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Incidence and predictors of chronic thromboembolic pulmonary hypertension following first episode of acute pulmonary embolism
Affiliations- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Tehran Heart Center, Tehran University of Medical Sciences, Teheran, Iran
open access
Abstract
Introduction: Late obstructive pulmonary artery remodeling presented as CTEPH portends adverse sequelae and therapeutic challenges. Although progressive dyspnea on exertion beyond three-month period of treatment with anticoagulants is a diagnostic cornerstone, uncertainty still surrounds early identification and risk factors.
Material and methods: We have conducted a prospective study among survivors of acute pulmonary embolism (PE) who were treated by anticoagulants for at least 3 months. Patients with preexisting pulmonary hypertension (PH), severe chronic obstructive pulmonary disease (COPD), and low ejection fraction (EF) in baseline echocardiography (EF < 30%) were excluded. Complete follow-up for 290 subjects were performed. According to a predetermined stepwise diagnostic protocol, patients with exertional Dyspnea and PH probable features in echocardiography underwent lung perfusion scan.
Results: Cumulative two-year incidence of CTEPH was 8.6% (n = 25). There was no patient with normal baseline right ventricular (RV) function in CTEPH group. In the same way, none of these patients had only segmental involvement in baseline CT angiography (CTA) in CTEPH group. Greater proportion of CTEPH group received fibrinolytic therapy, however the difference was not significant (2.6% vs 8 %, P = 0.16). Multivariate logistic regression demonstrated significant association of RV diameter, and PAP in baseline echocardiography as well as RV strain in CTA with development of CTEPH. Corresponding odds ratios were 1.147 (1.063–1.584) P < 0.0001) , 1.062 (1.019–1.106, P = 0.004), and 2.537 (1.041–6.674), P = 0.027), respectively.
Conclusions: We found that incidence of CTEPH was relatively high in the present investigation. RV diameter, baseline PAP and RV dysfunction were independent predictors of CTEPH.
Abstract
Introduction: Late obstructive pulmonary artery remodeling presented as CTEPH portends adverse sequelae and therapeutic challenges. Although progressive dyspnea on exertion beyond three-month period of treatment with anticoagulants is a diagnostic cornerstone, uncertainty still surrounds early identification and risk factors.
Material and methods: We have conducted a prospective study among survivors of acute pulmonary embolism (PE) who were treated by anticoagulants for at least 3 months. Patients with preexisting pulmonary hypertension (PH), severe chronic obstructive pulmonary disease (COPD), and low ejection fraction (EF) in baseline echocardiography (EF < 30%) were excluded. Complete follow-up for 290 subjects were performed. According to a predetermined stepwise diagnostic protocol, patients with exertional Dyspnea and PH probable features in echocardiography underwent lung perfusion scan.
Results: Cumulative two-year incidence of CTEPH was 8.6% (n = 25). There was no patient with normal baseline right ventricular (RV) function in CTEPH group. In the same way, none of these patients had only segmental involvement in baseline CT angiography (CTA) in CTEPH group. Greater proportion of CTEPH group received fibrinolytic therapy, however the difference was not significant (2.6% vs 8 %, P = 0.16). Multivariate logistic regression demonstrated significant association of RV diameter, and PAP in baseline echocardiography as well as RV strain in CTA with development of CTEPH. Corresponding odds ratios were 1.147 (1.063–1.584) P < 0.0001) , 1.062 (1.019–1.106, P = 0.004), and 2.537 (1.041–6.674), P = 0.027), respectively.
Conclusions: We found that incidence of CTEPH was relatively high in the present investigation. RV diameter, baseline PAP and RV dysfunction were independent predictors of CTEPH.
Keywords
pulmonary hypertension; pulmonary embolism; CTEPH; echocardiography; predictor; RV dysfunction
About this articleTitle
Incidence and predictors of chronic thromboembolic pulmonary hypertension following first episode of acute pulmonary embolism
Journal
Advances in Respiratory Medicine
Issue
Article type
Research paper
Pages
539-547
Published online
2020-12-30
DOI
10.5603/ARM.a2020.0200
Pubmed
Bibliographic record
Adv Respir Med 2020;88(6):539-547.
Keywords
pulmonary hypertension
pulmonary embolism
CTEPH
echocardiography
predictor
RV dysfunction
Authors
Sahar Asl Fallah
Saeed Ghodsi
Hamidreza Soleimani
Mehrnaz Mohebi
Ali Hossein Sabet
Hamid Ariannejad
Shahpour Shirani
Sakineh Jahanian
Yaser Jenab
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