Lachant Daniel, Bach Christina, Wilson Bennett, Chengazi Vaseem, Goldman Bruce, Lachant Neil, Pietropaoli Anthony, Cameron Scott, James White R
Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Division of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
Pulm Circ. 2020 Sep 21;10(3):2045894020952019. doi: 10.1177/2045894020952019. eCollection 2020 Jul-Sep.
Long-term outcomes after acute pulmonary embolism vary from complete resolution to chronic thromboembolic pulmonary hypertension (CTEPH). Guidelines after acute pulmonary embolism are generally limited to anticoagulation duration. We assessed patients with estimated prognosis >1 year in our pulmonary hypertension clinic 2-4 months after treatment for intermediate- or high-risk acute pulmonary embolism. At follow-up, ventilation-perfusion scan and echocardiogram were offered. The aim of this study was to assess for recurrent symptomatic disease, residual imaging defects or right ventricular dysfunction, and functional disability after acute management of pulmonary embolism. After treatment for acute intermediate- or high-risk pulmonary embolism, 104 patients followed up in pulmonary hypertension clinic. Of those, 55% of patients had self-reported limitation in activity. No patients had symptomatic recurrence of pulmonary embolism. Forty-eight percent of patients had residual perfusion defects on perfusion imaging, while 91% of patients had either normal or only mildly enlarged right ventricles. We identified heart failure preserved ejection fraction, iron deficiency, and obstructive sleep apnea as significant contributors to breathlessness. Treatment of these conditions was associated with improvement. Surprisingly, we diagnosed CTEPH in nine patients; for some, chronic thrombus may already have been present at the time of index evaluation. Our findings suggest that follow-up in a dedicated pulmonary hypertension clinic 2-4 months after acute intermediate- or high-risk pulmonary embolism may add value to patient care. We identified treatable comorbidities that could be contributing to post-pulmonary embolism syndrome as well as CTEPH.
急性肺栓塞后的长期预后各不相同，从完全缓解到慢性血栓栓塞性肺动脉高压（CTEPH）。急性肺栓塞后的指南通常仅限于抗凝持续时间。我们在肺动脉高压门诊对中高危急性肺栓塞治疗后2至4个月、预计预后超过1年的患者进行了评估。在随访时，进行了通气灌注扫描和超声心动图检查。本研究的目的是评估肺栓塞急性处理后复发性症状性疾病、残留影像缺陷或右心室功能障碍以及功能残疾情况。在对急性中高危肺栓塞进行治疗后，104例患者在肺动脉高压门诊接受了随访。其中，55%的患者自述活动受限。没有患者出现肺栓塞症状复发。48%的患者在灌注成像上有残留灌注缺陷，而91%的患者右心室正常或仅轻度增大。我们确定射血分数保留的心力衰竭、缺铁和阻塞性睡眠呼吸暂停是导致呼吸困难的重要因素。对这些情况的治疗与症状改善相关。令人惊讶的是，我们在9例患者中诊断出CTEPH；对于一些患者，在首次评估时可能已经存在慢性血栓。我们的研究结果表明，在急性中高危肺栓塞后2至4个月在专门的肺动脉高压门诊进行随访可能对患者护理有价值。我们确定了一些可治疗的合并症，这些合并症可能导致肺栓塞后综合征以及CTEPH。
