Systematic pulmonary embolism follow-up increases diagnostic rates of chronic thromboembolic pulmonary hypertension and identifies less severe disease: results from the ASPIRE Registry

被引：13

作者：

Durrington, Charlotte ^{[1
,2
]}

Hurdman, Judith A. ^{[1
]}

Elliot, Charlie A. ^{[1
]}

Maclean, Rhona ^{[3
]}

Van Veen, Joost ^{[3
]}

Saccullo, Giorgia ^{[3
]}

De-Foneska, Duneesha ^{[1
]}

Swift, Andrew J. ^{[2
,4
,5
,6
]}

Smitha, Rajaram ^{[2
,4
]}

Hill, Catherine ^{[4
]}

Thomas, Steven ^{[4
]}

Dwivedi, Krit ^{[2
,4
]}

Alabed, Samer ^{[2
,4
]}

Wild, James M. ^{[4
,5
,6
]}

Charalampopoulos, Athanasios ^{[1
]}

Hameed, Abdul ^{[1
,2
]}

Rothman, Alexander M. K. ^{[1
,2
,6
]}

Watson, Lisa ^{[1
]}

Hamilton, Neil ^{[2
]}

Thompson, A. A. Roger ^{[1
,2
,6
]}

Condliffe, Robin ^{[1
,2
,6
]}

Kiely, David G. ^{[1
,2
,5
,6
]}

机构：

[1] Royal Hallamshire Hosp, Sheffield Teaching Hosp NHS Fdn Trust, Sheffield Pulm Vasc Dis Unit, Sheffield, England

[2] Univ Sheffield, Div Clin Med, Sheffield, England

[3] Sheffield Teaching Hosp NHS Fdn Trust, Royal Hallamshire Hosp, Dept Haematol, Sheffield, England

[4] Sheffield Teaching Hosp NHS Fdn Trust, Royal Hallamshire Hosp, Dept Radiol, Sheffield, England

[5] Univ Sheffield, Insigneo Inst, Sheffield, England

[6] Natl Inst Hlth & Care Res, Sheffield Biomed Res Ctr, Sheffield, England

来源：

EUROPEAN RESPIRATORY JOURNAL | 2024年 / 63卷 / 03期

基金：

英国惠康基金;

关键词：

ANGIOGRAPHY; OUTCOMES;

D O I：

10.1183/13993003.00846-2023

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background Diagnostic rates and risk factors for the subsequent development of chronic thromboembolic pulmonary hypertension (CTEPH) following pulmonary embolism (PE) are not well defined. Methods Over a 10 -year period (2010-2020), consecutive patients attending a PE follow-up clinic in Sheffield, UK (population 554 600) and all patients diagnosed with CTEPH at a pulmonary hypertension (PH) referral centre in Sheffield (referral population estimated 15-20 million) were included. Results Of 1956 patients attending the Sheffield PE clinic 3 months following a diagnosis of acute PE, 41 were diagnosed with CTEPH with a cumulative incidence of 2.10%, with 1.89% diagnosed within 2 years. Of 809 patients presenting with pulmonary hypertension (PH) and diagnosed with CTEPH, 32 were Sheffield residents and 777 were non -Sheffield residents. Patients diagnosed with CTEPH at the PE follow-up clinic had shorter symptom duration (p<0.01), better exercise capacity (p<0.05) and less severe pulmonary haemodynamics (p<0.01) compared with patients referred with suspected PH. Patients with no major transient risk factors present at the time of acute PE had a significantly higher risk of CTEPH compared with patients with major transient risk factors (OR 3.6, 95% CI 1.11-11.91; p=0.03). The presence of three computed tomography (CT) features of PH in combination with two or more out of four features of chronic thromboembolic pulmonary disease at the index PE was found in 19% of patients who developed CTEPH and in 0% of patients who did not. Diagnostic rates and pulmonary endarterectomy (PEA) rates were higher at 13.2 and 3.6 per million per year, respectively, for Sheffield residents compared with 3.9-5.2 and 1.7-2.3 per million per year, respectively, for non -Sheffield residents. Conclusions In the real -world setting a dedicated PE follow-up pathway identifies patients with less severe CTEPH and increases population -based CTEPH diagnostic and PEA rates. At the time of acute PE diagnosis the absence of major transient risk factors, CT features of PH and chronic thromboembolism are risk factors for a subsequent diagnosis of CTEPH.

引用

页数：14

共 34 条

[1] The Rate of Resolution of Clot Burden Measured by Pulmonary CT Angiography in Patients With Acute Pulmonary Embolism [J].