Chronic thromboembolic pulmonary hypertension (CTEPH) is successfully treatable with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, and medical therapy. Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management risk score (RRS) is able to predict long-term outcome in inoperable patients or in patients with residual PH after surgery. We performed a post hoc analysis of RRS in patients who were enrolled in the CTREPH study (NCT01416636), a randomized, double-blind clinical trial comparing high-dose and low-dose subcutaneous (SC) treprostinil in patients with severe CTEPH that was classified by an interdisciplinary CTEPH team as nonoperable, or as persistent or recurrent pulmonary hypertension after PEA. Baseline mean RRS was similar in both treatment groups (8.7 in high-dose arm vs. 8.6 in low-dose arm), but mean RRS change from baseline to Week 24 was greater in the high-dose treprostinil group than in the low-dose treprostinil group (-0.88 vs. -0.17). The difference in RRS change from baseline to Week 24 between high dose versus low dose was statistically significant with mean difference of -0.70 (95% confidence interval: -1.36 to -0.05, p = 0.0352), and was driven mainly by improvement of World Health Organization functional class and N-terminal pro-brain natriuretic peptide concentration. SC treprostinil therapy administered in standard dose had positive effect on the risk profile measured by RRS in patients with inoperable or persistent/recurrent severe CTEPH. Although our study was limited by the small sample size and post hoc nature, assessment of risk profile is of great importance to this particular patient population with very poor prognosis.

2nd Department of Surgery Department of Cardiovascular Surgery General University Hospital Prague Czech Republic

Clinical Department of Cardiology and Angiology of the 2nd Department of Medicine General University Hospital Prague Czech Republic

Department of Cardiac and Vascular Diseases Pulmonary Circulation Centre Jagiellonian University Medical College and John Paul 2 Hospital in Krakow Krakow Poland

Department of Cardiology and Angiology of Medical Faculty Slovak Medical University and National Institute of Cardiovascular Diseases Bratislava Slovakia

Department of Cardiothoracic Surgery Medical University of Vienna Vienna Austria

Department of Internal Medicine 1 University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

Department of Internal Medicine 2 Division of Cardiology Medical University of Vienna Vienna Austria

Department of Internal Medicine 2 Ordensklinikum Linz Elisabethinen Linz Austria

Department of Pulmonary Circulation and Thromboembolic Diseases European Health Center Otwock Poland

Department of Pulmonary Diseases and Allergy Ljubljana University Medical Centre Ljubljana Slovenia

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