Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism

TLDR

Chronic thromboembolic pulmonary hypertension is a serious complication of pulmonary embolism, associated with significant morbidity and mortality, yet its incidence and risk factors remain poorly defined. The study aimed to determine the incidence and risk factors for symptomatic CTPH following acute pulmonary embolism to guide early detection and prevention strategies. Patients with persistent dyspnea were evaluated with transthoracic echocardiography, followed by ventilation‑perfusion scanning and pulmonary angiography when indicated, using hemodynamic thresholds and angiographic evidence to diagnose CTPH. The cumulative incidence of symptomatic CTPH was 1.0 % at 6 months, 3.1 % at 1 year, and 3.8 % at 2 years, with no new cases thereafter; risk factors included prior PE, younger age, larger perfusion defects, and idiopathic PE, underscoring CTPH as a relatively common serious complication.

Abstract

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.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.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).CTPH is a relatively common, serious complication of pulmonary embolism. Diagnostic and therapeutic strategies for the early identification and prevention of CTPH are needed.