Longitudinal Study to Identify Predictive Factors of Post-thrombotic Pulmonary Hypertension
The current data on the incidence of pulmonary hypertension (PH) are very variable, depending on the different studies designs. There are no data on the prognostic of PH in patients with asymptomatic pulmonary thromboembolisms (PT), neither paucisymptomatic PH, in which without a prospective follow-up would be underdiagnosed. We thought that the prognosis of both clinical forms (PT with or without symptoms) would be similar.
The objective of this study is know the real incidence of pulmonary hypertension (PH) post symptomatic and asymptomatic pulmonary thromboembolic (PT).
Studieöversikt
Status
Betingelser
Detaljerad beskrivning
Rationale
Pulmonary hypertension (PH) post pulmonary thromboembolisms is a serious and complex disease, is one major cause of pulmonary hypertension (1). It is the most feared late complication of pulmonary thromboembolism (PT) characterized by the organization of thrombotic material within the pulmonary arteries (2). Although a purely mechanical theory is too simplistic in view of the lack of correlation between the proportion of obliterated pulmonary arteries and the numbers of PH.
Acute, symptomatic, or asymptomatic PT may be the initial event, but disease progression would result from progressive vascular remodeling of small vessels. It is possible that unresolved pulmonary arterial thrombosis is a decisive factor for vascular endothelial cells to initiate their mesenchymal transition (3).
On the other hand, Pulmonary hypertension post pulmonary thromboembolisms is the only subclass of pulmonary hypertension that has a curative surgical treatment (4). The diagnosis of this situation should be detected as soon as possible to optimize the results of surgical and pharmacological treatment. Surgical indication should be established as early as possible to avoid progression (5).
Hypothesis
The current data on the incidence of PH are very variable, depending on the different studies designs. There are no data on the prognostic of PH in patients with asymptomatic PT, neither paucisymptomatic PH, in which without a prospective follow-up would be underdiagnosed. We thought that the prognosis of both clinical forms (PT with or without symptoms) would be similar. Also we thought and that there are forms of paucisymptomatic PH whose diagnosis and treatment would benefit from a prospective follow-up.
Objectives
Main objective
To know the incidence of pulmonary hypertension (PH) post symptomatic and asymptomatic pulmonary thromboembolic (PT).
The secondary objectives of the study are:
- To defined clinical subtypes of PT with a predictive value of diagnosis of PH in two years.
- To Measure biomarkers described that may be related to the diagnosis of PH or the disease progression.
- Use of genetic, proteomic, RNA transcription, cytometric and cellular and metabolic identification assays to aid in the search for new genetic factors and / or PH biomarkers.
Studietyp
Inskrivning (Faktisk)
Kontakter och platser
Studieorter
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Alava, Spanien
- Hospital de Araba
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Barcelona, Spanien
- Hospital del Mar
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Gerona, Spanien
- Hospital U. de Girona Doctor Josep Trueta
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Granada, Spanien
- Hospital U. Virgen de las Nieves
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Madrid, Spanien
- Hospital U. La Paz
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Madrid, Spanien
- Hospital U. Ramon y Cajal
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Sevilla, Spanien
- Hospital San Juan de Dios
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Valladolid, Spanien
- Hospital C. U. de Valladolid
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Zaragoza, Spanien
- Hospital C. U. Lozano Blesa
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Asturias
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Oviedo, Asturias, Spanien
- Hospital U. Central. de Asturias
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Barcelona
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Badalona, Barcelona, Spanien
- Hospital M. de Badalona
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Badalona, Barcelona, Spanien
- Hospital U. German Trias i Pujol
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Sant Cugat del Valles, Barcelona, Spanien
- Hospital G. de Cataluña
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Viladecans, Barcelona, Spanien
- Hospital de Viladecans
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Cantabria
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Santander, Cantabria, Spanien
- Hospital U. Marques de Valdecilla
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Torrelavega, Cantabria, Spanien
- Hospital Sierrallana
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Guipuzcua
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Bilbao, Guipuzcua, Spanien
- Hospital de Cruces
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La Rioja
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Logrono, La Rioja, Spanien
- Hospital San Pedro
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Madrid
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Alcorcón, Madrid, Spanien
- Hospital U. Fundación Alcorcón
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Getafe, Madrid, Spanien
- Hospital U. de Getafe
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Navarra
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Pamplona, Navarra, Spanien
- Hospital Virgen del Camino
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Sevilla
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Seville, Sevilla, Spanien, 41013
- Hospital Virgen del Rocío
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Vizcaya
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Galdacano, Vizcaya, Spanien
- Hospital Galdakao-Usansolo
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Testmetod
Studera befolkning
Beskrivning
Inclusion Criteria:
- Patients 18 years or older and able to provide informed consent
- Diagnosis of pulmonary thromboembolisms confirmed by
- Computed Tomography Angiography (CTA) if there are a partial transluminal defect surrounded by contrast or a complete occlusion of pulmonary artery.
- Pulmonary ventilation/perfusion scan.- Patients with high risk based on PIOPED study criteria or in patients with deep venous thrombosis confirmed by echography and positron emission tomography (PET) scan not concluding.
Exclusion Criteria:
- Any contraindication to the performance of the pulmonary hypertension diagnostic tests
- Any circumstance, to investigator criteria, to impede the patient follow up
- Life expectancy lower than 6 months
Studieplan
Hur är studien utformad?
Designdetaljer
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Pulmonary hypertension
Tidsram: 2 years
|
Diagnosis on pulmonary hypertension after pulmonary thromboembolism
|
2 years
|
Samarbetspartners och utredare
Utredare
- Studiestol: Remedios Otero Candelera, Hospital Universitario Virgen del Rocío IBIS
Publikationer och användbara länkar
Allmänna publikationer
- Condliffe R, Kiely DG, Gibbs JS, Corris PA, Peacock AJ, Jenkins DP, Hodgkins D, Goldsmith K, Hughes RJ, Sheares K, Tsui SS, Armstrong IJ, Torpy C, Crackett R, Carlin CM, Das C, Coghlan JG, Pepke-Zaba J. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008 May 15;177(10):1122-7. doi: 10.1164/rccm.200712-1841OC. Epub 2008 Feb 21.
- Tueller C, Stricker H, Soccal P, Tamm M, Aubert JD, Maggiorini M, Zwahlen M, Nicod L; Swiss Society for Pulmonary Hypertension. Epidemiology of pulmonary hypertension: new data from the Swiss registry. Swiss Med Wkly. 2008 Jun 28;138(25-26):379-84. doi: 10.4414/smw.2008.11915.
- Lang IM. Chronic thromboembolic pulmonary hypertension--not so rare after all. N Engl J Med. 2004 May 27;350(22):2236-8. doi: 10.1056/NEJMp048088. No abstract available.
- Humbert M. Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: pathophysiology. Eur Respir Rev. 2010 Mar;19(115):59-63. doi: 10.1183/09059180.00007309.
- Galie N, Kim NH. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006 Sep;3(7):571-6. doi: 10.1513/pats.200605-113LR.
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