Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.
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.
Pengo
Vittorio
V
Department of Clinical and Experimental Medicine, Division of Clinical Cardiology, University Hospital of Padua, Padua, Italy.
Lensing
Anthonie W A
AW
Prins
Martin H
MH
Marchiori
Antonio
A
Davidson
Bruce L
BL
Tiozzo
Francesca
F
Albanese
Paolo
P
Biasiolo
Alessandra
A
Pegoraro
Cinzia
C
Iliceto
Sabino
S
Prandoni
Paolo
P
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D012008:Recurrence; D012307:Risk Factors; D013923:Thromboembolism / Q000150:complications