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SGLT2i in HFpEF — EECC MCQ

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HardHeart FailureSGLT2i in HFpEFEECC

Six months after pulmonary embolism, a patient remains breathless despite therapeutic anticoagulation. Right-heart catheterisation confirms pre-capillary pulmonary hypertension, V/Q imaging shows mismatched defects and angiography demonstrates bilateral surgically accessible lobar webs. An expert CTEPH team finds no prohibitive comorbidity. Which disease-modifying treatment is preferred?

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Correct answer: A — Pulmonary endarterectomy performed at an expert chronic-thromboembolic centre

Pulmonary endarterectomy is potentially curative for operable CTEPH, and accessibility plus patient suitability must be decided by an expert team. Balloon pulmonary angioplasty and riociguat are central options for inoperable or residual disease but should not displace surgery in an operable case. Anticoagulation remains necessary but does not remove organised obstruction, while transplantation is not the initial mechanical treatment when endarterectomy is feasible.

Reference: 2022 ESC/ERS Guidelines for pulmonary hypertension. https://academic.oup.com/eurheartj/article/43/38/3618/6673929