title: Active search for chronic thromboembolic pulmonary hypertension does not appear indicated after acute pulmonary embolism.
abstract: BACKGROUND
  Chronic thromboembolic pulmonary hypertension (CTEPH) is a life threatening but often, by pulmonary endarterectomy, curable disease. The incidence of CTEPH after an acute pulmonary embolism (PE) appears to be much higher than previously thought. Systematic follow-up of patients after PE might increase the number of diagnosed CTEPH patients.
  
  
  OBJECTIVE
  To study whether, compared to current clinical practice, a systematic search for CTEPH in patients after acute PE would increase the number of patients diagnosed with symptomatic, potentially treatable CTEPH.
  
  
  METHODS
  Consecutive patients with a prior diagnosis of acute PE were presented with a questionnaire, designed to establish the presence of either new or worsened dyspnea after the acute PE episode. If so, patients were evaluated for the presence of CTEPH.
  
  
  RESULTS
  PE patients (n=110; 56+/-18 years) were included after a median follow-up of three years. Overall mortality was 34% (37 patients); 1 patient had died due to CTEPH. In total 62 out of 69 questionnaires were returned; 23 patients reported new or worsened dyspnea related to the PE episode, and qualified for additional testing. In 2 patients, CTEPH was already diagnosed prior to this study. None of the remaining patients met the criteria for the diagnosis of CTEPH. The overall incidence of 2.7% (3/110; 95%CI 0.6-7.8%) is in agreement with earlier reported incidences.
  
  
  CONCLUSIONS
  Our findings do not point to a role for a systematic search and pro-active approach towards patients with a recent history of pulmonary embolism to increase the number of patients diagnosed with potentially treatable CTEPH.
authors.affiliation: Department of Pulmonology, Academical Medical Center Amsterdam, the Netherlands. s.surie@amc.uva.nl
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Surie
authors.forename: Nadine S
authors.initials: NS
authors.lastname: Gibson
authors.forename: Victor E A
authors.initials: VE
authors.lastname: Gerdes
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: Harry R
authors.initials: HR
authors.lastname: Buller
authors.forename: Paul
authors.initials: P
authors.lastname: Bresser
mesh_terms: D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors