title: Association of deep vein thrombosis type with clinical phenotype of chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  Chronic thromboembolic pulmonary hypertension (CTEPH) has been considered to be caused by single or recurrent pulmonary embolism (PE) arising from deep vein thrombosis (DVT). In Japan, female predominance and association of HLA-B*5201 with CTEPH unrelated to DVT were reported. In acute PE residual proximal DVT is associated with larger obstruction of pulmonary arteries. However, it remains uncertain whether DVT and the type of DVT are associated with clinical phenotype of CTEPH.
  
  
  OBJECTIVE
  To clarify the association of DVT and DVT type with clinical phenotype of CTEPH.
  
  
  METHODS
  Among 98 consecutive patients who underwent 16 or 64-slice multidetector CT angiography and indirect venography, 91 patients (66% female, age: 56±3 years) with adequate images were enrolled. The associations of DVT and DVT type with pulmonary hemodynamics, CT obstruction index and other clinical parameters were analyzed.
  
  
  RESULTS
  DVT was found in 45 patients (49.5%) (distal: 12, proximal: 33), and was significantly associated with male gender and recurrent type. Furthermore, it was more frequent in HLA-B*5201-negative, and d-dimer positive patients. Compared with distal DVT, proximal DVT was associated with male gender, larger CT obstruction index (48.6±13.0 vs. 34.1±13.2%, p=0.004), and higher mean pulmonary arterial pressure (48.2±12.8 vs. 40.8±7.9 mmHg, p=0.03). Proximal DVT was significantly associated with the central type of CTEPH only in HLA-B*5201-negative patients.
  
  
  CONCLUSIONS
  The existence and type of DVT were associated with clinical phenotype of CTEPH, and proximal DVT might contribute to the central type of CTEPH in only HLA-B*5201-negative patients.
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. mkantake@gmail.com
authors.forename: Masashi
authors.initials: M
authors.lastname: Kantake
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanabe
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sugiura
authors.forename: Ayako
authors.initials: A
authors.lastname: Shigeta
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yanagawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Jujo
authors.forename: Naoko
authors.initials: N
authors.lastname: Kawata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Amano
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Matsuura
authors.forename: Rintaro
authors.initials: R
authors.lastname: Nishimura
authors.forename: Ayumi
authors.initials: A
authors.lastname: Sekine
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sakao
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kasahara
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tatsumi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D010641:Phenotype; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*