CTEPH is characterized by chronic obstruction of major pulmonary arteries with organized thrombi and a concomitant small-vessel arteriopathy that predominantly affects arteries in non obstructed lung territories. Despite CTEPH is being categorized as precapillary PH by guidelines, CTEPH is frequently complicated by a postcapillary disease component that is not only due to involvement of small pulmonary venules, but also due to increased LVFP. The authors demonstrate that at least 11% of patients with CTEPH have elevated LVFP at the time of diagnosis, representing an additional disease component in CTEPH that independently impacts prognosis. Hemodynamic seems to be more affected and is presenting more complex, therefore further research is needed in order to define hemodynamic phenotype in more detail.
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