Chronic Thromboembolic Pulmonary Hypertension
Conditions
Keywords
Chronic Thromboembolic Pulmonary Hypertension, Telerehabilitation
Brief summary
Balloon pulmonary angioplasty (BPA) is a new method of treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent CTEPH after surgery. BPA improves or even normalises hemodynamic parameters measured during a right heart catheterization. Nevertheless, the vast majority of patients retain dyspnea and impaired exercise capacity despite considerable hemodynamic improvements. Pulmonary rehabilitation (RHB) can improve symptoms, quality of life and exercise capacity in patients with CTEPH. Unfortunately, access to RHB remains a concern in many countries. Tele-rehabilitation (tRHB) has been shown feasible and effective some cardiac or pulmonary diseases. This randomized controlled study aims at comparing the effects of tRHB with the effects of simple advices regarding exercising in CTEPH patients with normalized or near-normalized pulmonary hemodynamics after BPA treatment.
Detailed description
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism leading to dyspnea, effort limitation and sometimes right heart failure and death. Balloon pulmonary angioplasty (BPA) is a new method of treatment for inoperable CTEPH or persistent CTEPH after surgery. BPA restores blood flow in the treated areas and improves or even normalises hemodynamic parameters measured during a right heart catheterization. Nevertheless, the vast majority of patients retain dyspnea and impaired exercise capacity after angioplasty procedures. Exercise training has been demonstrated to alleviate exercise dyspnea and to improve exercise capacity in many chronic cardiopulmonary conditions. Pulmonary rehabilitation (RHB) can improve symptoms, quality of life and exercise capacity in patients with pulmonary vascular disease of different etiologies including CTEPH. Furthermore, RHB does not present any particular risk for CTEPH patients with normalized or near-normalized pulmonary hemodynamics. Unfortunately, access to RHB remains a concern in many countries. Tele-rehabilitation (tRHB) has been shown feasible and effective some cardiac or pulmonary diseases. Our hypothesis is that tRHB may also be effective in CTEPH patients with normalized or near-normalized pulmonary hemodynamics after BPA treatment. This randomized controlled study aims at comparing the effects of tRHB with the effects of simple advices regarding exercising in CTEPH patients with normalized or near-normalized pulmonary hemodynamics after BPA treatment.
Interventions
PROCEDUREtelerehabilitation
24 sessions (less Thant 1h hour each) of tele rehabilitation. Patients can choose among several activities (gym, dance, cardio training, ...)
Sponsors
University Hospital, Grenoble
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years old * Patients who have undergone pulmonary angioplasty for CTEPH (group 4 of the international classification) * Patients with a mean pulmonary artery pressure \<= 30 mmHg and cardiac output \> 2.5 L/min/m2 at the last angioplasty session * Patients who had completed an incremental cardiopulmonary exercise test * Patients affiliated to the French social security system * Patients with signed informed consent
Exclusion criteria
* Patients unable to complete an incremental cardiopulmonary exercise test * Patients unable to complete a 6-minutes walking test, 3-minutes chair raising test and a rehabilitation * Patient unable, for technical or any other reason, to connect via the Internet for remote monitoring and/or telerehabilitation * Patient for whom a refusal to participate in a rehabilitation programme is anticipated * Patient who has participated in a rehabilitation programme in the 6 months prior to the date of inclusion * Patients referred to in Articles L1121-5 to L1121-8 of the CSP (pregnant women, parturients, nursing mothers, persons deprived of their liberty by a judicial or administrative decision, persons under psychiatric care and adults subject to a legal protection measure or unable to express their consent).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference of endurance time on cycloergometer | At inclusion and after 3 months | Expressed in seconds and calculated as follow: endurance time after 3 months - endurance time at inclusion The two tests are performed at 80% of the maximum power reached during a maximum incremental effort test (performed before inclusion) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 3-minutes chair rise test (3-CRT) | At inclusion and at Month 3 | Number of rises during 3-CRT (n) |
| SF-36 | At inclusion and at Month 3 | Physical dimensions of the SF-36 questionnaire |
| Dyspnea (NYHA scale) | At inclusion, at Month 1, Month 2 and Month 3 | Either I, II, III or IV |
| 6-minutes walking test (6MWT) | At inclusion and at Month 3 | Distance walked in 6-min (in meters) |
| St George Respiratory Questionnaire (SGRQ) | At inclusion and at Month 3 | Total SGRQ score |
| Dyspnea (mMRC score) | At inclusion, at Month 1, Month 2 and Month 3 | Either 0, 1, 2, 3 or 4 |
| Telerehabilitation | Through study completion, an average of 3 months | Total number of sessions achieved |
Contacts
Primary ContactBruno Degano, MD, PhD
Outcome results
None listed