Yang Suqiao, Yang Yuanhua, Zhai Zhenguo, Kuang Tuguang, Gong Juanni, Zhang Shuai, Zhu Jianguo, Liang Lirong, Shen Ying H, Wang Chen
1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China.
J Thorac Dis. 2015 Nov;7(11):1927-38. doi: 10.3978/j.issn.2072-1439.2015.11.43.
Early identification and treatment of chronic thromboembolic pulmonary hypertension (CTEPH) are critical to prevent disease progression. We determined the incidence and risk factors for CTEPH in patients with a first episode of acute pulmonary embolism (PE).
In this study, consecutive patients with first-episode acute PE were followed for ≤5 years. Pulmonary hypertension (PH) was screened for by echocardiography. Suspected cases were evaluated by right heart catheterization (RHC) and pulmonary angiography (PA). If invasive procedures were not permitted, PH was diagnosed by systolic pulmonary artery pressure (SPAP) >50 mmHg. Diagnosis of CTEPH was confirmed by PA, ventilation/perfusion (V/Q) lung scan, or computed tomography (CT) PA (CTPA).
Overall, 614 patients with acute PE were included (median follow-up, 3.3 years). Ten patients were diagnosed with CTEPH: cumulative incidence 0.8% [95% confidence interval (CI), 0.0-1.6%] at 1 year, 1.3% (95% CI, 0.3-2.3%) at 2 years, and 1.7% (95% CI, 0.7-2.7%) at 3 years. No cases of CTEPH developed after 3 years. History of lower-limb varicose veins [hazard ratio (HR), 4.3; 95% CI, 1.2-15.4; P=0.024], SPAP >50 mmHg at initial PE episode (HR, 23.5; 95% CI, 2.7-207.6; P=0.005), intermediate-risk PE (HR, 1.2; 95% CI, 1.0-1.4; P=0.030), and CT obstruction index over 30% at 3 months after acute PE (HR, 42.5; 95% CI, 4.4-409.8; P=0.001) were associated with increased risk of CTEPH.
CTEPH was not rare after acute PE in this Chinese population, especially within 3 years of diagnosis. Lower-limb varicose veins, intermediate-risk PE with elevated SPAP in the acute phase, and residual emboli during follow-up might increase the risk of CTEPH.
慢性血栓栓塞性肺动脉高压（CTEPH）的早期识别和治疗对于预防疾病进展至关重要。我们确定了首次发生急性肺栓塞（PE）患者中CTEPH的发病率及危险因素。
在本研究中，对连续的首次发生急性PE患者进行了≤5年的随访。通过超声心动图筛查肺动脉高压（PH）。对疑似病例采用右心导管检查（RHC）和肺血管造影（PA）进行评估。若不允许进行侵入性检查，则根据收缩期肺动脉压（SPAP）>50 mmHg诊断PH。通过PA、通气/灌注（V/Q）肺扫描或计算机断层扫描（CT）肺动脉造影（CTPA）确诊CTEPH。
总体而言，纳入了614例急性PE患者（中位随访时间为3.3年）。10例患者被诊断为CTEPH：1年时累积发病率为0.8%[95%置信区间（CI），0.0 - 1.6%]，2年时为1.3%（95% CI，0.3 - 2.3%），3年时为1.7%（95% CI，0.7 - 2.7%）。3年后未出现CTEPH病例。下肢静脉曲张病史[风险比（HR），4.3；95% CI，1.2 - 15.4；P = 0.024]、初次PE发作时SPAP>50 mmHg（HR，23.5；95% CI，2.7 - 207.6；P = 0.005）、中危PE（HR，1.2；95% CI，1.0 - 1.4；P = 0.030）以及急性PE后3个月时CT阻塞指数超过30%（HR，42.5；95% CI，4.4 - 409.8；P = 0.001）与CTEPH风险增加相关。
在该中国人群中，急性PE后CTEPH并不罕见，尤其是在诊断后的3年内。下肢静脉曲张、急性期SPAP升高的中危PE以及随访期间的残余栓子可能会增加CTEPH的风险。
