Key result
Applying the new mPAP >20 mmHg threshold two years after acute pulmonary embolism identified a 5.25% incidence of CTEPH, representing a 23.5% increase in diagnoses compared to former guidelines.
Why the study?
The impact of the new pulmonary hypertension definition on CTEPH incidence is unclear, and the incidence of CTEPD is unknown.
Does the new mPAP threshold > 20 mm Hg alter the diagnosed incidence of CTEPH and CTEPD in patients after acute pulmonary embolism?
Observational (n=400)
Does the new mPAP threshold > 20 mm Hg alter the diagnosed incidence of CTEPH and CTEPD in patients after acute pulmonary embolism?
Absolute Event Rate: 5.25% vs 4.25%
Applying the new mPAP >20 mmHg threshold significantly increases the diagnosis of CTEPH in post-PE patients, many of whom lack echocardiographic signs of PH but show abnormalities on cardiopulmonary exercise testing.
Post-PE incidence of CTEPH/CTEPD rises with mPAP >20 mmHg; leaves open optimal screening thresholds and management.
Background The influence of the new pulmonary hypertension (PH) definition on the incidence of chronic thromboembolic PH (CTEPH) is unclear. The incidence of chronic thromboembolic pulmonary disease without PH (CTEPD) is unknown. Objectives To determine the frequency of CTEPH and CTEPD using the new mPAP cut-off >20 mmHg for PH in patients who have suffered an incidence of pulmonary embolism (PE) and were recruited into an aftercare program. Methods In a prospective two-year observational study based on telephone calls, echocardiography and cardiopulmonary exercise tests, patients with findings suspicious for PH received an invasive work-up. Data from right heart catheterization were used to identify patients with or without CTEPH/CTEPD. Results Two years after acute PE (n = 400) we found an incidence of 5.25% for CTEPH (n = 21) and 5.75% for CTEPD (n = 23) according to the new mPAP threshold >20 mmHg. Five of 21 patients with CTEPH and 13 of 23 patients with CTEPD showed no signs of PH in echocardiography. CTEPH and CTEPD subjects showed a reduced VO₂ peak and work rate in cardiopulmonary exercise testing (CPET). The capillary end-tidal CO 2 gradient was comparably elevated in CTEPH and CTEPD, but it was normal in the Non-CTEPD-Non-PH group. According to the PH definition provided by the former guidelines, only 17 (4.25%) patients have been diagnosed with CTEPH and 27 individuals (6.75%) were classified having CTEPD. Conclusions Using mPAP >20 mmHg for diagnosis of CTEPH leads to an increase of 23.5% of CTEPH diagnosis. CPET may help to detect CTEPD and CTEPH.
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Held et al. (2023) conducted an observational in Pulmonary embolism (n=400). mPAP threshold > 20 mm Hg vs. Former guidelines PH definition was evaluated on Incidence of CTEPH. Applying the new mPAP >20 mmHg threshold two years after acute pulmonary embolism identified a 5.25% incidence of CTEPH, representing a 23.5% increase in diagnoses compared to former guidelines.
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