Elevated left heart filling pressure can limit the hemodynamic gains achieved with BPA in CTEPH. The study, published in Chest, retrospectively analyzed 170 patients who underwent BPA and were categorized by normal or elevated PAWP.

Elevated PAWP was observed in 13.5% of participants, who were older and had higher body mass index, troponin levels, and a greater prevalence of diabetes, atrial fibrillation, deep vein thrombosis, and chronic kidney disease. Compared with patients with normal PAWP, those with elevated PAWP demonstrated smaller reductions in mean pulmonary artery pressure (p = 0.026), less improvement in pulmonary arterial compliance (p = 0.002), and smaller gains in six-minute walk distance (p = 0.011).

Despite these attenuated improvements, procedural safety and long-term survival did not differ significantly between groups. The results indicate that BPA remains an effective and safe therapeutic option for CTEPH even in the presence of left ventricular dysfunction, although clinical expectations should be adjusted for more modest hemodynamic and functional outcomes.