Right ventricular adaptation after pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a comparative cardiac MRI-based study

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with elevated right ventricular (RV) afterload and progressive RV remodelling. Balloon pulmonary angioplasty (BPA) has emerged as an established and increasingly used alternative to pulmonary endarterectomy (PEA). This study aimed to evaluate haemodynamic, functional and structural cardiac responses to PEA and BPA, with specific focus on RV reverse remodelling. Methods In this prospective, multicentre cohort study, 93 patients with CTEPH (PEA n=50, BPA n=43) from the Netherlands and Denmark underwent cardiac magnetic resonance imaging, right heart catheterisation, exercise testing and biomarker assessment at baseline and 6 months post-intervention. Longitudinal changes were assessed with repeated-measures ANOVA. A subgroup underwent analysis at 18 months. Results BPA patients were older (mean± sd age 68.9±10.1 versus 62.4±11.1 years; p = 0.004), and used more pulmonary hypertension medication. PEA-treated patients had higher RV mass index at baseline (40.1±13.5 versus 32.9±12.2 g·m −2 ; p=0.017), and consistently higher relative RV wall thickness at baseline and follow-up (both 0.4±0.1 versus 0.3±0.1; p