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CTEPH Case Study 1

58-year-old woman with dyspnea on exertion (DOE), fatigue, and mild intermittent chest pain

  • Patient initially referred to local cardiologist

  • Mild hypertension, well-controlled Type II diabetes mellitus

  • No history of deep vein thrombosis or pulmonary embolism (PE)

  • Body mass index (BMI): 28 kg/m2; weight: 168 lbs



  • Normal left ventricular systolic function; grade 1 diastolic dysfunction

  • Mildly dilated right ventricle (RV), with mildly decreased RV function

  • Mild biatrial dilation

  • No significant valvular disease

  • Right ventricular systolic pressure: 64.3 mmHg


Additional studies

  • No evidence of acute PE on computed tomographic pulmonary angiogram (CTPA)

  • NT-proBNP, 1602 pg/mL

  • 6-minute walk distance (6MWD): 402 meters

  • Assessed as WHO Functional Class II


Right heart catheterization

  • Mean pulmonary arterial pressure (mPAP): 44 mmHg

  • Right atrial pressure (RAP): 8.5 mmHg

  • Pulmonary capillary wedge pressure (PCWP): 9.3 mmHg

  • Cardiac output (CO): 3.65 L/min

  • Cardiac index (CI): 2.3 L/min/m2

  • Pulmonary vascular resistance (PVR): 785 dyn∙sec∙cm-5


Key takeaways


Patients with confirmed PH should have a V/Q scan to rule out potentially curable (via pulmonary thromboendarterectomy) CTEPH1

A V/Q scan showing perfusion defects should prompt referral to an experienced center for further evaluation and, if CTEPH is confirmed, operability assessment1


1. Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(suppl D):D92-D99.