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Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: https://doi.org/10.1160/TH13-07-0538
Issue: 2014: 112/3 (Sep) pp. 427–626
Pages: 598-605

Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

Prevalence of CTEPH after pulmonary embolism

Online Supplementary Material

L. Guérin (1), F. Couturaud (2), F. Parent (3), M.-P. Revel (4), F. Gillaizeau (5), B. Planquette (1), D. Pontal (1), M. Guégan (2), G. Simonneau (3), G. Meyer (1, 6), O. Sanchez (1, 6)

(1) Université Paris Descartes, Sorbonne Paris Cité; APHP, service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, Paris, France; (2) Université Européenne de Bretagne, Université de Brest, EA3878, IFR148, et Département de Médecine Interne et de Pneumologie, CHU de La Cavale Blanche, Brest, France; (3) Université Paris-Sud ; (4) Université Paris Descartes, Sorbonne Paris Cité; APHP, service de Radiologie, Hôpital Européen Georges Pompidou, Paris, France; (5) Université Paris Descartes, Sorbonne Paris Cité; (6) INSERM UMR970, Paris, France

Keywords

Epidemiology, pulmonary embolism, echocardiography, Chronic thromboembolic pulmonary hypertension

Summary

Chronic thromboembolic pulmonary hypertension (CTEPH) has been estimated to occur in 0.1–0.5% of patients who survive a pulmonary embolism (PE), but more recent prospective studies suggest that its incidence may be much higher. The absence of initial haemodynamic evaluation at the time of PE should explain this discrepancy. We performed a prospective multicentre study including patients with PE in order to assess the prevalence and to describe risk factors of CTEPH. Follow-up every year included an evaluation of dyspnea and echocardiography using a predefined algorithm. In case of suspected CTEPH, the diagnosis was confirmed using right heart catheterisation (RHC). Signs of CTEPH were searched on the multidetector computed tomography (CT) and echocardiography performed at the time of PE. Of the 146 patients analysed, eight patients (5.4%) had suspected CTEPH during a median follow-up of 26 months. CTEPH was confirmed using RHC in seven cases (4.8%; 95%CI, 2.3 – 9.6) and ruled-out in one. Patients with CTEPH were older, had more frequently previous venous thromboembolic events and more proximal PE than those without CTEPH. At the time of PE diagnosis, patients with CTEPH had a higher systolic pulmonary artery pressure and at least two signs of CTEPH on the initial CT. After acute PE, the prevalence of CTEPH appears high. However, initial echocardiography and CT data at the time of the index PE suggest that a majority of patients with CTEPH had previously unknown pulmonary hypertension, indicating that a first clinical presentation of CTEPH may mimic acute PE.

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