Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but serious complication of acute pulmonary embolism. It may be clinically silent and often presents with non-specific symptoms, making diagnosis challenging. We present the case of a man in his 40s who presented with shortness of breath and acute hypoxic respiratory failure. His hypoxia persisted despite pneumonia and superimposed human metapneumovirus infection treatment.Despite two negative CT pulmonary angiograms, clinical suspicion for pulmonary vascular disease remained high given the otherwise unrevealing diagnostic workup, persistent tachycardia, right ventricular dysfunction on echocardiography and persistent mosaic attenuation on CT of the chest. A ventilation-perfusion scan ultimately showed CTEPH, later confirmed by right heart catheterisation and pulmonary angiography.This case highlights the complex presentation and diagnostic challenges of CTEPH. It emphasises that CTEPH should remain on the differential in patients with persistent hypoxia and signs of pulmonary hypertension, even when CT imaging does not demonstrate pulmonary embolism.

Chronic obstructive pulmonary disease (COPD) is associated with cardiovascular disease and chronic kidney disease, but with conflicting estimates. We aimed to quantify the association of COPD and incident cardiovascular diseases, chronic kidney disease and death.

Personalized 'digital twin' technology has the potential to revolutionize target guidance for catheter ablation therapy of ventricular tachycardia (VT); however, concerns regarding the practical implementation of these computationally intensive approaches, along with the robustness of simulation predictions given uncertainty in the interpretation and analysis of clinical imaging data used to reconstruct image-based models, are hindering clinical translation. Here we present a new technical framework that provides near-real-time guidance on VT ablation targets, inherently incorporating uncertainty in reconstructed scar anatomy. We demonstrate close agreement between simulated ECG 'fingerprint' signatures of VT circuits and clinical recordings in ischemic ablation patients, highlighting the need to account for variations in reconstructed scar anatomy to identify the best-matching simulated circuit. Finally, we introduce a robust method for integrating anatomical information across all viable simulated circuits from different model 'instances' into a simulated ablation target heatmap for practical clinical guidance.