What does this research mean for the field?

TRPG ≥ 44mmHg and RV/LV ratio ≥ 1.14 during acute pulmonary embolism identify an 28.2% CTEPH incidence in high-risk patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The goal is to identify echocardiographic parameters during acute pulmonary embolism that predict subsequent chronic thromboembolic pulmonary hypertension.

January 10, 2026Thrombosis Journal0 citationsOpen Access

Elevated tricuspid peak systolic gradient with enlarged right ventricle present during acute episode of pulmonary embolism predict subsequent chronic thromboembolic pulmonary hypertension

ODOlga Dzikowska-DiduchMedical University of Warsaw IDIwona Dudzik-NiewiadomskaMedical University of Warsaw KKKatarzyna KurnickaMedical University of Warsaw

Key Result

TRPG ≥ 44mmHg and RV/LV ratio ≥ 1.14 during acute pulmonary embolism identified an 28.2% CTEPH incidence in high-risk patients.

Key Points

The goal is to identify echocardiographic parameters during acute pulmonary embolism that predict subsequent chronic thromboembolic pulmonary hypertension.
Analyzed echocardiographic parameters during acute pulmonary embolism episodes.
Conducted follow-up diagnostic workup for chronic thromboembolic pulmonary hypertension.
Used multivariate analysis to assess significant predictors of CTEPH.
Tricuspid regurgitation peak gradient and RV to left ventricle ratio are significant predictors of CTEPH.
A specific combination of echocardiographic parameters identified an 8.1% high-risk group with 28.2% CTEPH incidence.
High sensitivity and specificity rates for predicting CTEPH were observed based on the echocardiographic parameters.

Structured PICO

Does the combination of elevated tricuspid regurgitation peak gradient and enlarged right ventricle on echocardiography during acute pulmonary embolism predict subsequent chronic thromboembolic pulmonary hypertension in APE survivors?

Population

625 acute pulmonary embolism (APE) survivors, mean age 60.36, 345 female (55.2%). Excluded patients with previously diagnosed CTEPH, remote residence, or significant mobility limitations.

Intervention

Echocardiographic assessment during acute pulmonary embolism episode, specifically the presence of tricuspid regurgitation peak gradient (TRPG) ≥ 44 mmHg and right ventricle to left ventricle (RV/LV) ratio ≥ 1.14

Comparator

Patients with TRPG < 44 mmHg and RV/LV ratio < 1.14 on echocardiography during acute pulmonary embolism episode

Outcome

Subsequent diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) confirmed by right heart catheterizationhard clinical

Echocardiographic assessment of TRPG ≥ 44 mmHg and RV/LV ratio ≥ 1.14 during acute pulmonary embolism can identify patients at high risk for developing chronic thromboembolic pulmonary hypertension, warranting active screening.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease with poor outcome if left untreated. Identifying patients at risk of CTEPH already at acute pulmonary embolism (APE) would lead to earlier goal-directed management. Since echocardiography is frequently performed during APE we aimed to assess its predictive value for subsequent CTEPH. During follow up all symptomatic patients underwent diagnostic workup for CTEPH. Echocardiographic parameters recorded during the APE episode were analyzed for subsequent CTEPH. The study included 625 patients (345 F, age 60.36 ± 17.71), 25 subjects (4%) (12 F; age 62.9 ± 18.8), were diagnosed with CTEPH. Patients with CTEPH presented at APE diagnosis more severe echocardiographic signs of right ventricular (RV) pressure overload. Multivariate analysis revealed that only tricuspid regurgitation peak gradient (TRPG), (OR = 1.05 CI 95 1.03; 1.08, p < 0.001) and RV to left ventricle ratio (RV/LV), (OR = 9.86 CI 95 2.26; 43.56, p = 0.002) were significant predictors of CTEPH. ROC analysis of TRPG for the diagnosis of CTEPH had AUC = 0.792 CI 95 0.683-0.900, while RV/LV 0.777 CI 95 0.675–0.878. Combination of RV/LV ≥ 1.14 and TRPG ≥ 44mmHg (tricuspid regurgitation velocity (TRV) ≥ 3.3 m/s) present in 8.1% of patients identified high risk category of subsequent CTEPH with CTEPH incidence of 28.2% CI 95 15.0-44.9% (sensitivity 47.8% CI 95 26.8–69.4%, specificity 93.9% CI 95 91.3–95.9%, NPV 97.3% CI 95 96.0-98.1%, PPV 28.2% CI 95 18.4–40.7%). TRPG < 44mmHg (TRV < 3.3 m/s) with RV/LV ratio < 1.14 present 66.7% of studied patents formed low risk group with CTEPH incidence of 1.6% CI 95 0.5–3.6% (sensitivity 21.7% CI 95 7.5–43.7%, specificity 31.1% CI 95 26.9–35.5%. Combination of TRPG ≥ 44mmHg (TRV ≥ 3.3 m/s) with RV/LV ≥ 1.14 present at echocardiography during acute PE identifies patients at high risk of subsequent CTEPH and our opinion warrants their active screening for CTEPH.

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