Abstract Background Chronic thromboembolic pulmonary disease (CTEPD) is a rare but severe complication that can occur after DVT or PE. Emerging evidence suggests a potential rise in CTEPD cases following COVID-19, but its true prevalence post-infection remains unclear. This study aimed to assess whether the incidence of CTEPD has increased after COVID-19 and to identify potential risk factors and predictors in affected individuals. Methods We prospectively followed 101 patients from a long COVID clinic with persistent dyspnea for more than six months after COVID-19 infection in two centers. All patients underwent biomarker testing (NT-proBNP, D-dimer, CRP), six-minute walk test (6MWT), transthoracic echocardiography, computed tomography (CT), ventilation-perfusion (V/Q) scan, and right heart catheterization (RHC) in suspected CTEPD. One patient declined RHC, leaving 100 for final analysis. Statistical comparisons between the groups were performed using Wilcoxon rank sum and Fisher’s exact tests. Correlations and regression models were used to identify potential risk factors and independent predictors of CTEPD. Results Among the 100 patients, 8 were diagnosed with CTEPD, and 92 had normal cardiopulmonary evaluations. The observed CTEPD rate (8%) appears higher than previously reported in non-COVID populations. NT-proBNP levels were significantly elevated in the CTEPD group compared to normal (median: 1,385 pg/mL vs. 94 pg/mL, p = 0.033). The 6MWT distance was significantly lower in the affected group (median: 340 m vs. 460 m, p = 0.036). No significant differences were observed in age (p = 0.6), gender distribution (p = 0.5), BMI (p = 0.11), D-dimer levels (p = 0.3), or CRP (p = 0.4). A history of DVT/PE was the strongest independent predictor of CTEPD (OR: 10.95, 95% CI: 2.32–78.78, p = 0.0051). Conclusion Our findings suggest a potentially higher-than-expected CTEPD incidence in post-COVID-19 patients with persistent dyspnea. BNP elevation and reduced 6MWT distance were significantly associated with CTEPD, while inflammatory and coagulation markers were not predictive. A history of DVT/PE remains the strongest risk factor. These results highlight the need for increased clinical vigilance and screening for CTEPD in post-COVID populations.
Shafran et al. (Sat,) studied this question.