Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Tabriz University of Medical Sciences, Imam Reza General Hospital, 29 Bahaman St, Tabriz, Iran.
Lung. 2020 Feb;198(1):59-64. doi: 10.1007/s00408-019-00315-3. Epub 2020 Jan 2.
Chronic thromboembolic pulmonary hypertension (CTEPH) is an important complication after acute pulmonary embolism (PE) with considerable morbidity and mortality. The aim of this study was to estimate the CTEPH incidence in a cohort after the first occurrence of PE.
We conducted a 1-year follow-up cohort study between 2015 and 2018 to assess the incidence of CTEPH in 474 patients with their first acute episode of PE. For the diagnosis of CTEPH, patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography, right heart catheterization, ventilation-perfusion lung scanning, and CT pulmonary angiography.
Overall, 317 patients were included in the study. The mean age of the patients was 56.5 ± 16 years. One hundred and three patients (32%) had exertional dyspnea at the 1-year follow-up. Patients with evidence of pulmonary hypertension (PH) on echocardiography underwent right heart catheterization. Eleven patients (18%) had no PH (mPAP < 25 mmHg); 47 patients (81%) had mPAP > 25 mmHg. Fifteen patients had PAWP > 15 mmHg, including those with underlying left heart problems or valvular diseases. There were 32 patients with PAH (mPAP > 25 mmHg and PVR > 3 WU) undergoing CTEPH studies; 22 patients (6.9%) had multiple segmental defects suggesting CTEPH on a perfusion scan.
The incidence of CTEPH observed in this study 1 year after the first episode of acute PE was approximately 6.9%. This incidence seems to be high in our population, and diagnostic and therapeutic strategies for the early identification of CTEPH are needed.
慢性血栓栓塞性肺动脉高压（CTEPH）是急性肺栓塞（PE）后的一种重要并发症，具有相当高的发病率和死亡率。本研究旨在评估首次发生 PE 后患者队列中的 CTEPH 发病率。
我们进行了一项为期 1 年的随访队列研究，以评估 474 例首次急性 PE 患者的 CTEPH 发病率。对于 CTEPH 的诊断，在随访期间出现不明原因持续性呼吸困难的患者进行了经胸超声心动图、右心导管检查、通气-灌注肺扫描和 CT 肺动脉造影。
共有 317 例患者纳入研究。患者的平均年龄为 56.5±16 岁。103 例患者（32%）在 1 年随访时有运动性呼吸困难。超声心动图显示存在肺动脉高压（PH）的患者接受了右心导管检查。11 例患者（18%）无 PH（mPAP＜25mmHg）；47 例患者（81%）mPAP＞25mmHg。15 例患者的肺动脉楔压（PAWP）＞15mmHg，包括那些存在基础左心问题或瓣膜疾病的患者。有 32 例肺动脉高压（mPAP＞25mmHg 和 PVR＞3 WU）患者进行了 CTEPH 研究；22 例患者（6.9%）在灌注扫描上存在多个节段性缺损，提示 CTEPH。
在首次急性 PE 发作后 1 年观察到的 CTEPH 发病率约为 6.9%。在我们的人群中，这一发病率似乎较高，需要制定早期识别 CTEPH 的诊断和治疗策略。
