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Acute vasoreactivity (≥10% mPAP reduction) independently predicts better 5-year survival in chronic thromboembolic pulmonary hypertension.
As per the outcomes of a large prospective study, acute vasoreactivity testing at diagnosis may improve risk stratification and treatment decisions in patients with chronic thromboembolic pulmonary hypertension (CTEPH)—a condition where prognostic markers have remained limited compared to pulmonary arterial hypertension.
Researchers evaluated 325 CTEPH sufferers who underwent right heart catheterization with inhaled nitric oxide (40 ppm) testing at diagnosis. Vasoreactivity—marked as a reduction in mean pulmonary arterial pressure (mPAP) with preserved cardiac output—was assessed using three established criteria:
Volunteers were followed for a median of 5.5 years (interquartile range 2.6–9.2 years), and outcomes were analyzed via Cox regression models adjusted for baseline mPAP, age, gender, and WHO functional class.
Key findings
To sum up, baseline vasoreactivity—particularly defined by ≥10% reduction in mPAP—emerges as a high-impact, independent predictor of 5-year transplantation-free survival in CTEPH. It also identifies a subgroup of patients who derive meaningful survival benefit from pulmonary vasodilator therapy, especially when surgery is not performed. This study positions acute vasoreactivity testing as a precision-medicine tool in CTEPH—enabling clinicians to refine prognosis, personalize treatment strategies, and optimize outcomes via a simple, catheterization-based assessment at diagnosis.
Pulmonary Circulation
Prognostic Value of Acute Vasoreactivity in Chronic Thromboembolic Pulmonary Hypertension
Justin A. G. Uphus et al.
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