October 26, 2020Journal of the American College of Cardiology
Chronic Thromboembolic Pulmonary Hypertension
Key result
CTEPH develops in ~2% of acute PE survivors and is managed via endarterectomy, pharmacotherapy, or angioplasty.
Key Points
- The aim is to clarify the diagnosis and treatment options available for chronic thromboembolic pulmonary hypertension (CTEPH).
- Evaluated the effectiveness of computed tomographic pulmonary angiography and digital subtraction pulmonary angiography for diagnosis.
- Assessed treatment options including pulmonary endarterectomy and pharmacotherapy alternatives.
- Determined operability of patients for surgical candidacy.
- CTEPH diagnosed in approximately 2.3% of acute pulmonary embolism survivors.
- Computed tomographic pulmonary angiography shows segmental defects that support CTEPH diagnosis.
- Pulmonary endarterectomy surgery offers a potentially curative option for operable patients.
Structured PICO
P
Population
Patients with or suspected of having chronic thromboembolic pulmonary hypertension (CTEPH)
I
Intervention
Diagnostic and therapeutic strategies including ventilation/perfusion scintigraphy, pulmonary angiography, pulmonary endarterectomy, pharmacotherapy, and balloon pulmonary angioplasty
This review outlines the diagnostic and therapeutic approach to chronic thromboembolic pulmonary hypertension, highlighting pulmonary endarterectomy as the primary curative option.
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Implication
May warrant post-PE CTEPH surveillance; leaves open precise incidence confirmation.
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is the result of pulmonary arterial obstruction by organized thrombotic material stemming from incompletely resolved acute pulmonary embolism. The exact incidence of CTEPH is unknown but appears to approximate 2.3% among survivors of acute pulmonary embolism. Although ventilation/perfusion scintigraphy has been supplanted by computed tomographic pulmonary angiography in the diagnostic approach to acute pulmonary embolism, it has a major role in the evaluation of patients with suspected CTEPH, the presence of mismatched segmental defects being consistent with the diagnosis. Diagnostic confirmation of CTEPH is provided by digital subtraction pulmonary angiography, preferably performed at a center familiar with the procedure and its interpretation. Operability assessment is then undertaken to determine if the patient is a candidate for potentially curative pulmonary endarterectomy surgery. When pulmonary endarterectomy is not an option, pulmonary arterial hypertension-targeted pharmacotherapy and balloon pulmonary angioplasty represent potential therapeutic alternatives.
JACC · literature review. Post-PE surveillance may be warranted: about 2.3% develop CTEPH. Chronic Thromboembolic Pulmonary Hypertension Should acute PE survivors be checked for CTEPH? How CTEPH is diagnosed: V/Q scintigraphy → CT shows segmental defects → Pulmonary angiography. Three management routes: Pulmonary endarterectomy, Pharmacotherapy, Balloon angioplasty. 2.3% PE survivors: Develop CTEPH after acute pulmonary embolism. Bottom line: Post-PE CTEPH surveillance may be warranted; precise incidence still unconfirmed.
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Cite This Study
Papamatheakis et al. (2020) conducted a review in Chronic thromboembolic pulmonary hypertension (CTEPH). Chronic thromboembolic pulmonary hypertension occurs in approximately 2.3% of acute pulmonary embolism survivors and is managed via pulmonary endarterectomy, pharmacotherapy, or balloon angioplasty.