Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Sean Gaine, Mater Misericordiae University Hospital, Ireland
- Second opponent: Adjunct Professor Ulrik Sartipy, Karolinska Institutet, Sweden
- Third member and chair of the evaluation committee: Associate Professor Siri Lagethon Heck, University of Oslo
Chair of the Defence
Professor Emeritus Odd Geiran, University of Oslo
Principal Supervisor
Senior Consultant Arne K. Andreassen, Oslo University Hospital
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare condition caused by persistent blood clots in the pulmonary arteries despite adequate anticoagulation. The treatment of choice is pulmonary endarterectomy (PEA), with excellent outcomes in suitable patients. However, a significant proportion of patients are inoperable due to clot distribution or comorbidities. For them, balloon pulmonary angioplasty (BPA) is an alternative. Uncertainty remains regarding optimal patient selection and long-term effects of both treatments.
The aim of this thesis was to evaluate the effect of PEA and BPA on pulmonary pressures, cardiac function and physical capacity, and to describe predictors of survival in CTEPH. Two observational cohort studies were conducted at Oslo University Hospital. The first study assessed hemodynamics and peak oxygen consumption in CTEPH patients before and after PEA or BPA. Pressure reduction was greater after PEA, improvements in exercise capacity were similar between groups.
The second study assessed right heart function via echocardiography in 54 PEA and 44 BPA patients. Both treatments improved right ventricular size and function. Ten-year survival was 80% after PEA and 75% after BPA. Improved right ventricular function predicted better survival.
The third study examined soluble ST2 as a biomarker in CTEPH and pulmonary arterial hypertension (PAH) in a Norwegian discovery cohort and a Swedish validation cohort. ST2 was associated with transplant-free survival, but lost independent significance in the discovery cohort after adjustment for other baseline variables. Changes in ST2 over time were not linked to survival.
In conclusion, PEA and BPA both improve hemodynamics, cardiac function, and exercise capacity in CTEPH. Right ventricular improvement predicts survival. ST2 is not independently predictive after adjustment for other baseline variables. Further research is needed to guide treatment choice, and to identify new biomarkers in CTEPH.
Additional information
Contact the research support staff.