Chronic Thromboembolic Pulmonary Hypertension (CTEPH): A Review of Another Sequel of Severe Post-Covid-19 Pneumonia

Cueto-Robledo, Guillermo; Roldan-Valadez, Ernesto; Graniel-Palafox, Luis-Eugenio; García-César, Marisol; Torres-Rojas, Maria-Berenice; Enriquez-García, Rocío; Cueto-Romero, Hector-Daniel; Rivera-Sotelo, Nathaly; Perez-Calatayud, Angel-Augusto

doi:10.1016/j.cpcardiol.2022.101187

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…[58][59][60] Therefore, cases of CTEPH following COVID-19-associated acute PE may yet emerge. 61 Consistent with this, a report from the USA found more diagnoses of pulmonary hypertension than expected among COVID-19 survivors. 53 It, therefore, remains possible that an increased incidence of CTEPH may be an important long-term consequence of widespread COVID-19 infection.…”

Section: Discussionmentioning

confidence: 52%

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Pulmonary thromboembolic events in COVID‐19—A systematic literature review

et al. 2022

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Pulmonary thromboembolic events (TE) have been linked to coronavirus disease 2019 (COVID‐19), but their incidence and long‐term sequelae remain unclear. We performed a systematic literature review to investigate the incidence of pulmonary embolism (PE), microthrombi, thrombosis in situ (thromboinflammatory disease) and chronic thromboembolic pulmonary hypertension (CTEPH) during and after COVID‐19. PubMed and the World Health Organization Global Research Database were searched on 7 May 2021. Hospital cohort and database studies reporting data for ≥ 1,000 patients and autopsy studies reporting data for ≥ 20 patients were included. Results were summarized descriptively. We screened 1,438 records and included 41 references (32 hospital/database studies and nine autopsy studies). The hospital/database studies reported the incidence of PE but not CTEPH, microthrombi or thromboinflammatory disease. PE incidence varied widely (0–1.1% of outpatients, 0.9–8.2% of hospitalized patients and 1.8–18.9% of patients in intensive care). One study reported PE events occurring within 45 days after hospital discharge (incidence in discharged patients: 0.2%). Segmental arteries were generally the most common location for PE. In autopsy studies, PE, thromboinflammatory disease and microthrombi were reported in 6–23%, 43–100% and 45–84% of deceased patients, respectively. Overall, the included studies mostly focussed on PE during the acute phase of COVID‐19. The results demonstrate the challenges of identifying and characterizing vascular abnormalities using current protocols (e.g. visual computed tomography reads). Further research is needed to detect subtle pulmonary vascular abnormalities, distinguish thromboinflammatory disease from PE, optimize treatment, and assess the incidence of long‐term sequelae after COVID‐19. This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 52%

“…Incomplete thrombus resolution has been reported in a subset of patients with COVID‐19 and PE 58–60 . Therefore, cases of CTEPH following COVID‐19‐associated acute PE may yet emerge 61 . Consistent with this, a report from the USA found more diagnoses of pulmonary hypertension than expected among COVID‐19 survivors 53 .…”

Section: Discussionmentioning

confidence: 75%

Pulmonary thromboembolic events in COVID‐19—A systematic literature review

et al. 2022

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“…A higher than expected prevalence of PH has been reported in COVID-19 survivors; however, specific data on CTEPH after COVID-19 are very limited. In a series of 77 patients with COVID-19-associated acute PE, three (4%) met the criteria for CTEPH [ 11 ]. Data from the CTEPH quaternary centre in the UK, however, showed a decrease in referrals during the pandemic to 228 referred CTEPH cases, of whom none had a history of COVID-19 [ 12 ].…”

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confidence: 99%

Chronic thromboembolic pulmonary hypertension and clot resolution after COVID-19-associated pulmonary embolism

et al. 2023

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The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) in coronavirus disease 2019 (COVID-19) survivors who were diagnosed with acute pulmonary embolism (PE) is currently unknown. Considering the high PE incidence reported in COVID-19 and its potentially unique pathophysiology, it may be hypothesised that thrombus resolution occurs to a lesser extent after COVID-19-associated PE, and that the prevalence of CTEPH is higher compared to non-COVID-19-associated PE populations. CTEPH could therefore be a treatable cause of long COVID, which captures a broad range of post-acute COVID-19 sequelae, in those with PE during acute COVID-19 [1]. In this multicentre cross-sectional study, we aimed to establish the prevalence of CTEPH and recurrent venous thromboembolism (VTE), and evaluate thrombus resolution in COVID-19-associated PE survivors.

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“…We did not identify studies describing the diagnostic work-up of suspected recurrent COVID-19 associated PE, so the clinical relevance of persistent clots remains unknown. Also, the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after COVID-19 associated PE, estimated to be 2–3% in non-COVID-19 PE survivors, is currently unknown [ 61 , 62 , 63 ]. Future studies are required to elucidate the clinical relevance of persistent clots on the long-term outcome of COVID-19 patients with PE.…”

Section: Follow-up Imaging After Confirmed Covid-19 Associated Pementioning

confidence: 99%

Diagnostic Management of Acute Pulmonary Embolism in COVID-19 and Other Special Patient Populations

2022

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Venous thromboembolism (VTE), in particular acute pulmonary embolism (PE), has been shown to be a frequent and potentially fatal complication of coronavirus disease 2019 (COVID-19). In response to the observed thrombotic complications, a large number of studies has been devoted to the understanding and management of COVID-19-associated coagulopathy. Notably, only a limited number of mostly retrospective studies has focused on the optimal diagnostic strategy for suspected PE in COVID-19 patients. As in other special populations, the accuracy of diagnostic algorithms for PE-exclusion has been debated in this specific patient subgroup as the specificity of D-dimer assays and clinical decision rules (CDRs) may be lower than normal. From this viewpoint, we discuss the current state-of-the-art diagnostic algorithms for acute PE with a focus on patients with COVID-19 in the perspective of other special patient populations. Furthermore, we summarize current knowledge regarding the natural history of PE resolution with anticoagulant treatment in patients with COVID-19.

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Chronic Thromboembolic Pulmonary Hypertension (CTEPH): A Review of Another Sequel of Severe Post-Covid-19 Pneumonia

Cited by 16 publications

References 22 publications

Pulmonary thromboembolic events in COVID‐19—A systematic literature review

Pulmonary thromboembolic events in COVID‐19—A systematic literature review

Chronic thromboembolic pulmonary hypertension and clot resolution after COVID-19-associated pulmonary embolism

Diagnostic Management of Acute Pulmonary Embolism in COVID-19 and Other Special Patient Populations

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