Chronic thromboembolic pulmonary hypertension after the first episode of pulmonary embolism? How often?

Abstract

Background. Surviving pulmonary embolism (PE) brings a risk of thromboembolic disease chronicity. Chronic thromboembolic pulmonary hypertension (CTEPH) develops as a result of one or multiple pulmonary embolic events. It is an incapacitating long-term complication of thromboembolic disease with a negative impact on the patient's quality of life and prognosis. Contemporary pharmacological and especially surgical treatment possibilities offer hope for the patient's full recovery, but an early diagnosis is crucial for success. Methods. In a prospective study cohort of 97 consecutive patients with a proven diagnosis of PE as the first documented thromboembolic event we tried to estimate the incidence of CTEPH during a 2-year follow-up. Results. Four individuals from our study population developed CTEPH, which represents an incidence of 4.2%. Conclusion. Chronic thromboembolic pulmonary hypertension in pulmonary embolism survivors is a not uncommon complication deserving the attention of clinicians. Patients at risk of CTEPH can be identified for effective follow-up according to echocardiographic finding of elevated pulmonary artery systolic pressure and NT-proBNP levels at the time of hospital discharge.

Incidence and risk factors of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a systematic review and meta-analysis of cohort studies

“…First, our analysis didn't include abstracts, reviews, and conference proceedings, because it's difficult to assess quality from incomplete data. Second, our analysis included the latest 4 studies published in 2016 (5,14,15,22) and 1 study published in 2018 (23). Third, the data from China were also included into our meta-analysis (14,15,21).…”

“…It is more likely to miss potential CTEPH patients if they have other potential causes for pulmonary hypertension; these patients were excluded from some CTEPH studies (2,16,18); (II) different strategies of follow-up may also result in a wide variation of incidences. In several studies, patients who had otherwise unexplained persistent dyspnea on exertion or at rest during follow-up were considered as suspected CTEPH and received further confirming examinations (1)(2)(3)(13)(14)(15)19,23), while other studies included both symptomatic and asymptomatic patients (5,(16)(17)(18)(20)(21)(22); (III) the variations in severity of the initial PE have also been included among the causes of substantial heterogeneity. Based on discussion above, the results need to be interpreted with caution.…”

Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature

“…One study applied the need for further investigation based on a not-further-defined clinical assessment prior to RHC [22]. Three studies targeted patients with a first PE (595 patients in total) [17,44,50] and one study included 87 patients with recurrent VTE only [18]. The other studies focused on a combination of first and recurrent PE.…”

“…One additional study in survivors included 87 patients with recurrent PE only, of whom 5.7% (95% CI 2.5-12.8) were diagnosed with CTEPH after a 22-month follow-up period [18]. Lastly, nine studies focused on survivors without major comorbidity [7,17,27,28,33,38,44,46,50]. In these studies, 1775 patients were followed for 24 months or longer.…”

Study of Cardiac Arrest Caused by Acute Pulmonary Thromboembolism and Thrombolytic Resuscitation in a Porcine Model

“…CTEPH is a common complication in PTE survivors. [ 25 ] In our model, the MPAP increased during CA, and CTEPH occurred regularly during the follow-up of acute PTE. [ 26 ] The increased afterload of the right ventricle caused by pulmonary hypertension, combined with tachycardia, contributed to the high oxygen consumption in the right ventricle.…”