Haemodynamic and functional outcomes by treatment strategy in chronic thromboembolic pulmonary hypertension: 18-month results

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension. Treatment options include pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and medical therapy with soluble guanylate cyclase (sGC) stimulators. Data on haemodynamic and functional outcomes according to treatment strategy remain limited. Purpose To evaluate haemodynamic and functional outcomes according to treatment strategy in patients with CTEPH during 18 months of follow-up. Methods This retrospective study included patients with confirmed CTEPH treated with PEA, BPA, or sGC stimulator monotherapy. Baseline and follow-up data over 18 months were collected from expert centres. Diagnosis was established by right heart catheterisation, ventilation/perfusion scanning, and pulmonary angiography. Changes in haemodynamics, six-minute walk distance, NT-proBNP, echocardiographic parameters, and World Health Organization (WHO) functional class were assessed between baseline and follow-up. Results Between September 2010 and January 2021, 74 patients were included: 26 (35.1%) underwent PEA, 15 (20.3%) received BPA, and 33 (44.6%) were treated with sGC stimulator monotherapy. At repeat right heart catheterisation, pulmonary vascular resistance improved most after PEA (9.8 ± 6.5 to 3.9 ± 2.0 Wood units), followed by BPA (10.1 ± 3.5 to 5.4 ± 3.3 Wood units) and sGC stimulator therapy (12.8 ± 5.6 to 9.9 ± 4.9 Wood units) (all p < 0.05). Improvements in six-minute walk distance, NT-proBNP, echocardiographic parameters, and WHO functional class were most pronounced in the PEA group, intermediate in the BPA group, and least marked with sGC stimulator therapy. Conclusions Treatment strategy was associated with distinct magnitudes of haemodynamic and functional improvement. PEA achieved the greatest benefit, BPA yielded meaningful but smaller improvements, and sGC stimulator monotherapy provided modest gains with a favourable safety profile. Further studies are needed to define optimal sequencing and long-term outcomes.