Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, LUMC, Leiden, the Netherlands.
Haematologica. 2010 Jun;95(6):970-5. doi: 10.3324/haematol.2009.018960. Epub 2010 Jan 6.
Chronic thromboembolic pulmonary hypertension after pulmonary embolism is associated with high morbidity and mortality. Understanding the incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism is important for evaluating the need for screening but is also a subject of debate because of different inclusion criteria among previous studies. We determined the incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism and the utility of a screening program for this disease.
We conducted a cohort screening study in an unselected series of consecutive patients (n=866) diagnosed with acute pulmonary embolism between January 2001 and July 2007. All patients who had not been previously diagnosed with pulmonary hypertension (PH) and had survived until study inclusion were invited for echocardiography. Patients with echocardiographic suspicion of PH underwent complete work-up for chronic thromboembolic pulmonary hypertension, including ventilation-perfusion scintigraphy and right heart catheterization.
After an average follow-up of 34 months of all 866 patients, PH was diagnosed in 19 patients by routine clinical care and in 10 by our screening program; 4 patients had chronic thromboembolic pulmonary hypertension, all diagnosed by routine clinical care. The cumulative incidence of chronic thromboembolic pulmonary hypertension after all cause pulmonary embolism was 0.57% (95% confidence interval [CI] 0.02-1.2%) and after unprovoked pulmonary embolism 1.5% (95% CI 0.08-3.1%).
Because of the low incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism and the very low yield of the echocardiography based screening program, wide scale implementation of prolonged follow-up including echocardiography of all patients with pulmonary embolism to detect chronic thromboembolic pulmonary hypertension does not seem to be warranted.
肺栓塞后慢性血栓栓塞性肺动脉高压与高发病率和死亡率相关。了解肺栓塞后慢性血栓栓塞性肺动脉高压的发生率对于评估筛查的必要性很重要，但由于先前研究的纳入标准不同，这也是一个有争议的话题。我们旨在确定急性肺栓塞后慢性血栓栓塞性肺动脉高压的发生率，并评估该疾病筛查计划的实用性。
我们对 2001 年 1 月至 2007 年 7 月连续确诊的急性肺栓塞患者进行了队列筛查研究（n=866）。所有未被诊断为肺动脉高压（PH）且存活至纳入研究的患者均被邀请接受超声心动图检查。超声心动图怀疑 PH 的患者进行慢性血栓栓塞性肺动脉高压的全面检查，包括通气灌注闪烁显像和右心导管检查。
在所有 866 例患者的平均随访 34 个月后，常规临床护理诊断 19 例 PH，筛查计划诊断 10 例；4 例患者患有慢性血栓栓塞性肺动脉高压，均由常规临床护理诊断。所有原因所致肺栓塞后慢性血栓栓塞性肺动脉高压的累积发生率为 0.57%（95%置信区间[CI] 0.02-1.2%），特发性肺栓塞后为 1.5%（95%CI 0.08-3.1%）。
由于肺栓塞后慢性血栓栓塞性肺动脉高压的发生率较低，且基于超声心动图的筛查计划的检出率非常低，广泛实施包括所有肺栓塞患者的超声心动图在内的延长随访以检测慢性血栓栓塞性肺动脉高压似乎没有必要。
