{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:14:28Z","timestamp":1780920868787,"version":"3.54.1"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"unspecified","delay-in-days":158,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,5,18]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary hypertension (PH) medical therapies are commonly used as a bridge to balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic PH (CTEPH) but their effectiveness remains unclear. We investigated the impact of different bridging therapies in patients undergoing BPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary analysis of the prospective CTEPD UK Registry to Assess Treatments and OutcomEs registry evaluated the impact of different PH medical therapies on haemodynamic and physiological parameters in the UK\u2019s national CTEPH cohort. Consecutive patients undergoing first BPA at Royal Papworth Hospital between October 2015 and October 2024 were included. Baseline parameters were assessed at CTEPH diagnosis and after initiating bridging PH medical therapy prior to BPA. Periprocedural complications at first BPA were compared between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Haemodynamic and functional parameters of 158\u2009patients were analysed. Patients managed with phosphodiesterase-5 inhibitor (PDE5i) and endothelin receptor antagonist (ERA) dual therapy had higher baseline mean pulmonary artery pressure (mPAP, p=0.019), right atrial pressure (RAP, p=0.038) and pulmonary vascular resistance (PVR, p=0.004) and lower cardiac output (CO, p=0.017) and cardiac index (CI, p=0.029) versus PDE5i or riociguat monotherapy. Dual therapy was associated with a greater percentage increase in CI (40% vs 13%\u2009vs 16%, p&lt;0.001) and CO (34% vs 8%\u2009vs 14%, p&lt;0.001) and a greater percentage decrease in PVR (\u221239% vs \u221230% vs \u221225%, p=0.008) and N-terminal pro-B-type natriuretic peptide (\u221267% vs \u221221% vs \u221232%, p=0.004) compared with PDE5i monotherapy and riociguat monotherapy. These differences persisted after multivariable adjustment for baseline haemodynamic severity. Lung injury occurred more frequently in patients with higher PVR (&gt;540 dynes\u00b7s\u00b7cm\u207b\u2075, p=0.049) and mPAP (&gt;40\u2009mm Hg, p=0.001) at first BPA. Periprocedural complication rates at first BPA were similar between bridging strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bridging with PH medical therapies to first BPA was associated with improved haemodynamic parameters in this real-world observational study. PDE5i and ERA dual therapy was associated with greater haemodynamic improvement than monotherapy with PDE5i or riociguat, without differences in complication rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004169","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:55:30Z","timestamp":1780919730000},"page":"e004169","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing bridging drug therapy approaches prior to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a prospective analysis from the national UK CURATE registry"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1306-8241","authenticated-orcid":false,"given":"Oliver M","family":"Li","sequence":"first","affiliation":[{"name":"University of Cambridge School of Clinical Medicine, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakim","family":"Ghani","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Appenzeller","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Amaral-Almeida","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bambrough","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E","family":"Cannon","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Taboada","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8785-0715","authenticated-orcid":false,"given":"Katherine L","family":"Bunclark","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Toshner","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"},{"name":"Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Sheares","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G","family":"Coghlan","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, Royal Free Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Pepke-Zaba","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"},{"name":"Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3530-3808","authenticated-orcid":false,"given":"Stephen P","family":"Hoole","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK"},{"name":"Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"2026060804552301000_13.1.e004169.1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00169113"},{"key":"2026060804552301000_13.1.e004169.2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0492"},{"key":"2026060804552301000_13.1.e004169.3","doi-asserted-by":"crossref","DOI":"10.1177\/2045894020977300","article-title":"Epidemiology of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: identification of the most accurate estimates from a systematic literature review","volume":"11","author":"Leber","year":"2021","journal-title":"Pulm Circ"},{"key":"2026060804552301000_13.1.e004169.4","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02268-2024","article-title":"Survival trends in patients with chronic thromboembolic pulmonary hypertension: an observational study","volume":"66","author":"Kiko","year":"2025","journal-title":"Eur Respir J"},{"key":"2026060804552301000_13.1.e004169.5","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00879-2022"},{"key":"2026060804552301000_13.1.e004169.6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.21037\/acs-2021-pte-17","article-title":"Pulmonary thromboendarterectomy-the Royal Papworth experience","volume":"11","author":"Jenkins","year":"2022","journal-title":"Ann Cardiothorac Surg"},{"key":"2026060804552301000_13.1.e004169.7","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.chest.2023.03.029","article-title":"Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension","volume":"164","author":"Yang","year":"2023","journal-title":"Chest"},{"key":"2026060804552301000_13.1.e004169.8","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.1016\/j.jacc.2025.04.021","article-title":"Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of an International Multicenter Prospective Registry","volume":"85","author":"Lang","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026060804552301000_13.1.e004169.9","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2019-001144","article-title":"Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: the UK experience","volume":"7","author":"Hoole","year":"2020","journal-title":"Open 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et al . Long-term effects of medical therapy pre- and post-pulmonary endarterectomy-insights from the UK CURATE registry. J Heart Lung Transplant 2026. doi:10.1016\/j.healun.2026.03.020","DOI":"10.1016\/j.healun.2026.03.020"},{"key":"2026060804552301000_13.1.e004169.19","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01032-2015"},{"key":"2026060804552301000_13.1.e004169.20","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02096-2019","article-title":"CAMPHOR score: patient-reported outcomes are improved by pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension","volume":"56","author":"Newnham","year":"2020","journal-title":"Eur Respir J"},{"key":"2026060804552301000_13.1.e004169.21","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01294-2024","article-title":"Chronic thromboembolic pulmonary disease","volume":"64","author":"Kim","year":"2024","journal-title":"Eur Respir J"},{"key":"2026060804552301000_13.1.e004169.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209657"},{"key":"2026060804552301000_13.1.e004169.23","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00039007"},{"key":"2026060804552301000_13.1.e004169.24","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/S2213-2600(24)00027-4","article-title":"Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study","volume":"12","author":"Ghofrani","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026060804552301000_13.1.e004169.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.08.059"},{"key":"2026060804552301000_13.1.e004169.26","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/j.healun.2022.05.002","article-title":"Complications of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: Impact on the outcome","volume":"41","author":"Wiedenroth","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"2026060804552301000_13.1.e004169.27","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13154313","article-title":"Complications of Balloon Pulmonary Angioplasty: A Comprehensive Analysis Based on the Latest ESC Consensus Statement","volume":"13","author":"van Leusden","year":"2024","journal-title":"J Clin Med"},{"key":"2026060804552301000_13.1.e004169.28","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.healun.2021.06.011","article-title":"Serial right heart catheter assessment between balloon pulmonary angioplasty sessions identify procedural factors that influence response to treatment","volume":"40","author":"Hug","year":"2021","journal-title":"J Heart Lung Transplant"},{"key":"2026060804552301000_13.1.e004169.29","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.jcin.2023.01.361","article-title":"Periprocedural Complications With Balloon Pulmonary Angioplasty: Analysis of Global Studies","volume":"16","author":"Jain","year":"2023","journal-title":"JACC Cardiovasc Interv"},{"key":"2026060804552301000_13.1.e004169.30","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02095-2018","article-title":"French experience of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension","volume":"53","author":"Brenot","year":"2019","journal-title":"Eur Respir J"},{"key":"2026060804552301000_13.1.e004169.31","doi-asserted-by":"crossref","unstructured":"Delcroix M , Lang IM , D\u2019Armini AM , et al . Long-term effects of medical treatment in patients with chronic thromboembolic pulmonary hypertension. ERJ Open Res 2025;11. doi:10.1183\/23120541.00769-2025","DOI":"10.1183\/23120541.00769-2025"},{"key":"2026060804552301000_13.1.e004169.32","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.chest.2016.05.024","article-title":"Riociguat: Mode of Action and Clinical Development in Pulmonary Hypertension","volume":"151","author":"Ghofrani","year":"2017","journal-title":"Chest"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:55:37Z","timestamp":1780919737000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,6,8]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2026-004169"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004169","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}