Preexisting Chronic Thromboembolic Pulmonary Hypertension in Acute Pulmonary Embolism
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is considered a complication of pulmonary embolism (PE). However, signs of CTEPH may exist in patients with a first symptomatic PE.
RESEARCH QUESTION: Which radiologic findings on CT pulmonary angiography (CTPA) at the time of acute PE could indicate the presence of preexisting CTEPH?.
STUDY DESIGN AND METHODS: This study included unselected patients with acute PE who were prospectively followed up for 2 years with a structured visit schedule. Two expert radiologists independently assessed patients' baseline CTPAs for preexisting CTEPH; in case of disagreement, a decision was reached by a 2:1 majority with a third expert radiologist. In addition, the radiologists checked for predefined individual parameters suggesting chronic PE and pulmonary hypertension.
RESULTS: Signs of chronic PE or CTEPH at baseline were identified in 46 of 303 included patients (15%). Intravascular webs, arterial narrowing or retraction, dilated bronchial arteries, and right ventricular hypertrophy were the main drivers of the assessment. Five (1.7%) patients were diagnosed with CTEPH during follow-up. All four patients diagnosed with CTEPH early (83-108 days following acute PE) were found in enriched subgroups based on the experts' overall assessment or fulfilling a minimum number of the predefined radiologic criteria at baseline. The specificity of preexisting CTEPH diagnosis and the level of radiologists' agreement improved as the number of required criteria increased.
INTERPRETATION: Searching for predefined radiologic parameters suggesting preexisting CTEPH at the time of acute PE diagnosis may allow for targeted follow-up strategies and risk-adapted CTEPH screening, thus facilitating earlier CTEPH diagnosis.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:163 |
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| Enthalten in: |
Chest - 163(2023), 4 vom: 01. Apr., Seite 923-932 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Barco, Stefano [VerfasserIn] |
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| Links: |
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| Themen: |
CT pulmonary angiography |
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| Anmerkungen: |
Date Completed 11.04.2023 Date Revised 26.04.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.chest.2022.11.045 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM351328408 |
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| 520 | |a Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is considered a complication of pulmonary embolism (PE). However, signs of CTEPH may exist in patients with a first symptomatic PE | ||
| 520 | |a RESEARCH QUESTION: Which radiologic findings on CT pulmonary angiography (CTPA) at the time of acute PE could indicate the presence of preexisting CTEPH? | ||
| 520 | |a STUDY DESIGN AND METHODS: This study included unselected patients with acute PE who were prospectively followed up for 2 years with a structured visit schedule. Two expert radiologists independently assessed patients' baseline CTPAs for preexisting CTEPH; in case of disagreement, a decision was reached by a 2:1 majority with a third expert radiologist. In addition, the radiologists checked for predefined individual parameters suggesting chronic PE and pulmonary hypertension | ||
| 520 | |a RESULTS: Signs of chronic PE or CTEPH at baseline were identified in 46 of 303 included patients (15%). Intravascular webs, arterial narrowing or retraction, dilated bronchial arteries, and right ventricular hypertrophy were the main drivers of the assessment. Five (1.7%) patients were diagnosed with CTEPH during follow-up. All four patients diagnosed with CTEPH early (83-108 days following acute PE) were found in enriched subgroups based on the experts' overall assessment or fulfilling a minimum number of the predefined radiologic criteria at baseline. The specificity of preexisting CTEPH diagnosis and the level of radiologists' agreement improved as the number of required criteria increased | ||
| 520 | |a INTERPRETATION: Searching for predefined radiologic parameters suggesting preexisting CTEPH at the time of acute PE diagnosis may allow for targeted follow-up strategies and risk-adapted CTEPH screening, thus facilitating earlier CTEPH diagnosis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a CT pulmonary angiography | |
| 650 | 4 | |a chronic thromboembolic pulmonary hypertension | |
| 650 | 4 | |a diagnosis | |
| 650 | 4 | |a imaging | |
| 650 | 4 | |a pulmonary embolism | |
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| 700 | 1 | |a Kreitner, Karl-Friedrich |e verfasserin |4 aut | |
| 700 | 1 | |a Bunck, Alexander C |e verfasserin |4 aut | |
| 700 | 1 | |a Gertz, Roman J |e verfasserin |4 aut | |
| 700 | 1 | |a Ley, Sebastian |e verfasserin |4 aut | |
| 700 | 1 | |a Valerio, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Klok, Frederikus A |e verfasserin |4 aut | |
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| 700 | 1 | |a Rosenkranz, Stephan |e verfasserin |4 aut | |
| 700 | 1 | |a Konstantinides, Stavros V |e verfasserin |4 aut | |
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