Related Experiment Video
Updated: Aug 22, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Central versus Peripheral CTEPH-Clinical and Hemodynamic Specifications
Monika Kaldararova1, Iveta Simkova1, Marcela Bohacekova1
1Department of Cardiology and Angiology, CTEPH Expert Centre, Medical Faculty, The National Institute of Cardiovascular Diseases, Slovak Medical University, Pod Krasnou horkou 1, 833 48 Bratislava, Slovakia.
Insights
Central and peripheral chronic thromboembolic pulmonary hypertension (CTEPH) show distinct hemodynamic profiles. Central CTEPH presents with worse hemodynamics, suggesting different disease mechanisms and potential treatment implications.
Area of Science:
- Cardiology
- Pulmonology
- Vascular Medicine
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease caused by persistent arterial obstruction and small-vessel remodeling.
- CTEPH is classified as central or peripheral based on the dominant lesion location, impacting treatment strategies.
Purpose of the Study:
- To investigate and compare the clinical, hemodynamic, and risk factor differences between central and peripheral types of CTEPH.
Main Methods:
- Analysis of 81 patients with confirmed CTEPH, categorized into central (63%) and peripheral (37%) types.
- Comparison of demographic, functional, echocardiographic, invasive hemodynamic, and risk factor data between the two CTEPH types.
Main Results:
- Significant gender differences observed (central: 72.5% male vs. peripheral: 46.7% male).
- Central CTEPH showed significantly worse hemodynamic parameters: higher mean pulmonary arterial pressure (46 vs. 58 mmHg) and transpulmonary gradient (34 vs. 47 mmHg), and lower cardiac index (2.04 vs. 2.5 L.min.m²).
- Acute pulmonary embolism was a more frequent risk factor in central CTEPH (93.8% vs. 60%), while malignancy was more common in peripheral CTEPH (2% vs. 13.3%).
Conclusions:
- Distinct hemodynamic profiles exist between central and peripheral CTEPH, with central disease exhibiting a more severe hemodynamic picture.
- These differences suggest potentially divergent pathophysiological mechanisms or contributing factors affecting the pulmonary vasculature in each CTEPH type.
- Understanding these distinctions is crucial for guiding surgical, interventional, and medical management of CTEPH.
Abstract:
Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic progressive disease, resulting from persistent arterial obstruction combined with small-vessel remodeling. Central and peripheral CTEPH are distinguished, according to the dominant lesion's location. This is important for surgical or percutaneous interventional assessment or for medical treatment. Material and Methods: Eighty-one patients (51 male/30 female) with confirmed CTEPH were analyzed, while the CENTRAL type included 51 patients (63%) and the PERIPHERAL type 30 patients (37%). Results: A significant difference in CENTRAL type vs. PERIPHERAL type was determined in gender (male 72.5% vs. 46.7%; p = 0.0198). No difference was found in age, functional status, or echocardiographic parameters. Invasive hemodynamic parameters showed a significant difference in mean pulmonary arterial pressure (46 vs. 58 mmHg; p = 0.0002), transpulmonary gradient (34 vs. 47 mmHg; p = 0.0005), and cardiac index (2.04 vs. 2.5 L.min.m2; p = 0.02) but not in pulmonary vascular resistance. Risk factors showed a significant difference only in acute pulmonary embolism (93.8% vs. 60%; p = 0.0002) and malignancy (2% vs. 13.3%; p = 0.0426). Conclusions: Our study showed hemodynamic differences between CENTRAL type vs. PERIPHERAL type CTEPH with a worse hemodynamic picture in CENTRAL form. This may indicate a different pathophysiological response and/or possible additional influences contributing especially to the peripheral pulmonary bed affection.
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:21Cardiac Catheterization II: Right Heart Catheterization
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests