Held Matthias, Pfeuffer-Jovic Elena, Wilkens Heinrike, Güder Gülmisal, Küsters Franziska, Schäfers Hans Joachim, Langen Heinz Jakob, Cheufou Danjouma, Schmitt Delia
Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital Klinikum Würzburg Mitte, Academic Teaching Hospital of the Julius Maximilian University, Würzburg, Germany.
Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital Klinikum Würzburg Mitte, Academic Teaching Hospital of the Julius Maximilian University, Würzburg, Germany.
Respir Med. 2023 Apr-May;210:107177. doi: 10.1016/j.rmed.2023.107177. Epub 2023 Mar 1.
The influence of the new pulmonary hypertension (PH) definition on the incidence of chronic thromboembolic PH (CTEPH) is unclear. The incidence of chronic thromboembolic pulmonary disease without PH (CTEPD) is unknown.
To determine the frequency of CTEPH and CTEPD using the new mPAP cut-off >20 mmHg for PH in patients who have suffered an incidence of pulmonary embolism (PE) and were recruited into an aftercare program.
In a prospective two-year observational study based on telephone calls, echocardiography and cardiopulmonary exercise tests, patients with findings suspicious for PH received an invasive work-up. Data from right heart catheterization were used to identify patients with or without CTEPH/CTEPD.
Two years after acute PE (n = 400) we found an incidence of 5.25% for CTEPH (n = 21) and 5.75% for CTEPD (n = 23) according to the new mPAP threshold >20 mmHg. Five of 21 patients with CTEPH and 13 of 23 patients with CTEPD showed no signs of PH in echocardiography. CTEPH and CTEPD subjects showed a reduced VO₂ peak and work rate in cardiopulmonary exercise testing (CPET). The capillary end-tidal CO gradient was comparably elevated in CTEPH and CTEPD, but it was normal in the Non-CTEPD-Non-PH group. According to the PH definition provided by the former guidelines, only 17 (4.25%) patients have been diagnosed with CTEPH and 27 individuals (6.75%) were classified having CTEPD.
Using mPAP >20 mmHg for diagnosis of CTEPH leads to an increase of 23.5% of CTEPH diagnosis. CPET may help to detect CTEPD and CTEPH.
新的肺动脉高压（PH）定义对慢性血栓栓塞性肺动脉高压（CTEPH）发病率的影响尚不清楚。无PH的慢性血栓栓塞性肺疾病（CTEPD）的发病率未知。
在发生过肺栓塞（PE）并纳入后续护理计划的患者中，使用新的mPAP截止值>20 mmHg来确定CTEPH和CTEPD的发生率。
在一项基于电话、超声心动图和心肺运动试验的前瞻性两年观察性研究中，对怀疑有PH的患者进行有创检查。右心导管检查数据用于识别有无CTEPH/CTEPD的患者。
急性PE后两年（n = 400），根据新的mPAP阈值>20 mmHg，我们发现CTEPH的发生率为5.25%（n = 21），CTEPD的发生率为5.75%（n = 23）。21例CTEPH患者中有5例，23例CTEPD患者中有13例在超声心动图中未显示PH迹象。CTEPH和CTEPD受试者在心肺运动试验（CPET）中的VO₂峰值和工作率降低。CTEPH和CTEPD患者的毛细血管呼气末CO梯度相对升高，但在非CTEPD-非PH组中正常。根据前指南提供的PH定义，只有17例（4.25%）患者被诊断为CTEPH，27例（6.75%）被归类为患有CTEPD。
使用mPAP>20 mmHg诊断CTEPH会使CTEPH诊断增加23.5%。CPET可能有助于检测CTEPD和CTEPH。
