CHEST 2026: Day 2 Recap — 4 Headlines to Know

Day 2 of the CHEST 2026 Annual Meeting, held October 18 to 21 in Phoenix, Arizona, brought sessions spanning pulmonary vascular disease, fibrotic interstitial lung disease (ILD), and pulmonary rehabilitation access. Highlights included a review of 3 recent randomized PE trials pointing toward catheter-based intervention in sicker intermediate-risk patients, a practical session on integrating echocardiography with right heart catheterization in pulmonary hypertension, a registry analysis linking short telomeres to Usual Interstitial Pneumonia (UIP) patterning rather than fibrosis burden in ILD, and a debate-based look at new Medicare coverage enabling virtual pulmonary rehabilitation delivery.

Here are 4 headlines from day 2 at CHEST 2026.

1. New Trials Favor PE Intervention in Sicker Intermediate-Risk Patients

Three recent randomized trials — HI-PEITHO, PRAGUE-26, and PEERLESS — each support escalating to catheter-based intervention in intermediate-high-risk PE, particularly in patients with additional markers of severity such as tachycardia, borderline hypotension, or hypoxemia. PEERLESS, the first head-to-head comparison of catheter-based approaches, found large-bore mechanical thrombectomy outperformed catheter-directed thrombolysis on a hierarchical win ratio driven by lower ICU utilization, though no trial has yet demonstrated a mortality benefit. HCPLive spoke with Samantha Pettigrew, MD, of the Lewis Katz School of Medicine at Temple University in a video interview on how these trials are reshaping the decision framework for intermediate-risk PE in 2026.

2. Pair Echo With Right Heart Catheterization in PH: Anjali Vaidya, MD

Accurate pulmonary hypertension diagnosis depends on integrating echocardiographic structural and Doppler data with right heart catheterization hemodynamics, rather than treating either as a standalone gold standard — a point reinforced in a CHEST 2026 session on navigating complex hemodynamics. Vaidya’s group developed the Virtual Echocardiography Screening Tool (VEST), which applies echocardiographic scoring to stratify patients toward PAH versus pulmonary venous or left heart disease hemodynamics, with the goal of narrowing the 2.5- to 3-year diagnostic delay that persists in PAH. HCPLive sat down with Anjali Vaidya, MD, professor of medicine at the Lewis Katz School of Medicine at Temple University, in a video interview on integrating the two modalities, common RHC pitfalls, and where imaging-guided assessment is headed.

3. Short Telomeres Linked to UIP Pattern, Not Fibrosis Extent, in ILD

A registry analysis of 503 patients with ILD found that whole-genome sequencing–derived telomere length below the 10th percentile was associated with a UIP radiologic pattern on CT and higher machine learning–derived MIL-UIP scores, but not with overall fibrosis extent by data-driven texture analysis. The dissociation between patterning and burden suggests telomere dysfunction may influence the fibrotic architecture of ILD rather than its total load, pointing to a biologically distinct pathway that imaging-derived biomarkers may help identify at the clinical level.

4. Virtual Pulmonary Rehab and Matched Care, With Omid Pourshahid, MD

New Medicare coverage under the Consolidated Appropriations Act, 2026, now allows hospital outpatient departments to deliver pulmonary rehabilitation via real-time audio and video at home through December 31, 2027, reimbursed at the same rate as in-person sessions. Pourshahid argued at CHEST 2026 for a matched-care model — assigning patients up front to center-based, hybrid, or virtual programs based on clinical complexity and access barriers — as an alternative to stepped-care pathways he said have failed to reach the majority of eligible patients for decades. HCPLive spoke with Omid Pourshahid, MD, MPH, director of pulmonary rehabilitation at the Lewis Katz School of Medicine at Temple University, in a video interview on how the new coverage changes the conversation and which patients should still start in a center-based program.