JACC Adv. 2026 Jun 29;5(8):102916. doi: 10.1016/j.jacadv.2026.102916. Online ahead of print.
ABSTRACT
BACKGROUND: Pulmonary vascular obstruction causes dyspnea in chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH). Conventional assessments, like 6-minute walk test (6MWT) and World Health Organization (WHO) functional class (WHO-FC), poorly discriminate the mechanism of dyspnea. Cardiopulmonary exercise testing (CPET) offers direct evaluation of ventilatory efficiency and gas-exchange abnormalities.
OBJECTIVES: The purpose of this study was to evaluate the impact of balloon pulmonary angioplasty (BPA) and pulmonary thromboendarterectomy (PTE) on CPET-derived gas-exchange parameters.
METHODS: In this prospective study, patients with CTEPD or CTEPH evaluated by a multidisciplinary team underwent outpatient point-of-care CPET (SHAPE-HF system) before and after BPA/PTE. The primary endpoint was change in ventilatory efficiency, assessed by the V/VCO (minute ventilation/carbon dioxide production) slope. Secondary endpoints included changes in WHO-FC and 6MWT.
RESULTS: Sixty patients were evaluated; 8 served as controls, and 52 underwent revascularization (20 PTE and 32 BPA). The V/VCO slope improved from 43 to 31 (P < 0.001) after BPA and from 42 to 32 (P = 0.02) after PTE. WHO-FC improved from class III to I in both groups (P < 0.001). The mean 6MWT increased 38 m (381 ± 146 vs 419 ± 151 m; P = 0.03) in the BPA and PTE group (349 ± 162 vs 358 ± 140 m; P = 0.7). V/VCO and Shape-HF Severity Score positively correlated (P < 0.001), but not with 6MWT (P = 0.83). Before and after revascularization, the Shape-HF score improved in the BPA (2.4 vs 1.5; P < 0.001) and the PTE (2.3 vs 1.6; P = 0.01) groups. Survival at 1-year follow-up was a 100%.
CONCLUSIONS: Point-of-care CPET provides objective assessment of gas-exchange improvements after pulmonary revascularization in mild-to-moderate CTEPH/CTEPD.
PMID:42372347 | DOI:10.1016/j.jacadv.2026.102916