TY - JOUR T1 - Predicting recurrent pulmonary embolism and chronic thromboembolic pulmonary hypertension: one more way to skin the cat JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00413-2017 VL - 49 IS - 5 SP - 1700413 AU - Frederikus A. Klok AU - Marius M. Hoeper Y1 - 2017/05/01 UR - http://erj.ersjournals.com/content/49/5/1700413.abstract N2 - In this issue of the European Respiratory Journal, Pesavento et al. [1] present the results of the Study on the Clinical Course Of Pulmonary Embolism (SCOPE). In this huge effort, 647 consecutive patients with a symptomatic, confirmed first episode of acute pulmonary embolism (PE) were recruited and subjected to lung scanning after an initial treatment period of 6 months to assess the presence of residual pulmonary obstruction. Patients were followed for an additional 3-year period to monitor the occurrence of recurrent venous thromboembolism (VTE) and/or chronic thromboembolic pulmonary hypertension (CTEPH). The primary aim of the SCOPE study was to evaluate the predictive value of persistent perfusion defects for recurrent PE and CTEPH. Notably, 50% of patients were found to have some degree of persistent perfusion defects, with 56 (8.7%) patients having a persistent perfusion obstruction of >25% and none >72%. Both higher age (OR 1.03, 95% CI 1.02–1.04, per year) and unprovoked PE (OR 1.40, 95% CI 1.01–1.95) were predictive of persistent perfusion defects, whereas among others reperfusion therapy at baseline was not. During the 3-year follow-up period, 40 patients were diagnosed with recurrent VTE (6.2%; 95% CI 4.5–8.3) and 11 with CTEPH (1.7%; 95% CI 0.9–3.0). In multivariate COX regression analysis, persistent perfusion defects predicted the combined endpoint of recurrent VTE and/or CTEPH for an adjusted hazard ratio of 2.26 (95% CI 1.23–4.16). From these results, the authors conclude that a single assessment of persistent perfusion defects at 6 months may guide treatment decisions regarding duration of anticoagulation therapy.Persistent perfusion defects predict recurrent pulmonary embolism and CTEPH http://ow.ly/xMHm30aD7aB ER -