The hemodynamic and clinical characteristics of recurrent hemoptysis in bronchiectasis patients after vascular intervention procedures

Background: Bronchial artery embolization (BAE) is an established treatment for hemoptysis in bronchiectasis, yet the risk of post-procedural recurrence remains significant. This study aimed to investigate the clinical and hemodynamic predictors of hemoptysis recurrence in patients with bronchiectasis following BAE. Methods: We retrospectively analyzed 426 patients with bronchiectasis-related hemoptysis who underwent BAE between 2019 and 2022. Patients were followed for a median of 2 years to monitor recurrence. Baseline clinical data, angiographic findings, and hemodynamic parameters obtained via right heart catheterization were compared between recurrence and non-recurrence groups. Multivariate Cox proportional hazards regression was employed to identify independent risk factors for recurrence. Results: 14.70%, P=0.003). Angiographically, the recurrence group had significantly more non-bronchial systemic artery (NBSA) branches and total embolized vessels (P<0.001). Hemodynamically, the recurrence group showed significantly higher mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and total pulmonary resistance (TPR) (all P<0.05). Multivariate Cox regression identified the presence of systemic-to-pulmonary shunts (SPS) [hazard ratio (HR) =2.434; 95% confidence interval (CI): 1.173-5.049; P=0.02] and increased TPR (HR =1.123; 95% CI: 1.014-1.242; P=0.03) as independent predictors of recurrence. Conclusions: BAE is an effective intervention for hemoptysis in bronchiectasis, but recurrence is common. The presence of SPS and elevated TPR are key independent risk factors for post-BAE recurrence, highlighting the importance of hemodynamic assessment in predicting long-term outcomes.