Multicentre observational screening survey for the detection of CTEPH following pulmonary embolism

Nicolas Coquoz, Daniel Weilenmann, Daiana Stolz, Vladimir Popov, Andrea Azzola, Jean-Marc Fellrath, Hans Stricker, Alberto Pagnamenta, Sebastian Ott, Silvia Ulrich, Sandor Györik, Jérôme Pasquier, John-David Aubert, Nicolas Coquoz, Daniel Weilenmann, Daiana Stolz, Vladimir Popov, Andrea Azzola, Jean-Marc Fellrath, Hans Stricker, Alberto Pagnamenta, Sebastian Ott, Silvia Ulrich, Sandor Györik, Jérôme Pasquier, John-David Aubert

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of pulmonary embolism. Its incidence following pulmonary embolism is debated. Active screening for CTEPH in patients with acute pulmonary embolism is yet to be recommended.This prospective, multicentre, observational study (Multicentre Observational Screening Survey for the Detection of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Following Pulmonary Embolism (INPUT on PE); ISRCTN61417303) included patients with acute pulmonary embolism from 11 centres in Switzerland from March 2009 to November 2016. Screening for possible CTEPH was performed at 6, 12 and 24 months using a stepwise algorithm that included a dyspnoea phone-based survey, transthoracic echocardiography, right heart catheterisation and radiological confirmation of CTEPH.Out of 1699 patients with pulmonary embolism, 508 patients were assessed for CTEPH screening over 2 years. CTEPH incidence following pulmonary embolism was 3.7 per 1000 patient-years, with a 2-year cumulative incidence of 0.79%. The Swiss pulmonary hypertension registry consulted in December 2016 did not report additional CTEPH cases in these patients. The survey yielded 100% sensitivity and 81.6% specificity. The second step echocardiography in newly dyspnoeic patients showed a negative predictive value of 100%.CTEPH is a rare but treatable disease. A simple and sensitive way for CTEPH screening in patients with acute pulmonary embolism is recommended.

Conflict of interest statement

Conflict of interest: N. Coquoz received travel support for the international CTEPH conference 2017 (Leuven) from MSD Switzerland, and grants from Swiss society for pulmonary hypertension, during the conduct of the study. Conflict of interest: S. Ulrich has received grants from the Swiss National Science Foundation, Zurich Lung and Orpha Swiss, grants and personal fees from Actelion SA, Switzerland, and personal fees from MSD SA, Switzerland, outside the submitted work. Conflict of interest: J-D. Aubert received grants from the Swiss Society for Pulmonary Hypertension, during the conduct of the study; and personal fees from Bayer and Actelion Switzerland for advisory board participation, and travel expenses from Actelion Switzerland, outside the submitted work.

Copyright ©ERS 2018.

References

    1. Dtsch Med Wochenschr. 2014 Aug;139(33):1647-52
    1. BMC Pulm Med. 2014 Aug 28;14:141
    1. Chest. 2001 Mar;119(3):818-23
    1. Thromb Res. 2010 May;125(5):e202-5
    1. Thromb Haemost. 2000 May;83(5):657-60
    1. Eur Respir Rev. 2017 Mar 29;26(143):
    1. Chest. 2006 Jul;130(1):172-5
    1. Respiration. 2014;87(5):379-87
    1. Respiration. 2016;91(6):503-9
    1. Circulation. 2011 Nov 1;124(18):1973-81
    1. J Thromb Thrombolysis. 2010 Oct;30(3):294-9
    1. Respiration. 2015;89(2):127-40
    1. Eur Respir Rev. 2017 Mar 29;26(143):
    1. Am J Respir Crit Care Med. 2010 Mar 1;181(5):501-6
    1. Eur Respir Rev. 2017 Dec 20;26(146):null
    1. Eur Respir J. 2017 Feb 23;49(2):null
    1. J Thorac Dis. 2015 Nov;7(11):1927-38
    1. Thromb Haemost. 2014 Sep 2;112(3):598-605
    1. N Engl J Med. 2011 Jan 27;364(4):351-60
    1. Haematologica. 2010 Jun;95(6):970-5
    1. J Thromb Haemost. 2017 Aug;15(8):1531-1540
    1. Arch Bronconeumol. 2010 Dec;46(12):628-33
    1. Eur Heart J. 2004 Dec;25(24):2243-78
    1. N Engl J Med. 2004 May 27;350(22):2257-64
    1. Thromb Res. 2015 May;135(5):796-801
    1. Eur Respir J. 2009 Dec;34(6):1219-63
    1. Eur Heart J. 2016 Jan 1;37(1):67-119
    1. Eur Respir J. 2015 Sep;46(3):728-37
    1. Ann Am Thorac Soc. 2016 Jul;13 Suppl 3:S201-6
    1. Thromb Res. 2017 Mar;151:1-7
    1. Thromb Haemost. 2005 Mar;93(3):512-6
    1. Eur Respir J. 2017 Feb 23;49(2):null
    1. Eur Respir Rev. 2017 Mar 29;26(143):

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj