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Previous Volume 350:2257-2264 May 27, 2004 Number 22 Next

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ABSTRACT

Background Chronic thromboembolic pulmonary hypertension (CTPH) is associated with considerable morbidity and mortality. Its incidence after pulmonary embolism and associated risk factors are not well documented.

Methods We conducted a prospective, long-term, follow-up study to assess the incidence of symptomatic CTPH in consecutive patients with an acute episode of pulmonary embolism but without prior venous thromboembolism. Patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography and, if supportive findings were present, ventilation–perfusion lung scanning and pulmonary angiography. CTPH was considered to be present if systolic and mean pulmonary-artery pressures exceeded 40 mm Hg and 25 mm Hg, respectively; pulmonary-capillary wedge pressure was normal; and there was angiographic evidence of disease.

Results The cumulative incidence of symptomatic CTPH was 1.0 percent (95 percent confidence interval, 0.0 to 2.4) at six months, 3.1 percent (95 percent confidence interval, 0.7 to 5.5) at one year, and 3.8 percent (95 percent confidence interval, 1.1 to 6.5) at two years. No cases occurred after two years among the patients with more than two years of follow-up data. The following increased the risk of CTPH: a previous pulmonary embolism (odds ratio, 19.0), younger age (odds ratio, 1.79 per decade), a larger perfusion defect (odds ratio, 2.22 per decile decrement in perfusion), and idiopathic pulmonary embolism at presentation (odds ratio, 5.70).

Conclusions CTPH is a relatively common, serious complication of pulmonary embolism. Diagnostic and therapeutic strategies for the early identification and prevention of CTPH are needed.

Source Information

From the Department of Clinical and Experimental Medicine, Division of Clinical Cardiology (V.P., A.B., C.P., S.I.) and the Department of Medical and Surgical Sciences, Clinica Medica II (A.M., P.P.), and the Division of Geriatric Medicine (F.T., P.A.), University Hospital of Padua, Padua, Italy; the Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands (A.W.A.L.); the Department of Clinical Epidemiology and Medical Technology Assessment, Academic Hospital, University of Maastricht, Maastricht, the Netherlands (M.H.P.); and the Division of Pulmonary and Critical Care Medicine, University of Washington and Swedish Medical Center, Seattle (B.L.D.).

Address reprint requests to Dr. Lensing at the Department of Vascular Medicine, Academic Medical Center F4-211, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands, or at awalensing{at}planet.nl.

Full Text of this Article

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Chronic Thromboembolic Pulmonary Hypertension
Paño-Pardo J. R., Fernández-Capitán C., Arnalich F., Lensing A. W.A., Prins M. H., Pengo V.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:1693, Oct 14, 2004. Correspondence

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