Abstract
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.