Vavera Zdenek, Elias Pavel, Ryska Pavel, Vojacek Jan
1st Department of Cardiovascular Medicine, Charles University and University Hospital; Hradec Kralove-Czech Republic.
Anatol J Cardiol. 2016 Apr;16(4):270-5. doi: 10.5152/akd.2015.6178. Epub 2015 May 6.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a relatively common long-term complication of acute pulmonary embolism (PE) with severely negative impact on the patient's quality of life and prognosis. The aim of our study was to assess morphological changes, with respect to CTEPH development, in the pulmonary artery vascular bed 6 months after diagnosis of acute PE as the first thromboembolic event in the patient`s history.
Our prospective study included a population of 87 consecutive patients with proven PE. Multidetector computer tomography pulmonary arteriography (CTA) was performed 6 months after acute PE to assess residua of thrombi and abnormalities supporting the presence of pulmonary hypertension. To quantify the individual totality of morphological abnormalities, a computer tomography pulmonary embolism residua index (CTPER-index) was constructed and groups of patients with and without CTEPH were compared. The study follow-up was 24 months, with echocardiography performed 6, 12, and 24 months after PE.
Morphological abnormalities corresponding to thrombi residua or pulmonary hypertension on CTA were found in 68% of patients. The CTPER-index reached significantly higher values in patients with CTEPH during a 2-year follow-up. A CTPER-index value ≥4 equates to a 12-fold higher risk of CTEPH development (p=0.013) with sensitivity 0.80 (95% CI 0.31; 0.989) and specificity 0.79 (95% CI 0.754; 0.799).
Our CTPER-index may provide useful information for a clinician performing CTA for differential diagnosis of dyspnea in a patient with a history of PE.
慢性血栓栓塞性肺动脉高压（CTEPH）是急性肺栓塞（PE）相对常见的长期并发症，对患者的生活质量和预后有严重负面影响。我们研究的目的是评估在患者病史中首次发生血栓栓塞事件即急性PE诊断6个月后，肺动脉血管床中与CTEPH发展相关的形态学变化。
我们的前瞻性研究纳入了87例经证实的PE连续患者。急性PE 6个月后进行多排计算机断层扫描肺动脉造影（CTA），以评估血栓残留和支持肺动脉高压存在的异常情况。为了量化形态学异常的个体总体情况，构建了计算机断层扫描肺栓塞残留指数（CTPER指数），并比较有和没有CTEPH的患者组。研究随访时间为24个月，在PE后6、12和24个月进行超声心动图检查。
68%的患者在CTA上发现了与血栓残留或肺动脉高压对应的形态学异常。在2年随访期间，CTEPH患者的CTPER指数值显著更高。CTPER指数值≥4相当于CTEPH发生风险高12倍（p = 0.013），敏感性为0.80（95% CI 0.31；0.989），特异性为0.79（95% CI 0.754；0.799）。
我们的CTPER指数可能为临床医生对有PE病史的患者进行CTA以鉴别诊断呼吸困难提供有用信息。
