title: A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study.
abstract: BACKGROUND
  Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH.This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool.
  
  
  METHODS
  In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH.
  
  
  RESULTS
  37.7%, 25.5% and 29.3% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4%, 11.5% and 18.8% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET.
  
  
  CONCLUSIONS
  A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.
authors.affiliation: Medical Mission Hospital, Department of Internal Medicine, Academic Teaching Hospital of the Julius-Maximilian University of Würzburg, Salvatorstrasse 7, Würzburg 97067, Germany. matthias.held@missioklinik.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Held
authors.forename: Alexander
authors.initials: A
authors.lastname: Hesse
authors.forename: Franziska
authors.initials: F
authors.lastname: Gött
authors.forename: Regina
authors.initials: R
authors.lastname: Holl
authors.forename: Gudrun
authors.initials: G
authors.lastname: Hübner
authors.forename: Philipp
authors.initials: P
authors.lastname: Kolb
authors.forename: Heinz Jakob
authors.initials: HJ
authors.lastname: Langen
authors.forename: Tobias
authors.initials: T
authors.lastname: Romen
authors.forename: Franziska
authors.initials: F
authors.lastname: Walter
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.forename: Berthold
authors.initials: B
authors.lastname: Jany
mesh_terms: D000359:Aftercare / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion / Q000502:physiology; D011446:Prospective Studies; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000150:complications*; D012042:Registries; D012146:Rest / Q000502:physiology; D013689:Telephone; D013997:Time Factors