Revisiting hemodynamic definition: Incidence of chronic thromboembolic pulmonary hypertension following acute intermediate-high and high-risk pulmonary embolism

Q4 Medicine
Bárbara Lacerda Teixeira, André Grazina, Ricardo Carvalheiro, Tiago Mendonça, Tiago Pereira da Silva, António Fiarresga, Ruben Ramos, Duarte Cacela, João Reis, Ana Galrinho, Luís Almeida Morais, Rui Cruz Ferreira
{"title":"Revisiting hemodynamic definition: Incidence of chronic thromboembolic pulmonary hypertension following acute intermediate-high and high-risk pulmonary embolism","authors":"Bárbara Lacerda Teixeira,&nbsp;André Grazina,&nbsp;Ricardo Carvalheiro,&nbsp;Tiago Mendonça,&nbsp;Tiago Pereira da Silva,&nbsp;António Fiarresga,&nbsp;Ruben Ramos,&nbsp;Duarte Cacela,&nbsp;João Reis,&nbsp;Ana Galrinho,&nbsp;Luís Almeida Morais,&nbsp;Rui Cruz Ferreira","doi":"10.1016/j.tru.2024.100194","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The hemodynamic definition of pulmonary hypertension (PH) was updated, lowering the mean pulmonary arterial pressure (PAP) threshold to 20 mmHg and the pulmonary vascular resistance (PVR) to 2 Wood units. The impact of these revised criteria on the number of patients reclassified as PH has not been extensively studied, namely in chronic thromboembolic pulmonary hypertension (CTEPH) population. Since the true incidence of CTEPH after acute pulmonary embolism (PE) is debatable, we aimed to analyze the incidence of CTEPH after high-risk forms of acute PE according to the new 2022 ESC/ERS hemodynamic criteria.</div></div><div><h3>Methods</h3><div>A prospective registry of consecutive intermediate-high- and high-risk PE patients submitted to catheter directed therapies (CDT) in a tertiary center was used. Clinical, echocardiographic, computed tomography angiography (CTA), right heart catheterization (RHC) and digital subtraction pulmonary angiogram (DSPA) data were collected at admission and at 3 months.</div></div><div><h3>Results</h3><div>Among 25 patients, RHC revealed that 36 % of patients met the criteria for PH per the new guidelines, compared to 16 % under the previous definition (p = 0.010), resulting in 20 % being reclassified. Mean PAP and PVR differed significantly according to both definitions. Under the new definition, additional parameters of RHC also showed significant differences (p &lt; 0.05). Perfusion defects were noted in 33 % of PH patients on DSPA but not on CTA, while the remained displayed them on both modalities. Among patients without PH, 31.3 % exhibited perfusion defects.</div></div><div><h3>Conclusion</h3><div>According to the new updated criteria for PH, 36 % of intermediate-high- and high-risk PE patients met the criteria of CTEPH at 3 months of follow-up. With a possible rising incidence of CTEPH, special monitoring and management is crucial.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"17 ","pages":"Article 100194"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thrombosis Update","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666572724000361","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Background

The hemodynamic definition of pulmonary hypertension (PH) was updated, lowering the mean pulmonary arterial pressure (PAP) threshold to 20 mmHg and the pulmonary vascular resistance (PVR) to 2 Wood units. The impact of these revised criteria on the number of patients reclassified as PH has not been extensively studied, namely in chronic thromboembolic pulmonary hypertension (CTEPH) population. Since the true incidence of CTEPH after acute pulmonary embolism (PE) is debatable, we aimed to analyze the incidence of CTEPH after high-risk forms of acute PE according to the new 2022 ESC/ERS hemodynamic criteria.

Methods

A prospective registry of consecutive intermediate-high- and high-risk PE patients submitted to catheter directed therapies (CDT) in a tertiary center was used. Clinical, echocardiographic, computed tomography angiography (CTA), right heart catheterization (RHC) and digital subtraction pulmonary angiogram (DSPA) data were collected at admission and at 3 months.

Results

Among 25 patients, RHC revealed that 36 % of patients met the criteria for PH per the new guidelines, compared to 16 % under the previous definition (p = 0.010), resulting in 20 % being reclassified. Mean PAP and PVR differed significantly according to both definitions. Under the new definition, additional parameters of RHC also showed significant differences (p < 0.05). Perfusion defects were noted in 33 % of PH patients on DSPA but not on CTA, while the remained displayed them on both modalities. Among patients without PH, 31.3 % exhibited perfusion defects.

Conclusion

According to the new updated criteria for PH, 36 % of intermediate-high- and high-risk PE patients met the criteria of CTEPH at 3 months of follow-up. With a possible rising incidence of CTEPH, special monitoring and management is crucial.
重新审视血液动力学定义:急性中、高、高危肺栓塞后慢性血栓栓塞性肺动脉高压的发生率
更新了肺动脉高压(PH)的血流动力学定义,将平均肺动脉压(PAP)阈值降至20 mmHg,肺血管阻力(PVR)降至2 Wood单位。这些修订后的标准对重新分类为PH的患者数量的影响尚未得到广泛研究,即慢性血栓栓塞性肺动脉高压(CTEPH)人群。由于急性肺栓塞(PE)后CTEPH的真实发病率存在争议,我们的目的是根据新的2022 ESC/ERS血液动力学标准分析高危急性PE后CTEPH的发病率。方法对在三级中心连续接受导管定向治疗(CDT)的中高、高危PE患者进行前瞻性登记。入院时和3个月时收集临床、超声心动图、计算机断层血管造影(CTA)、右心导管造影(RHC)和数字减影肺动脉造影(DSPA)数据。结果在25例患者中,RHC显示36%的患者符合新指南的PH标准,而在以前的定义下为16% (p = 0.010),导致20%的患者被重新分类。根据两种定义,平均PAP和PVR差异显著。在新的定义下,RHC的其他参数也有显著差异(p <;0.05)。33%的PH患者在DSPA上发现灌注缺陷,而在CTA上没有,而其余的患者在两种方式上都表现出灌注缺陷。在没有PH的患者中,31.3%表现为灌注缺陷。结论根据最新的PH标准,36%的中高、高危PE患者在随访3个月时符合CTEPH标准。随着CTEPH发病率的上升,特殊的监测和管理是至关重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Thrombosis Update
Thrombosis Update Medicine-Hematology
CiteScore
1.90
自引率
0.00%
发文量
33
审稿时长
86 days
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信