Imaging of the right ventricle in predicting the development of chronic thromboembolic pulmonary hypertension (CTEPH)

There is increasing evidence in the literature emphasizing the importance of right ventricular (RV) imaging in the prognosis of pulmonary hypertension. We aimed to investigate the predictive role of RV dysfunction parameters assessed by echocardiography (ECHO) and thorax computed tomography (CT) in developing CTEPH. We included prospectively patients diagnosed with pulmonary embolism (PE). All patients underwent ECHO and CT within 24 hours after admission. We repeated CT and ECHO after six months and one year to assess the incidence of CTEPH and the predictive role of RV dysfunction factors in the development of CTEPH. We included twenty-two patients (seven male) with a mean age of 53.9±17.9 years; CTEPH developed in two patients during the follow-up. Baseline PO2 levels were significantly lower in patients with CTEPH (61.5±11.4 vs 77.8±25.2, p<0.05). The baseline RV diameter, RV EF, and systolic PAP levels evaluated by ECHO differed significantly in two patients who developed CTEPH. Two patients that developed CTEPH had the lowest RVS (-10.3% and -11.7%). This study claims that hypoxemia, decreased RV EF, RVS, increased systolic PAP values in ECHO, and increased RV/LV ratio evaluated in thorax CT indicate the severity of RV dysfunction in acute PE and may predict CTEPH development.