Monitoring for Pulmonary Hypertension Following Pulmonary Embolism: The INFORM Study

Tapson, Victor F.; Platt, David; Xia, Fang; Teal, Simon; Orden, Margarita De La; Divers, Christine; Satler, Carol; Joish, Vijay N.; Channick, Richard N.

doi:10.1016/j.amjmed.2016.03.006

Cited by 61 publications

(42 citation statements)

References 29 publications

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“…While the weighted average incidence of CTEPH after an acute PE of 4% in this study was generally similar to the weighted incidence of 3.8% determined in the INFORM study [57], a subsequent and recent systematic review and meta-analysis of 16 studies has suggested lower incidences of CTEPH after acute PE: 0.56% in "all comers" (n=1186), 3.22% in "survivors" (n=999) and 2.79% in "survivors without major comorbidities" (n=1775) [72], which suggests that the full incidence of CTEPH may be lower. As PEA is performed infrequently in Japan, with physicians favouring BPA, the diagnosis rate for Japan is an assumption, based on the diagnosis rates calculated for the other countries; however, there is a possibility that the real figure is higher.…”

Section: Discussionsupporting

confidence: 61%

“…The full incidence was calculated based on a weighted average of 4% for the proportion of patients who develop CTEPH after PE. Data from the INFORM study, a retrospective US-based claims analysis, suggested the proportion of PE patients developing CTEPH to be 3.8% [57], which is close to the weighted average used in this analysis. A recent review by KIM [58] estimates full incidence of CTEPH in the USA to be 4886 cases per year, based on an incidence of CTEPH after PE of 0.57%, as reported by KLOK et al [50], while the diagnosed incidence of CTEPH in Spain, the UK and Germany is reported to be 0.9, 1.75 and 4 cases per million, respectively [59].…”

Section: Discussionmentioning

confidence: 79%

“…The authors suggested that there may be a need for increased education, awareness of guidelines and/or availability of resources to improve CTEPH diagnosis rates worldwide. In addition, data from the INFORM study suggest that V′/Q′ scanning, right heart catheterisation and pulmonary angiography are underused in the USA [57].…”

Section: Discussionmentioning

confidence: 99%

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An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan

et al. 2017

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Epidemiological data for chronic thromboembolic pulmonary hypertension (CTEPH) are limited and there are conflicting reports regarding its pathogenesis.A literature review was conducted to identify CTEPH epidemiological data up to June 2014. Data were analysed to provide estimates of the incidence of CTEPH in the USA, Europe and Japan. An epidemiological projection model derived country-specific estimates of future incidence and diagnosis rates of CTEPH.Overall, 25 publications and 14 databases provided quantitative epidemiological data. In the USA and Europe, the crude annual incidence of diagnosed pulmonary embolism and crude annual full (i.e. diagnosed and undiagnosed) incidence of CTEPH were 66-104 and 3-5 cases per 100 000 population, respectively, while in Japan these rates were lower at 6.7 and 1.9 per 100 000 population, respectively. In 2013, 7-29% of CTEPH cases in Europe and the USA were diagnosed, and the majority of patients were in New York Heart Association functional class III/IV at diagnosis. The projection model indicated that incidence of CTEPH will continue to increase over the next decade.These data suggest that CTEPH is underdiagnosed and undertreated, and there is an urgent need to increase awareness of CTEPH. High-quality epidemiological studies are required to increase understanding of CTEPH.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 79%

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An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan

et al. 2017

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“…However, systematic description of results of serial imaging by CTPA and Q lung scanning in the long term after acute PE and relation to functional outcome is largely lacking. For example, in a retrospective database analysis, Tapson et al6 showed that only 20% of patients had repeat CTPA and 6% had repeat ventilation/perfusion following acute PE. Furthermore, to our knowledge, the correlation between findings or change in findings over time on imaging and long‐term functional exercise limitation after PE has yet to be evaluated.…”

Section: Introductionmentioning

confidence: 99%

Serial imaging after pulmonary embolism and correlation with functional limitation at 12 months: Results of the ELOPE Study

Kahn

Akaberi

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials Exercise Limitation 1 year after an acute pulmonary embolism is common.Serial imaging after acute pulmonary embolism is not well described and how it affects exercise limitation remains unknown.1 year after an acute pulmonary embolism chronic changes are common, more so on perfusion lung scanning than CT pulmonary angiography, but imaging findings did not predict exercise limitation. IntroductionRisk factors for exercise limitation after acute pulmonary embolism (PE) are unknown. As a planned sub‐study of the prospective, multicenter ELOPE (Evaluation of Long‐term Outcomes after PE) Study, we aimed to describe the results of serial imaging by computed tomography pulmonary angiography (CTPA) and perfusion scan during 1 year after a first episode of acute pulmonary embolism, and to assess the association between imaging parameters and exercise limitation at 1 year.MethodsIn a prospective cohort study, 100 patients were recruited between June 2010 and February 2013 at five Canadian university–affiliated hospitals. CT pulmonary angiography was performed at baseline and 12 months, perfusion scan at 6 and 12 months, and cardio‐pulmonary exercise testing at 1 and 12 months. Imaging parameters included: on CT pulmonary angiography, CT obstruction index (CTO) (% clot burden in the pulmonary vasculature), and on perfusion scan, pulmonary vascular obstruction (PVO) (% perfusion defect). Abnormal cardio‐pulmonary exercise test (primary outcome) was defined as percent of predicted peak oxygen uptake (VO2) <80%.ResultsMean (median; SD) CT obstruction index was 28.1% (27.5%; 18.3%) at baseline, 1.2% (0%; 4.3%) at 12 months. Mean (median; SD) pulmonary vascular obstruction was 6.0% (0%; 9.6%) at 6 months, 5.6% (0%; 9.8%) at 12 months. Eighty‐six patients had exercise testing at 12 months, and 46.5% had VO2 < 80% predicted. Mean (median; SD) CT obstruction index at 1 year was similar in patients with percent‐predicted VO2 peak <80% vs >80% on 1‐year cardio‐pulmonary exercise testing (1.4% [0%; 5.7%] vs 1.0% [0%; 2.4%]; P = .70). Mean (SD) pulmonary vascular obstruction at 6 and at 12 months was similar in patients with percent‐predicted VO2 peak <80% vs >80% (6 months: 5.9% [0%; 10.4%] vs 6.2% [4.5%; 9.0%]; P = .91; 12 months: 5.1% [0%; 10.2%] vs 6.0% [0%; 9.7%]; P = .71).ConclusionsImaging findings after pulmonary embolism did not predict exercise limitation. Residual thrombus does not appear to explain long‐term functional limitation after pulmonary embolism.

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“…18 A claim database analysis suggests that less than 50% of patients with PE are evaluated with a follow-up echocardiogram. 19 Whether or not this is sufficient remains to be determined.…”

Section: Epidemiologymentioning

confidence: 99%

Epidemiology and Pathophysiology of Chronic Thromboembolic Pulmonary Hypertension: Risk Factors and Mechanisms

Medrek

Safdar

2016

Methodist DeBakey Cardiovascular Journal

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Chronic thromboembolic pulmonary hypertension (CTEPH) occurs when thromboemboli travel to the pulmonary vasculature, fail to resolve, and cause elevated pulmonary arterial pressure. Untreated, this disease leads to progressive right heart failure and death. It develops in approximately 1% to 5% of patients who suffer an acute pulmonary embolism (PE) and has an overall incidence of 3 to 30 per million in the general population. While it is not entirely evident why most but not all people are able to clear this clot burden, there are known risk factors for the development of CTEPH. These include signs of right heart strain at the time of incident PE, inherited coagulopathies, inflammatory conditions, hypothyroidism, and a history of splenectomy. Since CTEPH can be treated both surgically and medically, it is critical to understand the pathophysiology of the disease so affected patients can be identified and diagnosed appropriately.

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Monitoring for Pulmonary Hypertension Following Pulmonary Embolism: The INFORM Study

Cited by 61 publications

References 29 publications

An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan

An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan

Serial imaging after pulmonary embolism and correlation with functional limitation at 12 months: Results of the ELOPE Study

Epidemiology and Pathophysiology of Chronic Thromboembolic Pulmonary Hypertension: Risk Factors and Mechanisms

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