Martínez-Santos Paula, Velázquez-Martín María Teresa, Barberá Joan Albert, Fernández Pérez Cristina, López-Meseguer Manuel, López-Reyes Raquel, Martínez-Meñaca Amaya, Lara-Padrón Antonio, Domingo-Morera Juan Antonio, Blanco Isabel, Escribano-Subías Pilar
Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2021 May;74(5):384-392. doi: 10.1016/j.rec.2020.06.006. Epub 2020 Jul 9.
Chronic thromboembolic pulmonary hypertension (CTEPH) treatment has evolved in the last decade. However, there is scarce information on the long-term impact of this progress in a real-life population at a national level. This study was designed to analyze the characteristics of CTEPH patients in Spain over the last decade.
We prospectively collected epidemiological, clinical, and prognostic data from CTEPH patients consecutively included in the Spanish REHAP registry from January 1, 2007, to December 31, 2018. We evaluated differences over time, establishing 2013 as the reference date for analysis. Propensity scores for interventional treatment were calculated using a multivariable logistic regression model.
A total of 1019 patients were included; 659 (64.4%) were evaluated at a national CTEPH center. Overall, 350 patients (34.3%) were selected for surgery and 97 (9.6%) for percutaneous treatment. Patients diagnosed between 2007 and 2012 died more frequently than those diagnosed from 2013 onward (HR, 1.83; 95%CI, 1.07-3.15; P=.027). Within the subgroup of patients adjusted by propensity score, baseline pulmonary vascular resistance and the 6-minute walk test distance also determined the outcome (HR, 1.24; 95%CI, 1.15-1.33; P=.011; and HR, 0.93; 95%CI, 0.90-0.97; P=.001, respectively). High survival rates were found in patients who underwent an invasive procedure (pulmonary endarterectomy or balloon pulmonary angioplasty).
CTEPH diagnosis and prognosis have consistently improved in the last decade. Baseline disease severity determines the risk profile. Patients who undergo pulmonary endarterectomy or balloon pulmonary angioplasty have better outcomes.
慢性血栓栓塞性肺动脉高压（CTEPH）的治疗在过去十年中不断发展。然而，关于这一进展在全国实际人群中的长期影响的信息却很少。本研究旨在分析过去十年西班牙CTEPH患者的特征。
我们前瞻性地收集了2007年1月1日至2018年12月31日连续纳入西班牙REHAP注册研究的CTEPH患者的流行病学、临床和预后数据。我们评估了不同时间的差异，将2013年作为分析的参考日期。使用多变量逻辑回归模型计算介入治疗的倾向评分。
共纳入1019例患者；659例（64.4%）在全国CTEPH中心接受评估。总体而言，350例患者（34.3%）被选择进行手术，97例（9.6%）接受经皮治疗。2007年至2012年诊断的患者比2013年以后诊断的患者死亡更频繁（HR，1.83；95%CI，1.07 - 3.15；P = 0.027）。在倾向评分调整的患者亚组中，基线肺血管阻力和6分钟步行试验距离也决定了预后（HR，1.24；95%CI，1.15 - 1.33；P = 0.011；以及HR，0.93；95%CI，0.90 - 0.97；P = 0.001，分别）。接受侵入性手术（肺动脉内膜切除术或球囊肺动脉成形术）的患者生存率较高。
在过去十年中，CTEPH的诊断和预后持续改善。基线疾病严重程度决定风险特征。接受肺动脉内膜切除术或球囊肺动脉成形术的患者预后更好。
