Characteristics and long‐term survival of patients with chronic thromboembolic pulmonary hypertension in China

Deng, Limin; Quan, Ruilin; Yang, Yuanhua; Yang, Zhenwen; Tian, Hui; Li, Shengqing; Shen, Jieyan; Ji, Yingqun; Zhang, Gangcheng; Zhang, Caojin; Wang, Guangyi; Liu, Yu-Hao; Cheng, Zhaozhong; Yu, Zaixin; Zhang, Song; Zheng, Zeqi; Cui, Wei; Chen, Yu‐Cheng; Liu, Shuang; Xiong, Changming; Shan, Guangliang; He, Jian‐Guo

doi:10.1111/resp.13947

Cited by 23 publications

(31 citation statements)

References 26 publications

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“…Particularly, it is difficult for us to determine whether the patients had a prior history of VTE. However, this would be less likely to bias our findings considering that the prevalence of a prior history of VTE in this study is comparable to that in previous publications (1,31). Second, the sample size of patients without a prior history of VTE was relatively small.…”

Section: Discussionmentioning

confidence: 54%

Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

Zhu

Zhou

Wei

et al. 2021

Front. Cardiovasc. Med.

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Background: The association between anticoagulation outcomes and prior history of venous thromboembolism (VTE) in chronic thromboembolic pulmonary hypertension (CTEPH) has not been established. This study aimed to compare the efficacy and safety of anticoagulation treatment in CTEPH patients with and without prior history of VTE.Methods: A total of 333 CTEPH patients prescribed anticoagulants were retrospectively included from May 2013 to April 2019. The clinical characteristics were collected at their first admission. Incidental recurrent VTE and clinically relevant bleeding were recorded during follow-up. The Cox proportional regression models were used to identify potential factors associated with recurrent VTE and clinically relevant bleeding.Results: Seventy patients (21%) without a prior history of VTE did not experience recurrent VTE during anticoagulation. Compared to CTEPH patients without a prior history of VTE, those with a prior history of VTE had an increased risk of recurrent VTE [2.27/100 person-year vs. 0/100 person-year; hazard ratio (HR), 8.92; 95% confidence interval (CI), 1.18–1142.00; P = 0.029] but a similar risk of clinically relevant bleeding (3.90/100 person-year vs. 4.59/100 person-year; HR, 0.83; 95% CI, 0.38–1.78; P = 0.623). Multivariate Cox analyses suggested that a prior history of VTE and interruption of anticoagulation treatments were significantly associated with an increased risk of recurrent VTE, while anemia and glucocorticoid use were significantly associated with a higher risk of clinically relevant bleeding.Conclusions: This study is the first to reveal that a prior history of VTE significantly increases the risk of recurrent VTE in CTEPH patients during anticoagulation treatment. This finding should be further evaluated in prospective studies.

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Section: Discussionmentioning

confidence: 54%

Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

Zhu

Zhou

Wei

et al. 2021

Front. Cardiovasc. Med.

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“…However, why only a minority of patients (cumulative incidence 0.1–9.1%) may develop PH after an initial episode of PE remains to be clarified [ 13 , 14 , 15 , 16 ]. Some epidemiological studies have identified some predisposing factors offering some insight as to the etiology of CTEPH [ 17 , 18 , 19 ]. Based on available data, it can be stated that CTEPH originates from a remodeling process of the vessel wall after embolic obstruction and is initiated and enhanced by the combination of impaired angiogenesis, reduced fibrinolysis, and endothelial dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Chronic Thromboembolic Pulmonary Hypertension: An Update

et al. 2022

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease observed in a small proportion of patients after acute pulmonary embolism (PE). CTEPH has a high morbidity and mortality rate, related to the PH severity, and a poor prognosis, which mirrors the right ventricular dysfunction involvement. Pulmonary endarterectomy (PEA) reduces pulmonary vascular resistance, making it the treatment of choice and should be offered to operable CTEPH patients, as significant symptomatic and prognostic improvement has been observed. Moreover, these patients may also benefit from the advances made in surgical techniques and pulmonary hypertension-specific medication. However, not all patients are eligible for PEA surgery, as some have either distal pulmonary vascular obstruction and/or significant comorbidities. Therefore, surgical candidates should be carefully selected by an interprofessional team in expert centers. This review aims at making an overview of the risk factors and latest developments in diagnostic tools and treatment options for CTEPH.

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“…The majority of the patients in the HOPE registry are women and a history of PE/VTE is obvious in half of the patients, in concordance with the recently published data on the International CTEPH Registry [10], where the median age was 62 years for women and 63 for men and an episode of VTE was present in more than 70% of the enrolled patients. The Japanese registry [11] revealed 50.4% and 37.2% of patients had a history of deep vein thrombosis and acute pulmonary embolism, respectively. The corresponding percentages were 56.1% and 74.8% in the large European database [12] and in concordance with this registry, a large proportion of our patients had a history of PE (49%)) and DVT (30.6%) and a significant number had a history of splenectomy, perhaps due to the high prevalence of haemoglobinopathies in Greece.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Demerouti

Karyofyllis

Voudris

et al. 2021

JCM

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Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if left untreated, characterized by pulmonary vascular bed obstruction due to unresolving thromboembolic material. The Hellenic pulmonary hypertension registry (HOPE) was launched in Greece in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. In total, 98 patients with CTEPH were enrolled from January 2015 until November 2019. Of these patients, 55.1% represented incident population, 50% were classified in the World Health Organization functional class II and 49% had a history of acute pulmonary embolism. The median values of pulmonary vascular resistance (PVR) and cardiac index were 7.4 (4.8) WU and 2.4 (1.0) L/min/m2, respectively, the mean diffusing capacity for carbon monoxide was 74.8 ± 20.6%, the median 6-minute walk distance was 347 (220) meters and the median value of N Terminal-pro brain natriuretic peptide was 506.0 (1450.0) pg/mL. In total, 60.2% of the patients were under pulmonary arterial hypertension-targeted therapy at the time of enrolment; specifically, riociguat was received by 35.7% of the patients and combination therapy was the preferred strategy for 16% of the patients. In total, 74 patients were evaluated for pulmonary endarterectomy (PEA), 34 (45.9%) were assessed as operable but only 23 of those (31.1%) finally underwent PEA. The remaining 40 patients were ineligible for PEA according to the operability assessment and 13 (17.6%) of them underwent balloon pulmonary angioplasty. The age of the non-operable patients was significantly higher than the operable patients (p < 0.001), while there was no significant difference with regard to the history of coagulopathies between the operable and non-operable patients (p = 0.33).

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Characteristics and long‐term survival of patients with chronic thromboembolic pulmonary hypertension in China

Cited by 23 publications

References 26 publications

Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

Chronic Thromboembolic Pulmonary Hypertension: An Update

Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

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