Pulmonary Hypertension

RV Adaptation After PEA vs BPA in CTEPH — Multicenter Cardiac MRI Study

• Authors: Dutch + Danish CTEPH centers
• Journal / date: European Respiratory Journal, 2026
• DOI / URL: 10.1183/13993003.02314-2025 | PMID 42097683
• Source basis: Abstract only
• Study type: Prospective multicenter cohort
• PH group: Group 4 (CTEPH)
• Population: 93 patients (PEA n=50, BPA n=43) with cardiac MRI + RHC + exercise testing + biomarkers at baseline and 6 months; subgroup at 18 months
• Key findings:
• BPA patients were older (68.9 vs 62.4 yr) and on more PH medication.
• PEA: greater absolute reductions in mPAP, PVR (p-interaction ≤0.001 for both), and indexed RV mass/volumes (RVEDVi 76.2 vs 92.2 mL/m², p<0.001; RVESVi 39.0 vs 49.0, p=0.014).
• Both interventions significantly improved RV afterload, function, and exercise capacity (all p<0.05).
• "Remodeling sensitivity to unloading appeared broadly similar" — the RV responds proportionally to the unloading achieved.
• Why it matters (clinical takeaway):
• Both PEA and BPA achieve real RV reverse remodeling — the magnitude of remodeling tracks the hemodynamic improvement, not the modality itself.
• PEA remains the deeper unloading option and is preferred for operable CTEPH, but BPA delivers proportionally similar RV recovery in inoperable / older / higher-comorbidity patients.
• Supports continued aggressive use of BPA in patients who aren't surgical candidates, and use of cardiac MRI to track RV reverse remodeling as an objective response marker.
• Caveats / limitations: Not randomized — large baseline differences (age, medications). Authors call for RCT.
• Referenced trials pulled forward: None this pass.