Incidence of Symptomatic and Asymptomatic Chronic Thromboembolic Pulmonary Hypertension

Martí, David; Gómez, Vicente; Escobar, Carlos; Wagner, Carolin; Zamarro, Celia; Sánchez, Diana; Sam, Allan; Briongos, Sem; Gaudó, Javier; Sueiro, Antonio; Jiménez, David

doi:10.1016/S1579-2129(10)70137-3

Archivos de Bronconeumología

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Vol. 46. Issue 12.

Pages 628-633 (January 2010)

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Pages 628-633 (January 2010)

Original Article

DOI: 10.1016/S1579-2129(10)70137-3

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Incidence of Symptomatic and Asymptomatic Chronic Thromboembolic Pulmonary Hypertension

Incidencia de hipertensión pulmonar tromboembólica crónica sintomática y asintomática

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David Martía, Vicente Gómezb, Carlos Escobara, Carolin Wagnerb, Celia Zamarrob, Diana Sánchezb, Allan Samb, Sem Briongosa, Javier Gaudób, Antonio Sueirob, David Jiménezb,

Corresponding author

djc_69_98@yahoo.com

Corresponding author.

a Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, Spain

b Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain

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Abstract

Introduction and objectives

To assess the incidence of long-term symptomatic and asymptomatic chronic thromboembolic pulmonary hypertension (CTPH) in a cohort of patients with acute symptomatic pulmonary embolism (PE), and the potential risk factors for its diagnosis.

Methods

We conducted a prospective, long-term, follow-up study in 110 consecutive patients with an acute episode of pulmonary embolism (PE). All patients underwent transthoracic echocardiography (TTE) two years after the diagnosis of PE was made. If systolic pulmonary artery pressure exceeded 40 mm Hg and there was evidence of residual PE either by ventilation-perfusion or CT scan, patients underwent right heart catheterisation to confirm the diagnosis. In asymptomatic patients, right heart catheterisation was performed if a repeated TTE still demonstrated persistent pulmonary hypertension six months after the first.

Results

CTPH was diagnosed in 10 cases (6 patients during follow-up, and 4 at the end of the study) of the 110 patients (9.1%; 95% confidence interval [CI], 3.7-14.5). All patients had symptoms related to the disease according to a structured questionnaire. In the multivariate regression analysis, only concomitant age (relative risk [RR] 1.2 per age; 95% CI, 1.0-1.3; P=.03) and previous PE (RR 5.7; IC 95%, 1.5-22.0; P=.01) were independent predictors of CTPH.

Conclusions

The cumulative incidence of CTPH appears to be higher than previously reported. All patients had symptoms related to the disease.

Keywords:

Pulmonary embolism

Pulmonary hypertension

Echocardiography

Cardiac catheterisation

Resumen

Introducción y objetivos

Evaluar la incidencia de hipertensión pulmonar tromboembólica crónica (HPTEC) sintomática y asintomática en una cohorte de pacientes con tromboembolia de pulmón (TEP), y las variables predictoras de su aparición.

Métodos

Estudio prospectivo de cohorte de 110 pacientes consecutivos diagnosticados de TEP en un hospital universitario terciario, y seguidos durante 24 meses. Todos los pacientes fueron sometidos a una ecocardiografía transtorácica (ETT) al final del seguimiento. En los pacientes sintomáticos con una presión sistólica pulmonar estimada (PAP) ≥ 40 mmHg se realizó un cateterismo cardiaco derecho para confirmar la HPTEC. En los pacientes asintomáticos se repitió la ETT a los 6 meses de la primera y, si la PAP se mantenía por encima de 40 mmHg, se indicó un cateterismo cardiaco.

Resultados

Se confirmó HPTEC en 10 pacientes de la serie (9,1%; intervalo de confianza [IC] 95%, 3,7 a 14,5%). Todos los pacientes con HPTEC presentaron síntomas sugestivos de la enfermedad. La edad (riesgo relativo [RR] ajustado 1,2 por cada año; IC 95%, 1,0 a 1,3; p = 0,03) y el antecedente de TEP (RR 5,7; IC 95%, 1,5 a 22,0; p = 0,01) se asociaron de forma estadísticamente significativa al diagnóstico de HPTEC.

Conclusiones

La incidencia de HPTEC es más frecuente de lo descrito previamente en la literatura. La asociación entre las recurrencias tromboembólicas y la HPTEC sugiere la necesidad de optimizar la duración y la intensidad del tratamiento anticoagulante en los pacientes con TEP. No se detectaron episodios de HPTEC en pacientes asintomáticos.

Palabras clave:

Tromboembolia de pulmón

Hipertensión pulmonar

Ecocardiografía

Cateterismo cardiaco

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