Sex-Specific Differences in Chronic Thromboembolic Pulmonary Hypertension Treated with Balloon Pulmonary Angioplasty

Background/Objectives: Several studies describe the sex-specific difference in cardiovascular diseases. However, there are still limited research reporting the difference between men and woman with chronic thromboembolic pulmonary hypertension (CTEPH) treated with ballon pulmonary angioplasty (BPA). The aim of the study was to evaluate sex–specific differences in patients with CTEPH treated with BPA. Methods: This retrospective study included CTEPH patients treated with BPA. Patients’ hemodynamic and clinical parameters were assessed at baseline and 3 months after completion of BPA treatment. Results: The study included 94 patients (44 women, 46.8%). At baseline women had higher systolic pulmonary arterial pressure (sPAP) (7618.5 vs. 8517.6 mmHg; p=0.03), and pulmonary vascular resistance (8.21 [5.55-10.17] vs. 9.89 [6.31-14.06] Wood Units; p=0.03), compared to men. There were no differences in clinical characteristics between sexes. At follow-up, women had lower sPAP (49 [41-54] vs. 43 [37-49] mmHg; p=0.04) and pulmonary capillary wedge pressure (10 [9-14] vs. 9 [8-11] mmHg; p=0.03), but higher cardiac index (2.570.53 vs. 2.820.50 L/min/m2; p=0.03), as well as better Dyspnea Borg Scale outcomes, compared to men. Women had greater reduction of mean pulmonary artery pressure (-43% vs. -37%; p=0.049) than men. Conclusions: At baseline, women with CTEPH had worse hemodynamic parameters than men despite similar clinical symptoms. However, women hemodynamic status was better after BPA therapy. Hence, women seem better adapted to the disease at baseline and respond better to the BPA. Further data are needed to investigate whether the management of CTEPH a patients should be sex–differentiated.