title: Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature.
abstract: The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown.We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as "all comers", "survivors" or "survivors without major comorbidities". CTEPH incidences were calculated using random effects models.We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1-1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0-4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5-4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7-5.9) and 4.1 (95% CI 2.1-8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1-8.4).The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ∼3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.
authors.affiliation: Dept of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands Y.M.Ende-Verhaar@lumc.nl.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Ende-Verhaar
authors.affiliation: Dept of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Cannegieter
authors.affiliation: Dept of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Anton
authors.initials: A
authors.lastname: Vonk Noordegraaf
authors.affiliation: Dept of Respiratory Diseases, University Hospital of Leuven, Leuven, Belgium.
authors.forename: Marion
authors.initials: M
authors.lastname: Delcroix
authors.affiliation: Dept of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.affiliation: Dept of Vascular Medicine, Haga Hospital, The Hague, The Netherlands.
authors.forename: Albert T A
authors.initials: AT
authors.lastname: Mairuhu
authors.affiliation: Dept of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: Dept of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D011655:Pulmonary Embolism / Q000150:complications*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000150:complications* / Q000175:diagnosis