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Prevalence and predictors of Chronic Thromboembolic Pulmonary Hypertension following severe forms of Acute Pulmonary Embolism
Session:
Comunicações Orais - Sessão 20 - Tromboembolismo pulmonar agudo
Speaker:
Joana Pargana
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Joana Pargana; Rita Calé; Mariana Martinho; João Santos; Patrícia Araújo; João Morgado; Ernesto Pereira; Tiago Judas; Sofia Alegria; Filipa Ferreira; Francisca Delerue; Hélder Pereira
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-family:"Times New Roman",serif">Introduction and Purpose: </span></u><span style="font-family:"Times New Roman",serif">The true prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) in the Portuguese population remains unknown and underdiagnosis remains a concern. Therefore, we aimed to assess the prevalence and risk factors of CTEPH two years after a symptomatic high (HR) and intermediate-high risk (IHR) PE in a Portuguese referral center for pulmonary hypertension. </span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-family:"Times New Roman",serif">Methods: </span></u><span style="font-family:"Times New Roman",serif">This retrospective cohort study included patients admitted with PE between 2014-2019 in a tertiary care hospital, according to the International Classification of Diseases (ICD-9 and ICD-10) and stratified at the hospital admission in HR and IHR criteria as recommended by European Society of Cardiology (ESC). </span><span style="font-family:"Times New Roman",serif">We evaluated the prevalence of CTEPH in all consecutive pts hospitalized with severe forms of PE who survived 3 months after the acute PE event. Independent predictors of CTEPH were further evaluated by multivariable regression analysis. </span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-family:"Times New Roman",serif">Results:</span></u><span style="font-family:"Times New Roman",serif"> Of the 969 pts admitted with PE between 2014-2019, 194 were stratified as HR (5.4%) and IHR (14.7%) PE. After exclusion of the 54 pts who died and 11 pts without follow-up in the first 3 months, 129 pts were included in the analysis. During a median follow-up of 41.0 (24.0-58.5) months, overall prevalence of suspected CTEPH by clinical, Doppler echocardiography and V/Q lung scan was 6.2% (8 pts). CTEPH was confirmed by right heart catheterization in 4 of those pts (3.1%). Increased sPAP at admission (OR 1.12; 95%CI 1.04-1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95%CI 1.53-36.41; p=0.013) were predictors of CTEPH. sPAP at admission >60 mmHg identified pts with CTEPH at the follow-up with a sensitivity and specificity value of 83.3% and 76.3%, respectively (figure 1- ROC curve).</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-family:"Times New Roman",serif">Conclusions</span></u><span style="font-family:"Times New Roman",serif">: In our cohort, the prevalence of CTEPH in the survivors of severe forms of acute PE was 6.2%. The presence of varicose veins and sPAP at the admission of the index event were identified as early predictors of CTEPH and could assist to early recognition of CTEPH after PE. A systolic pulmonary artery pressure above 60 mmHg at the index event is highly suggestive of acute on chronic CTEPH.</span></span></span></span></p>
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