in other QOL domains, including mobility and usual activities after BPA. Given that QOL is determined by a broad spectrum of physical and psychological properties, patients with CTEPH and PD might require additional physical and psychological interventions, in addition to BPA, to improve their QOL.

The present study revealed a high prevalence of PD in patients with CTEPH, and showed similar PH severity compared with those without PD. Although the frequency of mental disorders in patients with CTEPH varied among individual studies [9, 10, 20], a higher prevalence of PD among patients with CTEPH rather than the general population suggest that patients with PD may be a high-risk group for developing CTEPH, which should be clarified in larger study population. In addition, the present study demonstrated that patients with CTEPH and preexisting PD did not benefit from BPA in terms of QOL, irrespective of favorable effects on hemodynamic and functional parameters, possibly because the beneficial effects of BPA on QOL were canceled out by mental and physical factors. Further studies are warranted to determine if BPA combined with physical and psychiatric interventions could improve QOL status in patients with CTEPH and concomitant PD.

This study had several limitations. First, its small-scale, single-center, retrospective observational study design may limit the applicability of the results to other populations. Second, QOL was evaluated in only 27 of the 75 patients, which may limit concluding a difference in the impact of BPA on QOL status according to the presence or absence of PD in CTEPH patients. Third, a depression scale was not conducted in this study to assess mental status, so a detailed analysis of depression is not available. Finally, the prevalence of acute VTE was relatively high compared to the previous report in Japan [33], which might be partially explained by the possibility that we might include “acute” and “acute on chronic” pulmonary embolism and could not precisely distinguish these two phenotypes due to the retrospective nature of the present study. Further studies are therefore required to investigate the long-term effects of BPA on QOL status in a large CTEPH population with PD.

Conclusions

This study found that 29.3% of patients with inoperable CTEPH who underwent BPA had co-existing PD. PH severity was comparable between PD and non-PD patients, and BPA improved hemodynamic and functional parameters in both groups. In terms of QOL, although the limited number of study population, PD patients were likely to have unfavorable QOL status compared with non-PD patients, and the effect of BPA on QOL was limited in the PD group. These results should be confirmed in further studies with a larger study population.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

A-aDO2 :

Alveolar-arterial oxygen gradient

BNP:

Brain natriuretic peptide

BPA:

Balloon pulmonary angioplasty

CTEPH:

Chronic thromboembolic pulmonary hypertension

EQ-5D:

European Quality of Life Five Dimension

mPAP:

Mean pulmonary artery pressure

PD:

Psychiatric disorder

PEA:

Pulmonary endarterectomy

PH:

Pulmonary hypertension

PVR:

Pulmonary vascular resistance

QOL:

Quality of life

RHC:

Right-sided heart catheterization

VTE:

Venous thromboembolism

References

  1. Feinstein JA, Goldhaber SZ, Lock JE, Ferndandes SM, Landzberg MJ. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary Hypertension. Circulation. 2001;103:10–3.

    Article  CAS  PubMed  Google Scholar 

  2. Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary Hypertension. Circ Cardiovasc Interv. 2012;5:748–55.

    Article  PubMed  Google Scholar 

  3. Kataoka M, Inami T, Hayashida K, Shimura N, Ishiguro H, Abe T, et al. Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary Hypertension. Circ Cardiovasc Interv. 2012;5:756–62.

    Article  PubMed  Google Scholar 

  4. Shinkura Y, Nakayama K, Yanaka K, Kinutani H, Tamada N, Tsuboi Y, et al. Extensive revascularisation by balloon pulmonary angioplasty for chronic thromboembolic pulmonary Hypertension beyond haemodynamic normalisation. EuroIntervention. 2018;13:2060–8.

    Article  PubMed  Google Scholar 

  5. Pepke-Zaba J, Delcroix M, Lang I, Mayer E, Jansa P, Ambroz D, et al. Chronic thromboembolic pulmonary Hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124:1973–81.

    Article  PubMed  Google Scholar 

  6. Papamatheakis DG, Poch DS, Fernandes TM, Kerr KM, Kim NH, Fedullo PF. Chronic thromboembolic pulmonary Hypertension: JACC focus seminar. J Am Coll Cardiol. 2020;76:2155–69.

    Article  PubMed  Google Scholar 

  7. Zhang R, Dong L, Shao F, Tan X, Ying K. Antipsychotics and venous thromboembolism risk: a meta-analysis. Pharmacopsychiatry. 2011;44:183–8.

    Article  CAS  PubMed  Google Scholar 

  8. Masopust J, Maly R, Valis M. Risk of venous thromboembolism during treatment with antipsychotic agents. Psychiatry Clin Neurosci. 2012;66:541–52.

    Article  CAS  PubMed  Google Scholar 

  9. Suzuki H, Sugimura K, Tatebe S, Aoki T, Shimokawa H. Chronic thromboembolic pulmonary Hypertension and schizophrenia. Int J Cardiol. 2016;207:363–4.

    Article  PubMed  Google Scholar 

  10. Tajima H, Kasai H, Tanabe N, Sugiura T, Miwa H, Naito A, et al. Clinical characteristics and prognosis in patients with chronic thromboembolic pulmonary Hypertension and a concomitant psychiatric disorder. Pulm Circ. 2019;9:2045894019836420.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Harzheim D, Klose H, Pinado FP, Ehlken N, Nagel C, Fischer C, et al. Anxiety and depression disorders in patients with pulmonary arterial Hypertension and chronic thromboembolic pulmonary Hypertension. Respir Res. 2013;14:104.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ogawa A, Satoh T, Fukuda T, Sugimura K, Fukumoto Y, Emoto N, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary Hypertension: results of a multicenter registry. Circ Cardiovasc Qual Outcomes. 2017;10:e004029.

    Article  PubMed  Google Scholar 

  13. Minatsuki S, Kodera S, Kiyosue A, Saito A, Maki H, Hatano M, et al. Balloon pulmonary angioplasty improves quality of life in Japanese patients with chronic thromboembolic pulmonary Hypertension. J Cardiol. 2020;76:205–10.

    Article  PubMed  Google Scholar 

  14. Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary Hypertension. Eur Heart J. 2022;43:3618–731.

    Article  CAS  PubMed  Google Scholar 

  15. Minatsuki S, Kiyosue A, Kodera S, Hara T, Saito A, Maki H, et al. Effectiveness of balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary Hypertension despite having lesion types suitable for surgical treatment. J Cardiol. 2020;75:182–8.

    Article  PubMed  Google Scholar 

  16. Lewczuk J, Piszko P, Jagas J, Porada A, Wojciak S, Sobkowicz B, et al. Prognostic factors in medically treated patients with chronic Pulmonary Embolism. Chest. 2001;119:818–23.

    Article  CAS  PubMed  Google Scholar 

  17. Janssen MF, Bonsel GJ, Luo N, Is. EQ-5D-5L better than EQ-5D-3L? A head-to-head comparison of descriptive systems and value sets from seven countries. PharmacoEconomics. 2018;36:675–97.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Konig HH, Born A, Gunther O, Matschinger H, Heinrich S, Riedel-Heller SG, et al. Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with anxiety disorders. Health Qual Life Outcomes. 2010;8:47.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, et al. Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiatry. 2018;5:477–85.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dering MR, Lepsy N, Fuge J, Meltendorf T, Hoeper MM, Heitland I, et al. Prevalence of mental disorders in patients with chronic thromboembolic pulmonary Hypertension. Front Psychiatry. 2022;13:821466.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Collaborators GBDMD. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of Disease Study 2019. Lancet Psychiatry. 2022;9:137–50.

    Article  Google Scholar 

  22. Ishikawa H, Kawakami N, Kessler RC, World Mental Health Japan Survey C. Lifetime and 12-month prevalence, severity and unmet need for treatment of common mental disorders in Japan: results from the final dataset of World Mental Health Japan Survey. Epidemiol Psychiatr Sci. 2016;25:217–29.

    Article  CAS  PubMed  Google Scholar 

  23. Parker C, Coupland C, Hippisley-Cox J. Antipsychotic Drugs and risk of venous thromboembolism: nested case-control study. BMJ. 2010;341:c4245.

    Article  PubMed  Google Scholar 

  24. Hsu WY, Lane HY, Lin CL, Kao CH. A population-based cohort study on deep vein Thrombosis and Pulmonary Embolism among schizophrenia patients. Schizophr Res. 2015;162:248–52.

    Article  PubMed  Google Scholar 

  25. Canoso RT, de Oliveira RM, Nixon RA. Neuroleptic-associated autoantibodies. A prevalence study. Biol Psychiatry. 1990;27:863–70.

    Article  CAS  PubMed  Google Scholar 

  26. Klok FA, Dzikowska-Diduch O, Kostrubiec M, Vliegen HW, Pruszczyk P, Hasenfuss G, et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary Hypertension after acute Pulmonary Embolism. J Thromb Haemost. 2016;14:121–8.

    Article  CAS  PubMed  Google Scholar 

  27. Olsson KM, Meltendorf T, Fuge J, Kamp JC, Park DH, Richter MJ, et al. Prevalence of mental disorders and impact on quality of life in patients with pulmonary arterial Hypertension. Front Psychiatry. 2021;12:667602.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Darocha S, Pietura R, Pietrasik A, Norwa J, Dobosiewicz A, Pilka M, et al. Improvement in quality of life and hemodynamics in chronic thromboembolic pulmonary Hypertension treated with balloon pulmonary angioplasty. Circ J. 2017;81:552–7.

    Article  PubMed  Google Scholar 

  29. Hoole SP, Coghlan JG, Cannon JE, Taboada D, Toshner M, Sheares K, et al. Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary Hypertension: the UK experience. Open Heart. 2020;7:e001144.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Miura K, Katsumata Y, Kawakami T, Ikura H, Ryuzaki T, Shiraishi Y, et al. Exercise tolerance and quality of life in hemodynamically partially improved patients with chronic thromboembolic pulmonary Hypertension treated with balloon pulmonary angioplasty. PLoS ONE. 2021;16:e0255180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Inami T, Kataoka M, Yanagisawa R, Ishiguro H, Shimura N, Fukuda K, et al. Long-term outcomes after percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary Hypertension. Circulation. 2016;134:2030–2.

    Article  PubMed  Google Scholar 

  32. Aoki T, Sugimura K, Tatebe S, Miura M, Yamamoto S, Yaoita N, et al. Comprehensive evaluation of the effectiveness and safety of balloon pulmonary angioplasty for inoperable chronic thrombo-embolic pulmonary Hypertension: long-term effects and procedure-related Complications. Eur Heart J. 2017;38:3152–9.

    Article  PubMed  Google Scholar 

  33. Hosokawa K, Abe K, Funakoshi K, Tamura Y, Nakashima N, Todaka K, et al. Long-term outcome of chronic thromboembolic pulmonary Hypertension using direct oral anticoagulants and warfarin: a Japanese prospective cohort study. J Thromb Haemost. 2023;21:2151–62.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Susan Furness, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medicine,, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kazutoshi Hirose, Shun Minatsuki, Akihito Saito, Hiroki Yagi, Norifumi Takeda, Masaru Hatano & Issei Komuro

  2. International University of Health and Welfare, Tokyo, Japan

    Issei Komuro

Authors
  1. Kazutoshi Hirose
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shun Minatsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akihito Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroki Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Norifumi Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaru Hatano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Issei Komuro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KH and SM contributed to the conception and design of the work. KH, SM, AS, HY, NT, MH, and IK contributed to the acquisition, analysis, or interpretation of the data for the study. KH drafted the manuscript. SM, AS, HY, NT, MH and IK critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work, ensuring integrity and accuracy.

Corresponding author

Correspondence to Shun Minatsuki.

Ethics declarations

Ethics approval and consent to participate

This investigation conformed to the principles outlined in the Declaration of Helsinki. The need for written informed consent was waived because of the retrospective nature of the study design and minimal risk to patients. This study was approved by the Institutional Review Boards of the University of Tokyo (No.2650).

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirose, K., Minatsuki, S., Saito, A. et al. Impact of psychiatric disorders on the hemodynamic and quality of life outcome of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a retrospective study. Respir Res 24, 274 (2023). https://doi.org/10.1186/s12931-023-02579-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12931-023-02579-z

Keywords

Respiratory Research

ISSN: 1465-993X

Contact us