Cross-sectional independent associations of anxiety and depressive symptoms with cardiopulmonary exercise performance in treatment-naïve chronic thromboembolic pulmonary hypertension.

OBJECTIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is often accompanied by anxiety and depressive symptoms, but their associations with objectively measured cardiopulmonary function in treatment-naïve patients remain unclear. This cross-sectional study aimed to investigate the independent associations of anxiety and depressive symptoms with cardiopulmonary exercise testing (CPET) variables in newly diagnosed, untreated CTEPH patients. METHODS: We enrolled 236 newly diagnosed, untreated CTEPH patients. Anxiety and depressive symptoms were assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), respectively. All patients underwent CPET, 6-min walk test (6MWT), and right heart catheterization. Multivariable linear regression models were adjusted for key clinical confounders. RESULTS: After adjustment, higher SAS and SDS scores were independently associated with lower exercise capacity and worse ventilatory efficiency. Depressive symptom scores showed broader associations, remaining independently associated with lower peak oxygen uptake (VO₂peak), lower oxygen uptake at anaerobic threshold, shorter 6MWD, and lower oxygen pulse (all P < 0.05). RER was not significantly associated with either scale. CONCLUSIONS: In treatment-naïve CTEPH patients, higher anxiety and depressive symptom scores were independently associated with lower exercise capacity and worse ventilatory efficiency, with broader associations observed for depressive symptoms. These findings support greater attention to psychological symptoms during initial clinical assessment. Future studies should examine the bidirectional relationship between psychological symptoms and functional recovery.