Pulmonary Vascular Disease: Pulmonary Arterial Hypertension |

Interventional Therapy in Sarcoidosis-Associated Pulmonary Arterial Stenosis and Pulmonary Hypertension FREE TO VIEW

Shengqing Li, MD
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Xijing Hospital, Xi'an, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A495. doi:10.1016/j.chest.2016.02.517
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SESSION TITLE: Pulmonary Arterial Hypertension

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 01:00 PM - 02:00 PM

PURPOSE: Pulmonary sarcoidosis is often complicated with pulmonary hypertension (PH), which is associated with increased disability and mortality. However, little is known about the mechanism of sarcoidosis-associated PH (SAPH), and not much progress has been made in the treatment of SAPH. In this paper, a prospective observational study was performed on 72 consecutive Chinese sarcoidosis patients to study the mechanism of SAPH, the response to corticosteroids, and the efficacy of interventional therapy.

METHODS: A prospective, observational study was performed on 72 consecutive Chinese sarcoidosis patients followed up at an outpatient clinic in Xijing Hospital. The patients were evaluated by Doppler echocardiography and computer tomography pulmonary angiography. SAPH was confirmed by right heart catheterization. The clinical parameters were compared between patients with and without 2 months of oral glucocorticoids treatment. Eight stage III and IV patients with moderate to severe PAS and SAPH after prednisone treatment underwent interventional therapy.

RESULTS: After 2 months of prednisone treatment, 32 stage III and IV patients remained displaying varying degrees of PAS and SAPH. Eight stage III and IV patients underwent interventional therapy and made great improvements in pulmonary arterial pressure, pulmonary vascular resistance, arterial oxygen saturation, and WHO function, with a low frequency of complications.

CONCLUSIONS: PAS caused by external compression in sarcoidosis is a significant reason for SAPH. Interventional therapy is effective and safe in the treatment of PAS and SAPH.

CLINICAL IMPLICATIONS: Stage I−IV sarcoidosis can cause pulmonary artery stenosis to different degrees by extrinsic compression and may even cause secondary PH. In stage I and II sarcoidosis, enlarged lymph nodes usually regress and pulmonary artery stenosis can be restored after steroid therapy. However, in some stage III and IV sarcoidosis patients, corticosteroid treatment yields no benefits and pulmonary artery stenosis remains unchanged or develops into PH and chronic right heart failure. Interventional therapy can decrease pulmonary arterial pressure, elevate arterial oxygen saturation, and improve WHO function in these patients. It is relatively safe and minimally invasive compared with surgical procedures. The long term efficacy and safety of interventional therapy needs to be assessed further.

DISCLOSURE: The following authors have nothing to disclose: Shengqing Li

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