Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain,
Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain,
Respiration. 2024;103(2):79-87. doi: 10.1159/000536064. Epub 2024 Feb 7.
Chronic thromboembolic pulmonary disease (CTEPD) consists of persistent pulmonary vascular obstruction on imaging and involves long-term functional limitations, with or without chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to evaluate the incidence and risk factors of both persistent pulmonary vascular defects and CTEPH after hospitalization in patients with COVID-19 and PE during a 2-year follow-up.
A prospective observational study was carried out in a tertiary hospital center. Patients were hospitalized between March 2020 and December 2021 with a diagnosis of PE during SARS-CoV-2 infection. Patients received anticoagulant treatment for at least 3 months and were followed up for 2 years. Between the third and fourth months after discharge, all patients were evaluated for the presence of residual thrombotic defects by CTPA and/or perfusion pulmonary scintigraphy. Clinical findings, lung function tests with DLCO, exercise capacity, and echocardiograms were also assessed.
Of the 133 patients included, 18% had persistent thrombotic defects on lung imaging at follow-up. The incidence of CTEPD was 0.75% at 2 years of follow-up. Patients with persistent defects were significantly older, had a higher prevalence of systemic arterial hypertension, higher D-dimer and NT-proBNP levels, and more severe PE at diagnosis. Furthermore, there was a higher prevalence of right ventricular dysfunction on echocardiogram at diagnosis of PE (25.0% vs. 2.7%, p = 0.006). This was the only variable independently related to persistent defects in multivariate analyses (OR: 8.13 [95% CI: 1.82-36.32], p = 0.006).
The persistence of thrombotic defects after PE is a common finding after SARS-CoV-2 infection, affecting 18% of the population. However, the incidence of CTEPH appears to be lower (0.75%) in COVID-19-related PE compared to that previously observed in PE unrelated to COVID-19.
慢性血栓栓塞性肺动脉高压（CTEPD）是指影像学上存在持续的肺血管阻塞，并伴有或不伴有慢性血栓栓塞性肺动脉高压（CTEPH）的长期功能受限。本研究的目的是评估 COVID-19 相关的 PE 患者在住院期间接受抗凝治疗后 2 年的随访中，持续的肺血管缺陷和 CTEPH 的发生率和风险因素。
这是一项在三级医院中心进行的前瞻性观察性研究。2020 年 3 月至 2021 年 12 月期间，在 SARS-CoV-2 感染期间，患者因 PE 住院。所有患者接受至少 3 个月的抗凝治疗，并随访 2 年。出院后第 3 至 4 个月，所有患者均通过 CTPA 和/或肺灌注闪烁显像评估残留血栓缺陷。还评估了临床症状、肺功能测试（DLCO）、运动能力和超声心动图。
133 例患者中，18%在随访时肺成像上存在持续的血栓缺陷。2 年时 CTEPD 的发生率为 0.75%。持续存在缺陷的患者年龄较大，有较高的系统性动脉高血压、较高的 D-二聚体和 NT-proBNP 水平，以及更严重的 PE 诊断。此外，PE 诊断时右心室功能障碍的发生率更高（25.0% vs. 2.7%，p=0.006）。这是多变量分析中唯一与持续缺陷相关的变量（OR：8.13 [95%CI：1.82-36.32]，p=0.006）。
SARS-CoV-2 感染后，PE 后血栓缺陷的持续存在是一种常见现象，影响 18%的人群。然而，与非 COVID-19 相关 PE 相比，COVID-19 相关 PE 中 CTEPH 的发生率似乎较低（0.75%）。
