Chronic thromboembolic pulmonary hypertension in acute pulmonary embolism: A risk factor evaluation study

Abstract

Pulmonary embolism (PE) is a form of venous thromboembolism and refers to an obstruction in pulmonary arteries or any branches of it. Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of PE which has high mortality and morbidity if not treated properly. The aim of this study is to investigate CTEPH presence and risk factors during a long follow-up period.

Between January 2014 and January 2017, 182 patients who were diagnosed with PE in emergency service by computer tomography pulmonary angiography (CTPA) are accepted retrospectively. CTPA, echocardiography (ECHO) and lower extremity Doppler ultrasonography results at 3th, 6th and 12th months follow-up are also included. If both systolic pulmonary arterial pressure (sPAB) was above 37 mmHg and residual thrombosis was present, ventilation-perfusion scintigraphy had been performed. To confirm CTEPH diagnosis, right ventricular catheterization was done among suitable patients. Patients whose clinical presentation was suitable for CTEPH but not suitable for catheterization were also accepted as CTEPH.

Average age of patients were 62. 71 (%39) were male and 111 (%61) were female. 130 (%71,4) had acquired risk factors, 16 (%8,8) had proven genetic mutations and the rest 36 (%19,8) did not have any risk factors. During first year follow-up, 5 (%2,7) patients were diagnosed with CTEPH. Further investigation on these patients revealed atrial fibrillation, persistent thrombosis at 12 months and sPAB above 55 mmHg to be significant risk factors. (P being 0,001/0,023/0,009 respectively). In multivariate analysis, no independent predictive factors were found for CTEPH.

To evaluate CTEPH better, utilization of CTPA and ECHO during follow-up may prove useful in high risk factors.