Echocardiographic assessment of pulmonary arterial pressure in the follow-up of patients with pulmonary embolism.
BACKGROUND
Echocardiography remains a clinically useful screening test for chronic thromboembolic pulmonary hypertension (CTEPH) in patients with a history of pulmonary embolism (PE). To devise an effective screening strategy, the definition of a high-risk group is necessary.


METHODS
We examined a total of 744 patients with acute symptomatic pulmonary embolism (PE) who were enrolled in a Spanish multicenter study. Patients were monitored every 6months during the first two years, and then once a year thereafter. Transthoracic echocardiography was used to screen patients with a clinical suspicion of CTEPH during follow-up. Pulmonary arterial hypertension was defined as an estimated pulmonary artery systolic pressure (PAP)>50mm Hg. The index thromboembolic episode was considered severe if: (a) the patient was immobilized for medical reasons; or (b) systolic blood pressure was less than 90mm Hg; or (c) troponin T values were above the reference range.


RESULTS
The incidence of PAP>50mm Hg at 36months was 8.3% (95% confidence interval=4.6%-14.5%). Statistical analysis showed a highly significant association between a severe index thromboembolic episode and the subsequent detection of PAP>50mm Hg on echocardiography, with high positive likelihood ratio (2.40) and negative predictive value (>0.97).


CONCLUSIONS
Patients with a severe index thromboembolic episode would constitute a high-risk group for the development of CTEPH. This group of patients should be subjected to a strict follow-up protocol.
Service of Pneumology, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot s/n, 41013 Seville, Spain. rotero@separ.es
Remedios
R
Otero
Mikel
M
Oribe
Aitor
A
Ballaz
David
D
Jimenez
Fernando
F
Uresandi
Dolores
D
Nauffal
Francisco
F
Conget
Consolación
C
Rodriguez
Teresa
T
Elias
Luis
L
Jara
Aurelio
A
Cayuela
Isabel
I
Blanco
Joan
J
Barberá
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000000981:diagnostic imaging; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015994:Incidence; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014463:Ultrasonography