JOPIC
Journal of Pulmonology and Intensive Care

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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Original Article
Chronic thromboembolic pulmonary hypertension in acute pulmonary embolism: a risk factor evaluation study
Abstract
Aims: Pulmonary thromboembolism (PTE) is a highly mortal disease, defined by presence of thrombus partially or completely obstructing pulmonary arteries and/or veins, commonly originated from deep venous system. Chronic thrombroembolic pulmonary hypertension (CTEPH) is a rare complication of PTE with high mortality if not treated properly. In recent studies, incidence of CTEPH was found between %0,4-9,1. Due to clinically silent PTE in roughly %50 of patients, it is difficult to pinpoint the exact incidence of CTEPH. In this study, we aim to investigate PTE patients during their long-term follow up to observe CTEPH presence and evaluate CTEPH risk factors.
Methods: Patients who had been evaluated in emergency service and/or admitted to pulmonary medicine ward between January 2014 and January 2017 with PTE diagnosis confirmed by computed tomography pulmonary angiogram (CTPA) were accepted retrospectively into the study. Their echocardiography, CTPA and lower extremity venous Doppler ultrasonography at 3., 6. and 12. months follow up were also included. In the patient group with pulmonary arterial pressure (PAP ) above 50 mmHg and residual thrombosis at CTPA, ventilation-perfusion scintigraphy had been performed and was added to the study. Among those suitable for CTEPH, right cardiac catheterization had been done to confirm the diagnosis and accepted as CTEPH. In addition to this group, patients who were not found suitable for right cardiac catheterization but wereclinically suitable for CTEPH are also included in the CTEPH group.
Results: Average age of patients included into the study was 62(±16, 5), with 71 (%39) being male and 111 (%61) female. As for risk factors, 130 (%71,4) had acquired, 16 (%8,8) had genetic and the rest 36 (%19,8) did not have any prominent risk factors. At time of diagnosis, 10 patients were accepted as massive, 26 as sub massive and the rest 139 were considered non-massive PTE. Due to hemodynamic instability, 7 (%3,8) patients were given thrombolytic therapy. During 1 year follow-up, 5 (%2,7) patients were diagnosed with CTPH. When further investigation was performed on these 5 patients, atrial fibrillation (AF), persistent thrombosis at 12. month follow up CTPA and PAP above 55 mmHg upon time of diagnosis were found significant risk factors (p being 0,001/0,023/0,009 respectively). In multivariate analysis, no independent predictive factors were found in regards to CTEPH diagnosis.
Conclusion: CTEPH is a preventable complication of PTE with severe mortality and morbidity if not properly treated. It might prove useful to utilize echocardiography and CTPA together, especially in those in high risk groups, for diagnosis of patients in early stage of CTEPH with no evident signs or symptoms.

Keywords : Pulmonary thromboembolism, chronic thromboembolic pulmonary hypertension, right cardiac catheterization

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1. Arseven O, Ekim N, Müsellim B, et al. Pulmoner embolizm tanı vetedavi uzlaşı raporu. Türk Toraks Derneği: 2015.
2. Humbert M, Kovacs G, Hoeper M, et al. 2022 ESC/ERS Guidelines forthe diagnosis and treatment of pulmonary hypertension. Eur Heart J.2022;43(38):3618-3731.
3. Tiede H, Hooper MM, Richter M, Cacheris W, Hinzmann B, Mayer E.Global burden of chronic thromboembolic pulmonary hypertension(CTEPH): an epidemiological analysis. Eur Respir J. 2014;44(Suppl58):2326.
4. Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survivalin pulmonary arterial hypertension insights from the registry toevaluate early and long-term pulmonary arterial hypertension diseasemanagement (REVEAL). Circ J. 2010;122(2):164-172.
5. Galie N, Hoeper MM, Humbert M, et al. Guidelines for thediagnosis and treatment of pulmonary hypertension. Eur Respir J.2009;34(6):1219-1263.
6. Moser KM, Fedullo PF, Finkbeiner WE, Golden J. Do patients withprimary pulmonary hypertension develop extensive central thrombi?Circ J. 1995;91(3):741-745.
7. Edward JA, Mandras S. An update on the management of chronicthromboembolic pulmonary hypertension. Curr Probl Cardiol.2017;42(1):7-38.
8. Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosisand treatment of pulmonary hypertension. The Task Force for theDiagnosis and Treatment of Pulmonary Hypertension of the EuropeanSociety of Cardiology (ESC) and the European Respiratory Society(ERS), endorsed by the International Society of Heart and LungTransplantation (ISHLT). Eur Heart J. 2009;30(20):2493-2537.
9. Dentali F, Donadini M, Gianni M, et al. Incidence of chronicthromboembolic pulmonary hypertension in patients with previouspulmonary embolism. Thromb Res. 2009:124(3):256-258.
10. Marti D, Gomez V, Escobar C, et al. Incidence of symptomatic andasymptomatic chronic thromboembolic pulmonary hypertension. ArchBronconeumol. 2010;46(12):628-633.
11. Poli D, Grifoni E, Antonucci E, et al. Incidence of recurrent venousthromboembolism and chronic thromboembolic pulmonaryhypertension in patients after a first episode of pulmonary embolism. JThromb Thrombolysis. 2010;30(3):294-299.
12. Korkmaz A, Ozlu T, Ozsu S, Kazaz Z, Bulbul Y. Long term outcomesin acute pulmonary thromboembolism: the incidence of chronicthromboembolic pulmonary hypertension. Clin Appl Thromb Hemost.2012;18(3):281-288.
13. Klok F, van Kralingen KW, van Dijk APJ, Heyning FH, Vliegen HW,Huisman MV. Prospective cardiopulmonary screening program todetect chronic thromboembolic pulmonary hypertension in patientsafteracute pulmonary embolism. Haematol. 2010;95(6):970-975.
14. Becattini C, Agnelli G, Peasvento R, et al. Incidence of chronicthromboembolic pulmonary hypertension after a first episode ofpulmonary embolism. Chest. 2006;130(1):172-175.
15. Pengo V, Lensing A, Prins M, et al. Incidence of chronicthromboembolic pulmonary hypertension after pulmonary embolism.N Eng J Med. 2004;350(22):2257-2264.
16. Surie S, Gibson NS, Gerdes VE, et al. Active search for chronicthromboembolic pulmonary hypertension does not appear indicatedafter acute pulmonary embolism. Thromb Res. 2010;125(5):e202-e205.
17. Kayaalp İ, Varol Y, Çimen P, et al. The incidence of chronicthromboembolic pulmonary hypertension secondary to acutepulmonary embolism. Tuber Toraks. 2014;62(3):199-206.
18. Morris TA. Why acute pulmonary embolism become chronicthromboembolic pulmonary hypertension: clinical and geneticalinsights. Curr Opin Pulm Med. 2013;19(5):422-429.
19. Cilingir B, Günbatar H. Chronic thromboembolic pulmonaryhypertension. Van Tıp Derg. 2016;23(1):125-131.
20. Paraskos JA, Adelstein SJ, Smith RE, et al. Late prognosis of acutepulmonary embolism. N Engl J. 1973;289(2):55-58.
21. Yang Suqiao, Yang Y, Zhai Z, et al. Incidence and risk factors of chronicthromboembolic pulmonary hypertension in patients after acutepulmonary embolism. J Thorac Dis. 2015;7(11):1927-1938.
22. Liu P, Meneveau N, Schiele F, Bassan JP. Predictors of long-term clinicaloutcome of patients with acute massive pulmonary embolism afterthrombolytic therapy. Chin Med J. 2003;116(4):503-509.
23. Ribeiro A, Lindmarker P, Johnsson H, Juhlin-Dannfelt A, JorfeldtL. Pulmonary embolism: one year follow up with echocardiographydoppler and five year survival analysis. Circulation. 1999;99(10):1325-1330.
24. Kaeron C. Natural history of venous thromboembolism. Circ J.2003;(1):122-130.
25. Martinez C, Wallenhorts C, Teal S, Cohen AT, Peacock AJ. Incidenceand risk factors of chronic thromboembolic pulmonary hypertensionfollowing venous thromboembolim, a population based cohort study inEngland . Pulm Circ. 2018;8(3):2045894018791358.
26. Klok FA, Dzikowska O, Kostrubiee M, et al. Derivation of a clinicalprediction score for chronic thromboembolic pulmonary hypertensionafter acute pulmonary embolism. Thromb Haemos. 2016;14(1):121-128.
Article available in :
Volume 2, Issue 2, 2024
Page : 33-38
https://doi.org/10.51271/JOPIC-0032
Article Information
Received : 13 Nis 2024
Accepted : 21 May 2024
Published : 23 May 2024
Corresponding Author :

Şilan Işık: Department of Chest Diseases, Van Training and Research Hospital, Van, Turkiye

[email protected]
Citation : Işık Ş, Kurt EB. Chronic thromboembolic pulmonary hypertension in acute pulmonary embolism: a risk factor evaluation study . J Pulmonol Intens Care. 2024;2(2):33-38.

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