Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of pulmonary embolism (PE). Its incidence following PE is debated. An active screening for CTEPH in patients with acute PE is yet to be recommended.
This prospective, multicentre, observational study (INPUT on PE; ISRCTN61417303) included patients with acute PE from 11 centres in Switzerland from March 2009 to November 2016. Screening for possible CTEPH was performed at 6, 12 and 24 months using a step-wise algorithm that included a dyspnoea phone-based survey, transthoracic echocardiography, right heart catheterisation and radiologic confirmation of CTEPH.
Of 1699 patients with PE, 508 patients were assessed for CTEPH screening over 2 years. The CTEPH incidence following PE was 3.7 per 1000 patient-years, with a two-year cumulative incidence of 0.79%. The Swiss pulmonary hypertension registry consulted in December 2016 did not report additional CTEPH cases in these patients. The survey yielded 100% sensitivity and 81.6% specificity. The second step echocardiography in newly dyspnoeic patients showed a negative predictive value of 100%.
CTEPH is a rare but treatable disease. A simple and sensitive way for CTEPH screening in patients with acute PE is recommended.
Abstract
CTEPH is an uncommon disease. An active screening of CTEPH in patients after acute PE should be considered
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Coquoz reports non-financial support from MSD Switzerland, grants from Swiss society for pulmonary hypertension, during the conduct of the study; .
Conflict of interest: Daniel Weilenmann
Conflict of interest: Dr. Stolz has nothing to disclose.
Conflict of interest: Dr. Popov has nothing to disclose.
Conflict of interest: Dr. Azzola has nothing to disclose.
Conflict of interest: Dr. Fellrath has nothing to disclose.
Conflict of interest: Dr. Stricker has nothing to disclose.
Conflict of interest: Dr. Pagnamenta has nothing to disclose.
Conflict of interest: Dr. Ott has nothing to disclose.
Conflict of interest: Dr. Ulrich reports grants from Swiss National Science Foundation, grants from Zurich Lung, grants and personal fees from Actelion SA, Switzerland, personal fees from MSD SA, Switzerland, grants from Orpha Swiss, outside the submitted work.
Conflict of interest: Dr. Györik has nothing to disclose.
Conflict of interest: Dr. Pasquier has nothing to disclose.
Conflict of interest: Dr. Aubert reports grants from Swiss Society for Pulmonary Hypertension, during the conduct of the study; personal fees from Bayer, personal fees from Actelion Switzerland, other from Actelion Switzerland, outside the submitted work.
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