Frequency and characterization of CTEPH and CTEPD according to the mPAP threshold > 20 mm Hg: Retrospective analysis from data of a prospective PE aftercare program - 15/03/23
, Elena Pfeuffer-Jovic a, Heinrike Wilkens b, Gülmisal Güder c, Franziska Küsters a, Hans Joachim Schäfers d, Heinz Jakob Langen e, Danjouma Cheufou f, Delia Schmitt aAbstract |
Background |
The influence of the new pulmonary hypertension (PH) definition on the incidence of chronic thromboembolic PH (CTEPH) is unclear. The incidence of chronic thromboembolic pulmonary disease without PH (CTEPD) is unknown.
Objectives |
To determine the frequency of CTEPH and CTEPD using the new mPAP cut-off >20 mmHg for PH in patients who have suffered an incidence of pulmonary embolism (PE) and were recruited into an aftercare program.
Methods |
In a prospective two-year observational study based on telephone calls, echocardiography and cardiopulmonary exercise tests, patients with findings suspicious for PH received an invasive work-up. Data from right heart catheterization were used to identify patients with or without CTEPH/CTEPD.
Results |
Two years after acute PE (n = 400) we found an incidence of 5.25% for CTEPH (n = 21) and 5.75% for CTEPD (n = 23) according to the new mPAP threshold >20 mmHg. Five of 21 patients with CTEPH and 13 of 23 patients with CTEPD showed no signs of PH in echocardiography. CTEPH and CTEPD subjects showed a reduced VO₂ peak and work rate in cardiopulmonary exercise testing (CPET). The capillary end-tidal CO2 gradient was comparably elevated in CTEPH and CTEPD, but it was normal in the Non-CTEPD-Non-PH group. According to the PH definition provided by the former guidelines, only 17 (4.25%) patients have been diagnosed with CTEPH and 27 individuals (6.75%) were classified having CTEPD.
Conclusions |
Using mPAP >20 mmHg for diagnosis of CTEPH leads to an increase of 23.5% of CTEPH diagnosis. CPET may help to detect CTEPD and CTEPH.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Two years after a PE event, CTEPH occurred in 5.25% of the cases and CTEPD without PH was 5.75% in the cohort (n = 400). |
• | Using mPAP >20 mmHg for diagnosis of CTEPH leads to a relative increase of 23.5% of CTEPH diagnosis. |
• | CPET seems to be a helpful tool to detect CTEPD without PH and CTEPH non-invasively. |
Keywords : Chronic thromboembolic pulmonary disease, Chronic thromboembolic pulmonary hypertension, Cardiopulmonary exercise testing, Right heart catheterization, Functional limitation, Pulmonary embolism
Plan
Vol 210
Article 107177- avril 2023 Retour au numéro
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