{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:07:21Z","timestamp":1790078841405,"version":"4.0.1"},"reference-count":44,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Progressive right ventricular dysfunction and elevated right atrial pressure, commonly observed in patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH), may lead to systemic venous congestion, including hepatic congestion. The liver fibrosis index (FIB-4) has been proposed as a non-invasive marker of hepatic congestion and fibrosis. Data and evidence regarding the prevalence and clinical significance of elevated FIB-4 index values in patients with CTEPH and\/or right-sided heart failure secondary to pulmonary hypertension (PH) are limited. Furthermore, it remains unclear whether interventional treatment with balloon pulmonary angioplasty (BPA), which improves right ventricular (RV) function and pulmonary hemodynamics and lowers pressure in right atrium and hepatic veins, also alleviates hepatic congestion and imitatively decreases the FIB-4 index. Aim: To investigate whether BPA-induced improvement in pulmonary hemodynamics and right ventricular function is accompanied by changes in the FIB-4 index in patients with CTEPH. Methods: This single-centre, retrospective analysis included 36 consecutive patients with CTEPH who underwent BPA and were followed at a tertiary PH centre between June 2020 and November 2025. All patients underwent comprehensive baseline evaluation prior to the first BPA session and repeated assessment after completion of the staged BPA treatment. Clinical evaluation included WHO functional class (WHO-FC) and the 6 min walk distance (6MWD). Right heart catheterization (RHC) was performed according to standards. Laboratory testing included N-terminal pro-brain natriuretic peptide (NT-proBNP), creatinine, aminotransferases (ALT, AST), complete blood count, and the fibrosis-4 (FIB-4) index. FIB-4 was classified into three categories: &lt;1.3 indicating low FIB-4 category, 1.3\u20132.67 representing an indeterminate or borderline range, and &gt;2.67 indicating high FIB-4 category. Change in FIB-4 status was assessed categorically. Improvement was defined as a downward shift of \u22651 category between baseline and follow-up; stability was defined as no categorical change; and worsening as an upward shift of \u22651 category. Results: Among the 36 patients in whom BPA treatment was initiated, 31 completed the planned BPA sessions, underwent the final assessment, and were eligible for the current analysis. This resulted in a median decrease in mRAP of \u22123 (\u22125 to \u22121) mmHg, in mPAP of \u22129 (\u221213 to \u22121) mmHg, and in PVR of \u22121.7 (\u22123.9 to \u22120.3) WU, accompanied by an increase in CI of 0.24 (\u22120.15 to 0.71) L\/min\/m2 and a reduction in NT-proBNP of \u2212317 (\u22121553 to \u221230) pg\/mL. In parallel, FIB-4 decreased by a median of \u22120.20 (\u22120.50 to \u22120.07). At baseline, 7 patients had low FIB-4 values (&lt;1.3), 16 had indeterminate values (1.3\u20132.67), and 8 had high FIB-4 values (&gt;2.67). All patients with baseline FIB-4 &lt;1.3 remained in the low category. Among the 24 patients with baseline FIB-4 \u22651.3, 8 (33.3%; exact 95% CI 15.6\u201355.3%) improved by one category, 14 (58.3%) remained stable, and 2 (8.3%) worsened (exact two-sided sign test among patients with categorical change, p = 0.109). In the exploratory binary analysis of improvement versus no improvement, with stable and worsening cases classified as no improvement, the exact one-sided McNemar test yielded p = 0.0039. In an exploratory multivariate linear regression analysis, only the change in NT-proBNP was associated with a concurrent change in FIB-4 (p = 0.0375). Conclusions: In our study, the FIB-4 index was elevated in 77.4% of patients with CTEPH. BPA is an effective procedure that markedly improves hemodynamics and alleviates right heart failure. In addition, FIB-4 category in every third patient who had elevated FIB-4 decreased following BPA. A reduction in NT-proBNP, a marker of right ventricular dysfunction, was the only variable associated with concurrent FIB-4 change.<\/jats:p>","DOI":"10.3390\/jcm15187251","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Balloon Pulmonary Angioplasty (BPA) on Changes in the Liver Fibrosis Index (FIB-4 Index) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH)"],"prefix":"10.3390","volume":"15","author":[{"given":"Ilona","family":"Skoczylas","sequence":"first","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Piegza","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0672-6369","authenticated-orcid":false,"given":"Marcin","family":"Walig\u00f3ra","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, 31-202 Krakow, Poland"},{"name":"Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland"},{"name":"Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1200-1617","authenticated-orcid":false,"given":"Maciej","family":"Skoczylas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine & Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Wr\u00f3bel","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Tajstra","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariusz","family":"G\u0105sior","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"20406223211002961","DOI":"10.1177\/20406223211002961","article-title":"Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: Data from the Polish multicenter registry (BNP-PL)","volume":"12","author":"Mroczek","year":"2021","journal-title":"Ther. 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