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Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.

Abstract

BACKGROUND
Chronic thromboembolic pulmonary hypertension (CTPH) is associated with considerable morbidity and mortality. Its incidence after pulmonary embolism and associated risk factors are not well documented.
METHODS
We conducted a prospective, long-term, follow-up study to assess the incidence of symptomatic CTPH in consecutive patients with an acute episode of pulmonary embolism but without prior venous thromboembolism. Patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography and, if supportive findings were present, ventilation-perfusion lung scanning and pulmonary angiography. CTPH was considered to be present if systolic and mean pulmonary-artery pressures exceeded 40 mm Hg and 25 mm Hg, respectively; pulmonary-capillary wedge pressure was normal; and there was angiographic evidence of disease.
RESULTS
The cumulative incidence of symptomatic CTPH was 1.0 percent (95 percent confidence interval, 0.0 to 2.4) at six months, 3.1 percent (95 percent confidence interval, 0.7 to 5.5) at one year, and 3.8 percent (95 percent confidence interval, 1.1 to 6.5) at two years. No cases occurred after two years among the patients with more than two years of follow-up data. The following increased the risk of CTPH: a previous pulmonary embolism (odds ratio, 19.0), younger age (odds ratio, 1.79 per decade), a larger perfusion defect (odds ratio, 2.22 per decile decrement in perfusion), and idiopathic pulmonary embolism at presentation (odds ratio, 5.70).
CONCLUSIONS
CTPH is a relatively common, serious complication of pulmonary embolism. Diagnostic and therapeutic strategies for the early identification and prevention of CTPH are needed.

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  • Authors

    Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, Albanese P, Biasiolo A, Pegoraro C, Iliceto S, Prandoni P, Thromboembolic Pulmonary Hypertension Study Group

    Institution

    Department of Clinical and Experimental Medicine, Division of Clinical Cardiology, University Hospital of Padua, Padua, Italy.

    Source

    The New England journal of medicine 350:22 2004 May 27 pg 2257-64

    MeSH

    Adolescent
    Adult
    Age Factors
    Aged
    Chronic Disease
    Female
    Follow-Up Studies
    Humans
    Hypertension, Pulmonary
    Incidence
    Logistic Models
    Male
    Middle Aged
    Pulmonary Embolism
    Recurrence
    Risk Factors
    Thromboembolism

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15163775