Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Division of Clinical Medicine, University of Sheffield, Sheffield, UK.
Eur Respir J. 2024 Mar 14;63(3). doi: 10.1183/13993003.00846-2023. Print 2024 Mar.
Diagnostic rates and risk factors for the subsequent development of chronic thromboembolic pulmonary hypertension (CTEPH) following pulmonary embolism (PE) are not well defined.
Over a 10-year period (2010-2020), consecutive patients attending a PE follow-up clinic in Sheffield, UK (population 554 600) and all patients diagnosed with CTEPH at a pulmonary hypertension (PH) referral centre in Sheffield (referral population estimated 15-20 million) were included.
Of 1956 patients attending the Sheffield PE clinic 3 months following a diagnosis of acute PE, 41 were diagnosed with CTEPH with a cumulative incidence of 2.10%, with 1.89% diagnosed within 2 years. Of 809 patients presenting with pulmonary hypertension (PH) and diagnosed with CTEPH, 32 were Sheffield residents and 777 were non-Sheffield residents. Patients diagnosed with CTEPH at the PE follow-up clinic had shorter symptom duration (p<0.01), better exercise capacity (p<0.05) and less severe pulmonary haemodynamics (p<0.01) compared with patients referred with suspected PH. Patients with no major transient risk factors present at the time of acute PE had a significantly higher risk of CTEPH compared with patients with major transient risk factors (OR 3.6, 95% CI 1.11-11.91; p=0.03). The presence of three computed tomography (CT) features of PH in combination with two or more out of four features of chronic thromboembolic pulmonary disease at the index PE was found in 19% of patients who developed CTEPH and in 0% of patients who did not. Diagnostic rates and pulmonary endarterectomy (PEA) rates were higher at 13.2 and 3.6 per million per year, respectively, for Sheffield residents compared with 3.9-5.2 and 1.7-2.3 per million per year, respectively, for non-Sheffield residents.
In the real-world setting a dedicated PE follow-up pathway identifies patients with less severe CTEPH and increases population-based CTEPH diagnostic and PEA rates. At the time of acute PE diagnosis the absence of major transient risk factors, CT features of PH and chronic thromboembolism are risk factors for a subsequent diagnosis of CTEPH.
肺栓塞（PE）后发生慢性血栓栓塞性肺动脉高压（CTEPH）的诊断率和风险因素尚不清楚。
在 10 年期间（2010-2020 年），纳入了在英国谢菲尔德 PE 随访诊所就诊的连续患者（人口 554600 人）和在谢菲尔德肺动脉高压（PH）转诊中心诊断为 CTEPH 的所有患者（估计转诊人群为 15-2000 万人）。
在急性 PE 诊断后 3 个月就诊于谢菲尔德 PE 诊所的 1956 例患者中，41 例诊断为 CTEPH，累积发病率为 2.10%，其中 2 年内诊断出 1.89%。在 809 例因 PH 就诊并诊断为 CTEPH 的患者中，32 例为谢菲尔德居民，777 例为非谢菲尔德居民。在 PE 随访诊所诊断为 CTEPH 的患者症状持续时间更短（p<0.01），运动能力更好（p<0.05），肺血流动力学更轻（p<0.01）。与有主要一过性危险因素的患者相比，急性 PE 时无重大一过性危险因素的患者发生 CTEPH 的风险显著更高（OR 3.6，95%CI 1.11-11.91；p=0.03）。在索引性 PE 时，同时存在 3 个 CT 肺动脉高压特征和 4 个慢性血栓栓塞性肺疾病特征中的 2 个或更多特征的患者中，19%发展为 CTEPH，而无 CTEPH 的患者中，这一比例为 0%。在谢菲尔德居民中，诊断率和肺动脉内膜切除术（PEA）率分别为每年每百万 13.2 和 3.6，而非谢菲尔德居民中，这一比例分别为每年每百万 3.9-5.2 和 1.7-2.3。
在实际环境中，专门的 PE 随访途径可识别出 CTEPH 症状较轻的患者，并提高基于人群的 CTEPH 诊断和 PEA 率。在急性 PE 诊断时，无主要一过性危险因素、CT 肺动脉高压特征和慢性血栓栓塞是随后诊断为 CTEPH 的危险因素。
Zotero 插件
