Yu Yongping, Yang Li, Zhang Yuhai, Dong Liang, Xia Jingwen, Zhu Ning, Han Xinpeng, Fang Liying, Chai Yaqin, Niu Mengjie, Liu Lingli, Yang Xuemin, Qu Shuoyao, Li Shengqing
Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Department of Respiratory Medicine, Shaanxi Normal University Hospital, Shaanxi, China.
Clin Respir J. 2018 Nov;12(11):2551-2558. doi: 10.1111/crj.12955. Epub 2018 Oct 9.
The incidence and risk factors of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with acute pulmonary embolism (PE) have been well reported. However, in real world, patients diagnosed with PE for the first time were usually composed of acute PE, sub-acute PE, and chronic PE, and the cumulative incidence and risk factors of CTEPH in this cohort were still unknown.
A prospective, long-term, follow-up study was conducted to assess the incidence of symptomatic CTEPH in consecutive patients with PE diagnosed for the first time. Patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography and, if the findings indicated pulmonary hypertension, ventilation-perfusion lung scanning and right heart catheterization. CTEPH was confirmed if perfusion defects were present, mean pulmonary artery pressure (mPAP) ≥25 mmHg and pulmonary artery wedge pressure (PAWP) ≤15 mmHg.
The cumulative incidence of CTEPH in patients with PE diagnosed for the first time was 11.2% at 3 months, 12.7% at 1 year, 13.4% at 2 years, and 14.5% at 3 years. The following factors increased the risk of CTEPH: time from symptoms to treatment of PE ≥1 month (odds ratio (OR), 14.77), intermediate (OR, 37.63) to high risk PE (OR, 39.81), segmental and sub-segmental branch location of embolism (OR, 8.30) and PE-related primary risk factors (OR, 5.01). 9.4% of CTEPH patients developed from acute PE, and 90.6% from sub-acute and chronic PE.
In real world, CTEPH is a relatively common and serious complication in PE patients diagnosed for the first time. Early diagnosis and treatment of PE will decrease the incidence of CTEPH in these unspecified patients.
急性肺栓塞（PE）患者中慢性血栓栓塞性肺动脉高压（CTEPH）的发病率及危险因素已有大量报道。然而，在现实世界中，首次诊断为PE的患者通常包括急性PE、亚急性PE和慢性PE，该队列中CTEPH的累积发病率及危险因素仍不明确。
开展一项前瞻性长期随访研究，以评估首次诊断为PE的连续患者中症状性CTEPH的发病率。随访期间出现无法解释的持续性呼吸困难的患者接受经胸超声心动图检查，若检查结果提示肺动脉高压，则进行通气-灌注肺扫描及右心导管检查。若存在灌注缺损、平均肺动脉压（mPAP）≥25 mmHg且肺动脉楔压（PAWP）≤15 mmHg，则确诊为CTEPH。
首次诊断为PE的患者中，CTEPH的累积发病率在3个月时为11.2%，1年时为12.7%，2年时为13.4%，3年时为14.5%。以下因素会增加CTEPH的风险：从症状出现到开始治疗PE的时间≥1个月（比值比（OR），14.77）、中危（OR，37.63）至高危PE（OR，39.81）、栓塞位于节段及亚节段分支部位（OR，8.30）以及与PE相关的原发性危险因素（OR，5.01）。9.4%的CTEPH患者由急性PE发展而来，90.6%由亚急性和慢性PE发展而来。
在现实世界中，CTEPH是首次诊断为PE的患者中一种相对常见且严重的并发症。对PE进行早期诊断和治疗将降低这些未明确分类患者中CTEPH的发病率。
