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. 2015 Nov;7(11):1927-38.
doi: 10.3978/j.issn.2072-1439.2015.11.43.

Incidence and risk factors of chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism

Suqiao Yang  1 , Yuanhua Yang  1 , Zhenguo Zhai  1 , Tuguang Kuang  1 , Juanni Gong  1 , Shuai Zhang  1 , Jianguo Zhu  1 , Lirong Liang  1 , Ying H Shen  1 , Chen Wang  1
Affiliations

Incidence and risk factors of chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism

Suqiao Yang et al. J Thorac Dis. 2015 Nov.

Abstract

Background: Early identification and treatment of chronic thromboembolic pulmonary hypertension (CTEPH) are critical to prevent disease progression. We determined the incidence and risk factors for CTEPH in patients with a first episode of acute pulmonary embolism (PE).

Methods: In this study, consecutive patients with first-episode acute PE were followed for ≤5 years. Pulmonary hypertension (PH) was screened for by echocardiography. Suspected cases were evaluated by right heart catheterization (RHC) and pulmonary angiography (PA). If invasive procedures were not permitted, PH was diagnosed by systolic pulmonary artery pressure (SPAP) >50 mmHg. Diagnosis of CTEPH was confirmed by PA, ventilation/perfusion (V/Q) lung scan, or computed tomography (CT) PA (CTPA).

Results: Overall, 614 patients with acute PE were included (median follow-up, 3.3 years). Ten patients were diagnosed with CTEPH: cumulative incidence 0.8% [95% confidence interval (CI), 0.0-1.6%] at 1 year, 1.3% (95% CI, 0.3-2.3%) at 2 years, and 1.7% (95% CI, 0.7-2.7%) at 3 years. No cases of CTEPH developed after 3 years. History of lower-limb varicose veins [hazard ratio (HR), 4.3; 95% CI, 1.2-15.4; P=0.024], SPAP >50 mmHg at initial PE episode (HR, 23.5; 95% CI, 2.7-207.6; P=0.005), intermediate-risk PE (HR, 1.2; 95% CI, 1.0-1.4; P=0.030), and CT obstruction index over 30% at 3 months after acute PE (HR, 42.5; 95% CI, 4.4-409.8; P=0.001) were associated with increased risk of CTEPH.

Conclusions: CTEPH was not rare after acute PE in this Chinese population, especially within 3 years of diagnosis. Lower-limb varicose veins, intermediate-risk PE with elevated SPAP in the acute phase, and residual emboli during follow-up might increase the risk of CTEPH.

Keywords: China; Incidence; chronic thromboembolic pulmonary hypertension (CTEPH); pulmonary embolism (PE); risk factors.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient disposition. CTEPH, chronic thromboembolic pulmonary hypertension; CTPA, computed tomography pulmonary angiography; PA, pulmonary angiography; PE, pulmonary embolism; PH, pulmonary hypertension; RHC, right heart catheterization; SPAP, systolic pulmonary artery pressure; V/Q, ventilation/perfusion.
Figure 2
Figure 2
Clinical characteristics, treatment, and outcomes for patients with CTEPH. CTEPH, chronic thromboembolic pulmonary hypertension; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; PH, pulmonary hypertension; WHO FC, World Health Organization functional class.
Figure 3
Figure 3
Cumulative incidence of CTEPH. CTEPH, chronic thromboembolic pulmonary hypertension.
See this image and copyright information in PMC

References

    1. Fedullo PF, Auger WR, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001;345:1465-72. - PubMed
    1. Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2011;364:351-60. - PubMed
    1. Hoeper MM, Madani MM, Nakanishi N, et al. Chronic thromboembolic pulmonary hypertension. Lancet Respir Med 2014;2:573-82. - PubMed
    1. Lang IM, Madani M. Update on chronic thromboembolic pulmonary hypertension. Circulation 2014;130:508-18. - PubMed
    1. Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257-64. - PubMed