Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Practice Guideline

Mehta, Sanjay; Helmersen, Doug; Provencher, Steeve; Hirani, Naushad; Rubens, Fraser D.; Perrot, Marc de; Blostein, Mark; Boutet, Kim; Chandy, George; Dennie, Carole; Granton, John; Hernández, Paul; Hirsch, Andrew; Laframboise, Karen; Levy, Robert D.; Lien, Dale; Martel, Simon; Shoemaker, Gerard; Swiston, John R.; Weinkauf, J.

doi:10.1155/2010/704258

Cited by 71 publications

(49 citation statements)

References 173 publications

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“…CTEPH is defined as mean pulmonary artery pressure greater than 25 mmHg that persists six months after an acute PE and pulmonary vascular resistance of 3 Wood units (240 dyne·s/cm 5 ) or greater with persistent pulmonary arterial thrombotic obstruction despite at least three months of effective, uninterrupted anticoagulation therapy (78). The pathogenesis of CTEPH is poorly understood, although a clinical history of VTE has been recorded in 80% of patients.…”

Section: Ct Findings Of Cteph As a Complication Of Acute Pementioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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Section: Ct Findings Of Cteph As a Complication Of Acute Pementioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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“…Acute PH and right ventricular dysfunction are common in acute pulmonary embolism, being present in about half of affected patients. 3 However, these acute abnormalities resolve in most patients who receive appropriate treatment with systemic anticoagulation. As a result, the cumulative incidence of CTEPH following acute symptomatic pulmonary embolism is 1%-4%.…”

Section: Box 1: Evidence Used In This Reviewmentioning

confidence: 99%

“…The clinical and diagnostic strategies described are supported by expert consensus. 1,3 The approach to medical management is based on strong evidence from randomized controlled trials (RCTs) and metaanalyses (Box 1).…”

mentioning

confidence: 99%

Pulmonary hypertension: diagnostic approach and optimal management

Hambly

Alawfi

Mehta

2016

CMAJ

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“…Definition of PH is based on shared pathophysiology that categorizes many classes of PH: pulmonary arterial hypertension (PAH), which may be idiopathic (IPAH) or associated with left heart disease; or lung disease in association with chronic thromboembolic pulmonary hypertension (CTEPH) [2]. In patients with PAH, progressive narrowing of the small pulmonary arteries and arterioles results in increased pulmonary vascular resistance, which may ultimately lead to right ventricular failure.…”

Section: Introductionmentioning

confidence: 99%

Findings Associated with Pulmonary Hypertension: CT Angiography Based Study

Aloub¹,

Ayad²,

Elnabi³

2016

OJRad

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Pulmonary hypertension (PH) is a complex disorder and may be related to a variety of diseases. It may arise in association with chronic thromboembolic pulmonary hypertension (CTEPH) or pulmonary embolism (PE). Knowledge of the radiological features is required to characterize and accurately diagnose the conditions and may improve the outcome. This study was designed to evaluate the clinical characteristics and the computerized tomography angiography findings in patients with PH, PE and CTEPH. Contrast-enhanced CT scans were acquired in 55 Sudanese patients with PE, 20 patients with PH, 25 patients with CTEPH and 50 normal subjects who were considered as control group. The CT diagnostic criteria for all cases were characterized. The clinical signs, parenchymal abnormalities, pulmonary tree and cardiac segments in all groups were characterized and compared with the control group. The results showed that the most common clinical characteristics were found to be chest pain, dyspnea, lower limb swelling, tachycardia and syncope which were correlated significantly with the presence of the disease. In all patients groups, the pulmonary vascular segments, cardiac segments and lung parenchyma changes were detected and were significantly different from the normal control subjects at p ≤ 0.01. It was found that CT angiography has a significant role in the diagnostic evaluation of these groups of patients. CT imaging is acceptably used in diagnosis, defining cause, quantifying heart segments and parenchyma changes in order to assess the feasibility of surgery, monitoring and therapeutic planning.

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Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Practice Guideline

Cited by 71 publications

References 173 publications

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Pulmonary hypertension: diagnostic approach and optimal management

Findings Associated with Pulmonary Hypertension: CT Angiography Based Study

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