Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and INSERM U1304, CIC INSERM 1412, Brest, France.
Unité de recherche clinique, Innovation et pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, France.
J Thromb Haemost. 2022 Dec;20(12):2850-2861. doi: 10.1111/jth.15866. Epub 2022 Sep 25.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication of a pulmonary embolism (PE) whose incidence and predictors are not precisely determined.
To determine the frequency and predictors for CTEPH after a first unprovoked PE.
PATIENTS/METHODS: In a randomized trial comparing an additional 18-month warfarin versus placebo in patients after a first unprovoked PE initially treated with vitamin K antagonist for 6 months, we applied recommended CTEPH screening strategies through an 8-year follow-up to determine cumulative incidence of CTEPH. CTEPH predictors were estimated using Cox models. Pulmonary vascular obstruction (PVO) and systolic pulmonary arterial pressure (sPAP) at PE diagnosis and 6 months were studied by receiver operating curves analysis. All CTEPH cases and whether they were incident or prevalent were adjudicated.
During a median follow-up of 8.7 years, nine CTEPH cases were diagnosed among 371 patients, with a cumulative incidence of 2.8% (95% confidence interval [CI] 0.95-4.64), and of 1.31% (95% CI 0.01-2.60) after exclusion of five cases adjudicated as prevalent. At PE diagnosis, PVO > 45% and sPAP > 56 mmHg were associated with CTEPH with a hazard ratio (HR) of 33.00 (95% CI 1.64-667.00, p = .02) and 12.50 (95% CI 2.10-74.80, p < .01), respectively. Age > 65 years, lupus anticoagulant antibodies and non-O blood groups were also predictive of CTEPH. PVO > 14% and sPAP > 34 mmHg at 6 months were associated with CTEPH (HR 63.90 [95% CI 3.11-1310.00, p < .01]and HR 17.2 [95% CI 2.75-108, p < .01]).
After a first unprovoked PE, CTEPH cumulative incidence was 2.8% during an 8-year follow-up. PVO and sPAP at PE diagnosis and at 6 months were the main predictors for CTEPH diagnosis.
慢性血栓栓塞性肺动脉高压（CTEPH）是肺栓塞（PE）的一种危及生命的并发症，其发病率和预测因素尚未精确确定。
确定首次无诱因 PE 后 CTEPH 的频率和预测因素。
患者/方法：在一项比较维生素 K 拮抗剂初始治疗 6 个月后，最初接受 18 个月华法林与安慰剂治疗的首次无诱因 PE 患者的随机试验中，我们通过 8 年的随访应用了推荐的 CTEPH 筛查策略，以确定 CTEPH 的累积发生率。使用 Cox 模型估计 CTEPH 的预测因素。通过接受者操作曲线分析研究 PE 诊断时和 6 个月时的肺血管阻塞（PVO）和收缩期肺动脉压（sPAP）。所有 CTEPH 病例以及它们是新发还是已存在均经过裁决。
在中位随访 8.7 年期间，371 例患者中有 9 例诊断为 CTEPH，累积发生率为 2.8%（95%置信区间[CI]0.95-4.64），排除 5 例裁决为已存在的病例后，发生率为 1.31%（95%CI0.01-2.60）。PE 诊断时，PVO>45%和 sPAP>56mmHg 与 CTEPH 相关，风险比（HR）分别为 33.00（95%CI1.64-667.00，p=0.02）和 12.50（95%CI2.10-74.80，p<0.01）。年龄>65 岁、狼疮抗凝抗体和非 O 血型也是 CTEPH 的预测因素。6 个月时 PVO>14%和 sPAP>34mmHg 与 CTEPH 相关（HR63.90[95%CI3.11-1310.00，p<0.01]和 HR17.2[95%CI2.75-108，p<0.01]）。
在首次无诱因 PE 后，8 年随访期间 CTEPH 的累积发生率为 2.8%。PE 诊断时和 6 个月时的 PVO 和 sPAP 是 CTEPH 诊断的主要预测因素。
