Incidence of chronic thromboembolic pulmonary hypertension in Thammasat University Hospital

Abstract

Background:Chronic thromboembolic pulmonary hypertension (CTEPH) is usually underrecognized due to nonspecific presentations. Undiagnosed CTEPH leads to unnecessary investigations for other diseases, and more importantly, increased morbidities and mortality.Objectives:The aim of this study was to define overall CTEPH incidence and the rate of CTEPH after acute pulmonary embolism (APE) in a tertiary care university hospital and to record risk factors, clinical and imaging characteristics, diagnosis assessment, and management methods.Materials and Methods:The retrospective 5-year data, between 2012 and 2016, was extracted. Out of 1751 patients, we screened, 286 had, at least, evidence of pulmonary embolism. CTEPH was diagnosed in 20 patients, and 12 in this group had characteristics of combined APE or history of APE.Results:The overall incidence of CTEPH was 37.8 cases per million patients, and the incidence of CTEPH after APE was 5.1%. The most common presentation was progressive exertional dyspnea (50%). All patients were diagnosed by computed tomography pulmonary angiography combined with echocardiogram. Surprisingly, only two patients had investigations with ventilation/perfusion lung scan. None underwent the preferred curative surgical treatment of pulmonary endarterectomy and two had balloon pulmonary angioplasty. All patients received anticoagulants, while only 5 patients were treated with pulmonary arterial hypertension-specific drugs.Conclusion:CTEPH was uncommon in our institute, with an underuse of the standard test. Suboptimal diagnosis assessment and management remain critical problems. Developing a properly trained CTEPH care team would improve patient outcomes, but cost/resources may be prohibitive for such a relatively rare disease.Trial Registration:TCTR20180220008 registered February 19, 2018.

Higher Incidence of Chronic Thromboembolic Pulmonary Hypertension After Acute Pulmonary Embolism in Asians Than in Europeans: A Meta-Analysis

“…The baseline characteristics of the included cohorts were shown in Table 1 . These studies were published between 2004 and 2020, and performed in Italy ( 11 – 13 , 16 , 19 , 28 ), Spain ( 15 ), the Netherlands ( 14 , 17 ), Germany ( 18 , 21 , 23 ), France ( 20 ), Turkey ( 22 ), Czech ( 25 ), Switzerland ( 29 ), China ( 24 , 26 , 27 , 31 ), Thailand ( 30 ), and Iran ( 32 ). Eighteen of the included studies were prospective cohort studies ( 11 – 17 , 20 – 29 , 32 ), while the other four were retrospective ( 18 , 19 , 30 , 31 ).…”

“…These studies were published between 2004 and 2020, and performed in Italy ( 11 – 13 , 16 , 19 , 28 ), Spain ( 15 ), the Netherlands ( 14 , 17 ), Germany ( 18 , 21 , 23 ), France ( 20 ), Turkey ( 22 ), Czech ( 25 ), Switzerland ( 29 ), China ( 24 , 26 , 27 , 31 ), Thailand ( 30 ), and Iran ( 32 ). Eighteen of the included studies were prospective cohort studies ( 11 – 17 , 20 – 29 , 32 ), while the other four were retrospective ( 18 , 19 , 30 , 31 ). The numbers of acute PE patients included in each study varied from 43 to 866.…”

“…Our study, using a similar pre-defined classification of the patients showed a similar incidence of CTEPH in consecutive acute PE patients. However, eight recently published studies were included in this updated meta-analysis (24,(26)(27)(28)(29)(30)(31)(32), which predominantly included patients with acute PE survivors. By incorporating these data, we found that the incidence of CTEPH in acute PE survivors were higher than that in acute PE survivors without major comorbidity, which was not consistent with the finding of similar incidence in the two group patients in the previous meta-analysis (9).…”

“…Although two previous metaanalyses have been published to summarize the incidence of CTEPH in acute PE patients (9,10), only studies published before 2018 were included (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Some recently published trials were not included (28)(29)(30)(31)(32). Moreover, it remains unknown whether patient and study characteristics such as patient ethnicity, study design, or sample size could significantly affect the incidence of CTEPH.…”

Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

“…If not treated appropriately, CTEPH patients will quickly develop right heart failure or even death ( 2 ). The overall incidence of CTEPH is 8~37.8 cases per million patients, and the probability of developing CTEPH after acute pulmonary embolism is 0.5~5.1% ( 3 – 5 ). A number of factors, including mechanical obstruction and secondary pulmonary vascular disease, may cause PH and right ventricular (RV) remodeling and dilation, eventually leading to dyspnea, deterioration of exercise tolerance, syncope, and fatigue.…”