Risk factors for chronic thromboembolic pulmonary hypertension

¹ Division of Cardiology
² University Hospital of Saarland, Pneumology, Allergology, and Environmental Medicine
³ Core Unit for Medical Statistics and Informatics
⁴ Dept of Thoracic and Cardiovascular Surgery, Homburg/Saar, Germany
⁵ General Teaching Hospital, 2^nd Medical Department-Clinical Dept of Cardiology and Angiology
⁶ General Teaching Hospital, 2^nd Surgical Department-Clinical Dept of Cardiovascular Surgery, Prague, Czech Republic
⁷ Cardiology Clinic, National Institute of Cardiovascular Diseases, Dept of Cardiology, Slovak Medical University, Bratislava, Slovak Republic
⁸ Division of Cardiothoracic Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

^* To whom correspondence should be addressed. E-mail: irene.lang{at}meduniwien.ac.at.

	Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by non-resolving pulmonary thromboemboli that can be treated by surgical pulmonary endarterectomy (PEA). We sought to confirm known and to identify novel CTEPH risk factors in a controlled retrospective cohort study of prevalent CTEPH cases collected in 3 European centers offering PEA.

Data from CTEPH patients were compared with non-thromboembolic precapillary pulmonary arterial hypertension cohorts at the participating institutions. The study population comprised 687 patients assessed at the time of diagnosis between 1996 and 2007. VA-shunts and infected pacemakers (odds ratio (OR) and 95% confidence interval, 76.40 [7.67–10351], p<0.001), splenectomy (OR 17.87 [1.56–2438], p=0.017), previous venous thromboembolism (VTE) (OR 4.52 [2.35–9.12], p<0.001), recurrent VTE (OR 14.49 [5.40–43.08], p<0.001), blood groups non-0 (OR (OR 2.09 [1.12–3.94], p=0.019), and lupus anticoagulant/anti-phospholipid antibodies (OR 4.20 [1.56–12.21], p=0.004) were more often associated with CTEPH. Thyroid replacement therapy (OR 6.10 [2.73–15.05], p<0.001) and a history of malignancy (OR 3.76 [1.47–10.43], p=0.005) emerged as novel CTEPH risk factors.

This European database confirmed previous knowledge on CTEPH risk factors, and identified thyroid replacement therapy and a history of malignancy as new medical conditions associated with CTEPH.

This article has been cited by other articles:

				Authors/Task Force Members, N. Galie, M. M. Hoeper, M. Humbert, A. Torbicki, J.-L. Vachiery, J. A. Barbera, M. Beghetti, P. Corris, S. Gaine, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT) Eur. Heart J., October 2, 2009; 30(20): 2493 - 2537. [Full Text] [PDF]

				O. Sanchez, B. Planquette, and G. Meyer Update on acute pulmonary embolism Eur. Respir. Rev., September 1, 2009; 18(113): 137 - 147. [Full Text] [PDF]

				M. M. Hoeper, J. A. Barbera, R. N. Channick, P. M. Hassoun, I. M. Lang, A. Manes, F. J. Martinez, R. Naeije, H. Olschewski, J. Pepke-Zaba, et al. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S85 - S96. [Abstract] [Full Text] [PDF]

				M. Humbert Update in Pulmonary Hypertension 2008 Am. J. Respir. Crit. Care Med., April 15, 2009; 179(8): 650 - 656. [Full Text] [PDF]