A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study

BMC Pulmonary Medicine

Berthold Jany²  Heinrike Wilkens⁴  Hans Joachim Schäfers¹  Franziska Walter²  Tobias Romen²  Heinz Jakob Langen⁵  Philipp Kolb³  Gudrun Hübner²  Regina Holl²  Franziska Gött²  Alexander Hesse²  Matthias Held² 

[1] University Hospital Homburg Saar, Clinic for Thoracic and Cardiovascular Surgery, Kirrberger Strasse, Homburg, Saar D 66421, Germany;Medical Mission Hospital, Department of Internal Medicine, Academic Teaching Hospital of the Julius-Maximilian University of Würzburg, Salvatorstrasse 7, Würzburg 97067, Germany;Firestone Institute for Respiratory Health, Department of Medicine, Pathology & Molecular Medicine, McMaster University, 50 Charlton Ave East, T2131, Hamilton, ON L8N 4A6, Canada;Department of Internal Medicine V, Respiratory and Critical Care Medicine, University Hospital Homburg Saar, Kirrberger Strasse, Homburg, Saar D 66421, Germany;Medical Mission Hospital, Department of Radiology, Academic Teaching Hospital of the Julius-Maximilian University of Würzburg, Salvatorstrasse 7, Würzburg 97067, Germany

关键词: Pulmonary circulation;    Pulmonary hypertension;    Pulmonary embolism;    Follow-up;    Chronic thromboembolic pulmonary hypertension;    Pulmonary artery pressure;    Pulmonary artery;    Cardiopulmonary exercise testing;    Dyspnea;   

Others  :  1109534
DOI  :  10.1186/1471-2466-14-141

 received in 2014-05-09, accepted in 2014-08-18,  发布年份 2014

【 摘 要 】

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH.

This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool.

Methods

In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH.

Results

37.7%, 25.5% and 29.3% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4%, 11.5% and 18.8% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET.

Conclusion

A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.

【 授权许可】

   
2014 Held et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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