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Evaluation of the Incidence of Chronic Thromboembolic Pulmonary Hypertension 1 Year After First Episode of Acute Pulmonary Embolism: A Cohort Study

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Abstract

Purpose

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important complication after acute pulmonary embolism (PE) with considerable morbidity and mortality. The aim of this study was to estimate the CTEPH incidence in a cohort after the first occurrence of PE.

Methods

We conducted a 1-year follow-up cohort study between 2015 and 2018 to assess the incidence of CTEPH in 474 patients with their first acute episode of PE. For the diagnosis of CTEPH, patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography, right heart catheterization, ventilation-perfusion lung scanning, and CT pulmonary angiography.

Results

Overall, 317 patients were included in the study. The mean age of the patients was 56.5 ± 16 years. One hundred and three patients (32%) had exertional dyspnea at the 1-year follow-up. Patients with evidence of pulmonary hypertension (PH) on echocardiography underwent right heart catheterization. Eleven patients (18%) had no PH (mPAP < 25 mmHg); 47 patients (81%) had mPAP > 25 mmHg. Fifteen patients had PAWP > 15 mmHg, including those with underlying left heart problems or valvular diseases. There were 32 patients with PAH (mPAP > 25 mmHg and PVR > 3 WU) undergoing CTEPH studies; 22 patients (6.9%) had multiple segmental defects suggesting CTEPH on a perfusion scan.

Conclusion

The incidence of CTEPH observed in this study 1 year after the first episode of acute PE was approximately 6.9%. This incidence seems to be high in our population, and diagnostic and therapeutic strategies for the early identification of CTEPH are needed.

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Authors and Affiliations

  1. Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Farid Rashidi & Ata Koohi

  2. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Rezayat Parvizi & Eisa Bilejani

  3. Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran

    Babak Mahmoodian

  4. Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Fatemeh Rahimi

  5. Tabriz University of Medical Sciences, Imam Reza General Hospital, 29 Bahaman St, Tabriz, Iran

    Farid Rashidi

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  1. Farid Rashidi
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  2. Rezayat Parvizi
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Correspondence to Farid Rashidi.

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Rashidi, F., Parvizi, R., Bilejani, E. et al. Evaluation of the Incidence of Chronic Thromboembolic Pulmonary Hypertension 1 Year After First Episode of Acute Pulmonary Embolism: A Cohort Study. Lung 198, 59–64 (2020). https://doi.org/10.1007/s00408-019-00315-3

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  • DOI: https://doi.org/10.1007/s00408-019-00315-3

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