Background and Aim: Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by pulmonary artery obstruction by persistent organized thrombus and remodeling of pulmonary vascular structures. CTEPH treatment in considered as a multimodal approach including pulmonary endarterectomy (PEA) surgery, balloon pulmonary angioplasty and medical treatment. We aimed to report our experience of 12 years with CTEPH patients and describe risk factors for mortality in a real-life setting.

Methods: Patients older than 18 years old evaluated by a multidisciplinary expert team between 01/07/2011 and 01/07/2023 and diagnosed as CTEPH were included in the study.

Results: The study population consisted of 32 CTEPH patients, with a mean age of 61.0 ± 13.8 years and a median follow-up duration of 28 months. At the end of the follow-up period 13 (40.6%) patients were dead. The high neutrophil-to-lymphocyte ratio (NLR) and high BNP measurements at the time of diagnosis, along with low BNP and PAP changes in the first year, were observed in patients with mortality. Survival analysis, including NLR, BNP, pulmonary endarterectomy, and Hct; showed that high NLR and not undergoing surgical treatment are independently associated with mortality.

Conclusion: Our study emphasizes the importance of PEA surgery in treatment of CTEPH in addition to the importance of BNP trajectories and neutrophil to lymphocyte ratio as prognostic biomarkers. Further studies might evaluate the accuracy of easily obtained measurements such as NLR can be used to categorize patients with high risk.