Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT

Perrot, Marc de; Gopalan, Deepa; Jenkins, David P.; Lang, Irene; Fadel, Élie; Delcroix, Marion; Benza, Raymond L.; Heresi, Gustavo A.; Kanwar, Manreet; Granton, John; McInnis, Micheal; Klok, Frederikus A.; Kerr, Kim M.; Pepke‐Zaba, Joanna; Toshner, Mark; Быкова, А А; Armini, Andrea M. D’; Robbins, Ivan M.; Madani, Michael M.; McGiffin, David C.; Wiedenroth, Christoph B.; Mafeld, Sebastian; Opitz, Isabelle; Mercier, Olaf; Uber, Patricia A.; Frantz, Robert P.; Auger, William R.

doi:10.1016/j.healun.2021.07.020

Cited by 49 publications

(71 citation statements)

References 268 publications

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“…A diagnosis of CTEPH should be suspected in the acute setting by the presence of long-standing shortness of breath, large clot burden on CT scan and evidence of pulmonary hypertension on echocardiogram [ 18 ]. These patients are frequently haemodynamically stable despite an impressive extent of thromboembolic material on the CT pulmonary angiogram (CTPA) due to the chronic adaptation of the right ventricle.…”

Section: Indications For Surgical Embolectomymentioning

confidence: 99%

Role of extracorporeal membrane oxygenation and surgical embolectomy in acute pulmonary embolism

Perrot¹

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewSurgery is an important option to consider in patients with massive and submassive pulmonary emboli. Earlier intervention, better patient selection, improved surgical techniques and the use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) have contributed to improve the safety of surgery for pulmonary emboli. Recent findingsVA ECMO is rapidly changing the initial management of patients with massive pulmonary emboli, providing an opportunity for stabilization and optimization before intervention. The early and long-term consequences of acute pulmonary emboli are better understood, in particular with regard to the risks of chronic thromboembolic pulmonary hypertension (CTEPH), an entity that should be identified in the acute setting as much as possible. The presence of chronic thromboembolic pulmonary disease can be associated with persistent haemodynamic instability despite removal of the acute thrombi, particularly if pulmonary hypertension is established. The pulmonary embolism response team (PERT) is an important component in the management of massive and submassive acute pulmonary emboli to determine the best treatment options for each patient depending on their clinical presentation.

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Section: Indications For Surgical Embolectomymentioning

confidence: 99%

Role of extracorporeal membrane oxygenation and surgical embolectomy in acute pulmonary embolism

Perrot¹

2022

Current Opinion in Pulmonary Medicine

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“…3 In most cases, clinicians do not have access to pulmonary vascular pathology because traditional vascular examination mainly includes invasive procedures, such as histopathology, right heart catheterization, and/or angiography. [4][5][6][7] With the improvement in computed tomography (CT) technology and quantitative analysis, the pulmonary vessels may be evaluated noninvasively. The percentage of cross-sectional area (CSA) of small pulmonary vessels smaller than 5 mm 2 to the total lung area (%CSA<5) is one of the most commonly used two-dimensional CT vascular parameters, which correlates with histological vascular CSA.…”

Section: Introductionmentioning

confidence: 99%

“…Figure5 Association between %CSA<5 and %LAA-950. The fitting effect of segmented regression (adjust R2, 0.474; P <0.001) was much better than ordinary linear regression (adjust R2, 0.332, P<0.001).…”

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confidence: 99%

Correlations of Computed Tomography Measurement of Distal Pulmonary Vascular Pruning with Airflow Limitation and Emphysema in COPD Patients

Tang¹,

Wang²,

Liang³

et al. 2022

COPD

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Background Pulmonary vascular alteration is an important feature of chronic obstructive pulmonary disease (COPD), which is characterized by distal pulmonary vascular pruning in angiography. We aimed to further investigate the clinical relevance of pulmonary vasculature in COPD patients using non-contrast computed tomography (CT). Methods Seventy-one control subjects and 216 COPD patients completed the questionnaires, spirometry, and computed tomography (CT) scans within 1 month and were included in the study. Small pulmonary vessels represented by percentage of cross-sectional area of pulmonary vessels smaller than 5 mm 2 or 5–10 mm 2 to the total lung fields (%CSA<5 or %CSA5–10, respectively) were measured using ImageJ software. Spearman correlation was used to investigate the relationship between %CSA<5 and airflow limitation. A receiver operating characteristic (ROC) curve was built to evaluate the value of %CSA<5 in discriminating COPD patients from healthy control subjects. Segmented regression was used to analyze the relationship between %CSA<5 and %LAA-950 (percentage of low-attenuation areas less than −950 HU). Results We found a significant correlation between %CSA<5 and forced expiratory volume in one second (FEV1) percentage of predicted value (%pred) (r = 0.564, P < 0.001). The area under the ROC curve for the value of %CSA<5 in distinguishing COPD was 0.816, with a cut-off value of 0.537 (Youden index J, 0.501; sensitivity, 78.24%; specificity, 71.83%). Since the relationship between %CSA<5 and %LAA-950 was not constant, performance of segmented regression was better than ordinary linear regression (adjusted R 2 , 0.474 vs 0.332, P < 0.001 and P < 0.001, respectively). As %CSA<5 decreased, %LAA-950 slightly increased until an inflection point (%CSA<5 = 0.524) was reached, after which the %LAA-950 increased apparently with a decrease in %CSA<5. Conclusion %CSA<5 was significantly correlated with both airflow limitation and emphysema, and we identified an inflection point for the relationship between %CSA<5 and %LAA-950.

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“…Chronic thromboembolic pulmonary hypertension (CTEPH) is considered a severe complication of acute pulmonary embolism with an occurrence of ∼3% ( 1 ). Pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) are the most effective for CTEPH and have been suggested in the current treatment guidelines ( 2 , 3 ). Generally, PEA is the recommended treatment for CTEPH patients with operable vascular lesions, while BPA is an alternative option for those not suitable for PEA.…”

Section: Introductionmentioning

confidence: 99%

Different response of the oxygen pathway in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy versus balloon pulmonary angioplasty

Tao

Xie

et al. 2022

Front. Cardiovasc. Med.

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BackgroundOxygen pathway limitation exists in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) are two effective interventions for CTEPH, but their effects and comparison of these two interventions on the oxygen pathway are not well demonstrated.MethodsCTEPH patients with available pulmonary function test, hemodynamics, and blood gas analysis before and after the interventions were included for comparison of oxygen pathway in terms of lung ventilation, lung gas exchange, oxygen delivery, and oxygen extraction between these two interventions.ResultsThe change in the percentage of the predicted forced expiratory volume in the 1 s (−3.4 ± 12.7 vs. 3.8 ± 8.7%, P = 0.006) and forced vital capacity (−5.5 ± 13.0 vs. 4.2 ± 9.9%, P = 0.001) among the PEA group (n = 24) and BPA group (n = 46) were significantly different. Patients in the PEA group had a significant increase in their arterial oxygen saturation (from 92.5 ± 3.6 to 94.6 ± 2.4%, P = 0.022), while those in the BPA group had no change, which could be explained by a significant improvement in ventilation/perfusion (−0.48 ± 0.53 vs. −0.17 ± 0.41, P = 0.016). Compared with patients post-BPA, patients post-PEA were characterized by higher oxygen delivery (756.3 ± 229.1 vs. 628.8 ± 188.5 ml/min, P = 0.016) and higher oxygen extraction (203.3 ± 64.8 vs. 151.2 ± 31.9 ml/min, P = 0.001).ConclusionPartial amelioration of the oxygen pathway limitations could be achieved in CTEPH patients treated with PEA and BPA. CTEPH patients post-PEA had better performance in lung gas exchange, oxygen delivery, and extraction, while those post-BPA had better lung ventilation. Cardiopulmonary rehabilitation may assist in improving the impairment of the oxygen pathway.

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Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT

Cited by 49 publications

References 268 publications

Role of extracorporeal membrane oxygenation and surgical embolectomy in acute pulmonary embolism

Role of extracorporeal membrane oxygenation and surgical embolectomy in acute pulmonary embolism

Correlations of Computed Tomography Measurement of Distal Pulmonary Vascular Pruning with Airflow Limitation and Emphysema in COPD Patients

Different response of the oxygen pathway in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy versus balloon pulmonary angioplasty

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