Pulmonary Hypertension
Hemodynamic Reclassification of CTEPD to CTEPH Under New mPAP >20 mmHg Threshold
- Authors: Pulmonary Circulation authors
- Journal / date: Pulmonary Circulation, 2026
- DOI / URL: 10.1002/pul2.70310 | PMID 42064831 | PMC13126078
- Source basis: Full text (open access)
- Study type: Clinical validation cohort
- PH group: Group 4 (CTEPH / CTEPD)
- Key finding: Patients previously labeled CTEPD-without-precapillary-PH under the old definition (mPAP ≥25) but reclassified as CTEPH under the new 2022 ESC/ERS definition (mPAP >20, PVR >2 WU) demonstrate exercise oxygen desaturation and reduced ventilatory efficiency comparable to more-severe CTEPH patients — supporting the clinical relevance of the new threshold.
- Why it matters (clinical takeaway):
- Validates that the lower mPAP threshold isn't just statistical — these patients have measurable exercise physiology abnormalities.
- Reinforces the case for active management (CTEPH workup, BPA/PEA consideration, riociguat) in patients who would have been observed under the old definition.
- Practically: any CTEPD patient with mPAP >20 should now have a CTEPH workup, not just symptomatic management.
- Caveats / limitations: Brief letter/study, limited methodological detail in abstract. No survival data yet for the reclassified group.
- Referenced trials pulled forward: CHEST-1 (riociguat in inoperable CTEPH) — to add to trials/ on next pass.