Usefulness of standard computed tomography pulmonary angiography performed for acute pulmonary embolism for identification of chronic thromboembolic pulmonary hypertension: results of the InShape III study
Section snippets
Study population
Patient selection for the InShape III study occurred post hoc from the local patient registry of the Vrije University Medical Center (VUmc) (cases) and previous prospective studies (controls).10, 17, 18 Assessment of CTPA scans was performed prospectively. The cases consisted of 50 consecutive patients who were referred to the VUmc, Amsterdam, in the period between 2014 and 2016 for treatment of CTEPH, and had a prior diagnosis of acute PE. The CTEPH diagnosis was confirmed by right heart
Patients
Patients’ characteristics at the time of initial CTPA scan for PE diagnosis are presented in Table 1. Mean age at the time of PE diagnosis was 61 ± 15 years in cases and 56 ± 15 years in controls. A total of 43 (86%) cases had an unprovoked acute PE event and 20 (40%) had recurrent venous thromboembolism (VTE). In the control cohort, these numbers were 29 (58%) and 10 (20%), respectively, for ORs of 5.2 (95% CI 2.0–14) and 2.7 (95% CI 1.1–6.5), respectively. Symptom onset was >2 weeks before PE
Discussion
In this study we have demonstrated that expert radiologists were able to identify 36 of 50 patients with acute PE who were later diagnosed with CTEPH, and correctly excluded CTEPH in 47 of 50 patients from those who did not develop CTEPH after at least 2 years of follow-up, based on close reading of the CTPA scan performed for the initial PE diagnosis. The interobserver agreement between the 3 expert radiologists for the majority of the best predictive radiologic parameters was good. The
Disclosure statement
The authors have no conflicts of interest to disclose. This study was supported by an unrestricted grant from Merck Sharp & Dohme and by a grant from the Dutch Heart Foundation (2017T064 to F.A.K. and G.J.A.M.B.).
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2022, Journal of ElectrocardiologyCitation Excerpt :Mainly, more focus on computed tomography pulmonary angiogram (CTPA) images at baseline may also help identifying patients with CTEPH early in the course of time. We and others showed that signs of chronicity, e.g. the presence of webs/bands, bronchial artery dilatation and right ventricle hypertrophy identified on CTPA images is a strong predictor of a future CTEPH diagnosis [35,36,38]. Indeed, these radiological signs are not effected by anticoagulation therapy and can be evaluated by CTEPH experts as well as by non-specifically trained board-certified radiologists [41–43].