title: The incidence of chronic thromboembolic pulmonary hypertension secondary to acute pulmonary thromboembolism.
abstract: BACKGROUND
  Chronic thromboembolic pulmonary hypertension (CTEPH) is a curable and partially preventable complication, with a substantial incidence, leading to severe morbidity and mortality. The aim of the present study was to find out the incidence of CTEPH secondary to acute pulmonary thromboembolism (PTE) using non-invasive procedures such as ventilation/perfusion (V/Q) scintigraphy and pulmonary multidetector CT (MDCT) angiography in determining the diagnosis of CTEPH.
  
  
  METHODS
  The study included a total of 99 patients diagnosed with initial PTE between January 2010 and December 2012. The patients who received anticoagulant therapy at least for three months underwent transthoracic echocardiography (TTE) (n= 85). Thirty one patients with a SPAP value > 30 mmHg and/or an evidence of right ventricular dysfunction in TTE underwent MDCT pulmonary angiography and V/Q scintigraphy. The patients with an evidence of residual chronic thromboembolic signs in MDCT pulmonary angiography and/or segmental perfusion defect(s) in V/Q scintigraphy underwent right heart catheterization (RHC) (n= 7). The mean PAP was measured, and a vasoreactivity test was performed. During RHC, a non-contrast medium was delivered to the pulmonary arteries for pulmonary arteriography imaging.
  
  
  RESULTS
  Among patients diagnosed with PTE, 44 were male and 55 were female. The mean age was 60 ± 17 years. Of these patients, 63.6% had history of at least one additional disease and at least one risk factor for PTE. During diagnosis, 24 subjects were considered having massive, 61 submassive and 14 non-massive PTE. Nineteen (19.1%) patients received thrombolythic therapy. Other 80 (80.8%) patients received standard anticoagulant therapy with an INR value within the therapeutic range. In 79.8% of patients, thromboembolism was bilateral, and it was unilateral in 21.8%. After a minimum of 1 year, and maximum of 2 years follow up five subjects (5.5%) were diagnosed with CTEPH. The univariate analysis showed no association between the development of CTEPH and factors like; age, etiologic risk factors for PTE, receiving thrombolytic treatment, prevalence and type of PTE.
  
  
  CONCLUSIONS
  Potentially preventabl complication of pulmonary embolism; CTEPH, had a substantial incidence during follow-up.
authors.forename: Ismail
authors.initials: I
authors.lastname: Kayaalp
authors.affiliation: Department of Chest Diseases, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey. yeldavatansever@hotmail.com.
authors.forename: Yelda
authors.initials: Y
authors.lastname: Varol
authors.forename: Pınar
authors.initials: P
authors.lastname: Çimen
authors.forename: Fatma
authors.initials: F
authors.lastname: Demirci Üçsular
authors.forename: Nuran
authors.initials: N
authors.lastname: Katgı
authors.forename: Mehmet
authors.initials: M
authors.lastname: Unlü
authors.forename: Cenk
authors.initials: C
authors.lastname: Kıraklı
authors.forename: Salih Zeki
authors.initials: SZ
authors.lastname: Güçlü
authors.forename: Oktay
authors.initials: O
authors.lastname: Ergene
mesh_terms: D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis; D011877:Radionuclide Imaging; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014421:Turkey / Q000453:epidemiology