BPA Improved the Cognitive Dysfunction of Patients with CTEPH

BACKGROUNDChronic thromboembolic pulmonary hypertension (CTEPH) is a severe and progressive condition characterized by dyspnea and fatigue. Our previous study reported cognitive impairment in pulmonary hypertension (PH) patients. However, balloon pulmonary angioplasty (BPA) capable of alleviating cognitive impairment in patients with CTEPH is largely unknown. METHODSThis was a prospective study involving a total of 131 patients with CTEPH who underwent BPA at the Shanghai Pulmonary Hospital. We collected Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) questionnaires and examined plasma A{beta} and phosphorylated-tau217 (p-tau217) levels to assess the cognitive function of patients with CTEPH between the pre-BPA and post-BPA stages. RESULTSFollowing BPA, patients exhibited improved cognitive performance, accompanied by reduced plasma levels of A{beta}1-42 and p-tau217. After the third BPA session, patients with a mean pulmonary arterial pressure (mPAP) of[&ge;]25 mmHg had significantly lower MMSE and MoCA scores compared to those with an mPAP of <25 mmHg. Linear regression analyses revealed that baseline and post-intervention MMSE or MoCA total scores were significant predictors of cardiac output (CO) levels measured after the last BPA procedure. Logistic regression analyses incorporating pre- and post-BPA clinical parameters identified three independent predictors of baseline cognitive dysfunction: lower educational attainment, higher baseline A{beta}1-42 levels, and elevated baseline p-tau217 concentrations. CONCLUSIONSOur findings suggest promising therapeutic effects of BPA, associated with improvements in cognitive dysfunction and reductions in plasma A{beta}1-42 and p-tau217 levels in patients with CTEPH. NOVELTY AND RELEVANCEO_ST_ABSWhat Is New?C_ST_ABSThis is the first study to demonstrate that balloon pulmonary angioplasty (BPA) improves cognitive function (MMSE/MoCA scores) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). And the first report that BPA reduces plasma levels of A{beta}1-42 and p-tau217-- key Alzheimers disease-related proteins--in CTEPH patients, establishing a peripheral biomarker for CTEPH-associated cognitive impairment. What Is Relevance?Cognitive impairment is common but underrecognized in CTEPH, BPA now addresses both cardiopulmonary and cognitive dysfunction, improving quality of life beyond hemodynamic recovery. Findings support the cardiopulmonary-brain axis in CTEPH: improved pulmonary hemodynamics and oxygenation reduce systemic pathological protein release, benefiting brain function. Clinical/Pathophysiological Implications?Our findings suggest promising therapeutic effects of BPA, associated with improvements in cognitive dysfunction and reductions in plasma A{beta}1-42 and p-tau217 levels in patients with CTEPH.