Key result
Elevated pre-operative oxLDL is linked to non-response and residual pulmonary hypertension after pulmonary endarterectomy.
Why the study?
Up to 50% of CTEPH patients exhibit residual pulmonary hypertension after pulmonary endarterectomy due to persistent microvasculopathy, prompting the search for pre-operative molecular pathways associated with non-response.
Are pre-operative plasma proteomic and lipid profiles associated with residual pulmonary hypertension after pulmonary endarterectomy in patients with CTEPH?
Observational (n=34)
Are pre-operative plasma proteomic and lipid profiles associated with residual pulmonary hypertension after pulmonary endarterectomy in patients with CTEPH?
Elevated pre-operative circulating oxidized LDL is associated with residual pulmonary hypertension after pulmonary endarterectomy in patients with CTEPH, suggesting a role for lipid remodeling in microvasculopathy.
Answers are grounded in this paper and cite their sources.
May support oxidized LDL as a pre-PEA risk marker for residual PH; hypothesis-generating and requires prospective validation before clinical use.
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by two distinct vascular lesions: proximal thromboembolic obstructions and secondary distal microvasculopathy. These lesions lead to elevated pulmonary vascular resistance (PVR > 2 Wood Units, WU), ultimately resulting in right heart failure and death if left untreated. Pulmonary endarterectomy is the guideline-recommended surgical intervention for obstructive lesions in operable patients. However, up to 50% of patients exhibit residual pulmonary hypertension after surgery, due to persistent microvascular lesions. Aims The aim of this project was to identify molecular pathways in pre-operative plasma samples associated with non-response to surgery, in order to explore potential predictive biomarkers and therapeutic targets for microvasculopathy. Methods We included 34 patients who met the following criteria: availability of pre-operative plasma samples, underwent pulmonary endarterectomy, and had a right heart catheterization at the one-year follow-up visit. A plasma proteomic analysis was performed on these pre-operative samples. Patients were classified as Responders (PVR ≤ 2 WU at one-year post-surgery) or Non-Responders (PVR > 2 WU). Results Responders and Non-Responders exhibited comparable pre-operative hemodynamic parameters. Proteomic analysis of pre-operative plasma samples revealed distinct molecular profiles between the two groups. Enrichment analysis of differentially expressed proteins identified dysregulated pathways related to lipid transport and remodeling in Non-Responders. Pre-operative circulating lipid analysis showed comparable total cholesterol, LDL, HDL, and triglyceride levels between the two groups. However, pre-operative circulating oxidized LDL levels were significantly higher in Non-Responders, whereas plasma total antioxidant capacity was significantly lower. Conclusion Our findings suggest that lipid remodeling, and in particular elevated pre-operative circulating oxidized LDL, is associated with non-response and residual pulmonary hypertension after surgery. Further studies are required to clarify the contribution of elevated oxidized LDL to the development of microvasculopathy in CTEPH.
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Robert et al. (2026) conducted an observational in Chronic thromboembolic pulmonary hypertension (n=34). Elevated pre-operative circulating oxidized LDL vs. Responders (PVR ≤ 2 WU) was evaluated on Non-response to surgery (PVR > 2 WU at one-year post-surgery). Elevated pre-operative circulating oxidized LDL levels were significantly associated with non-response and residual pulmonary hypertension one year after pulmonary endarterectomy.
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