Right ventricular dysfunction is associated with the development of chronic thromboembolic pulmonary hypertension but not with mortality post-acute pulmonary embolism

Chih‐Hsin Hsu; Chih-Chan Lin; Wei-Ting Li; Hsien‐Yuan Chang; Wei‐Ting Chang

doi:10.1097/md.0000000000017953

November 1, 2019MedicineOpen Access

Right ventricular dysfunction is associated with the development of chronic thromboembolic pulmonary hypertension but not with mortality post-acute pulmonary embolism

View Full Paper

Ask AI

Bookmark

Share

Why the study?

Whether right ventricular echocardiographic parameters can predict the development of chronic thromboembolic pulmonary hypertension and mortality after pulmonary embolism in the short- and long-term remains unknown.

Do right ventricular echocardiographic parameters predict the development of CTEPH and mortality after acute pulmonary embolism?

Structured PICO

Do right ventricular echocardiographic parameters predict the development of CTEPH and mortality after acute pulmonary embolism?

P

Population

358 patients with acute pulmonary embolism (PE)

I

Intervention

Right ventricular (RV) echocardiographic parameters (RV dilatation, hypertrophy, increased pulmonary pressure)

O

Outcome

Incidence of chronic thromboembolic pulmonary hypertension (CTEPH) and mortalityhard clinical

Right ventricular echocardiographic abnormalities after acute PE predict the development of CTEPH but not long-term mortality, which is driven by underlying comorbidities.

Implication

RV parameters after PE may flag CTEPH risk for surveillance; leaves open mortality prediction beyond comorbidities.

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH), a late complication of pulmonary embolism (PE), is associated with high mortality. However, whether the right ventricular (RV) echocardiographic parameters can predict - in the short- and long-term - the development of CTEPH and mortality after PE remains unknown. Herein, we aim to investigate the incidence of CTEPH after acute PE and to evaluate the risk factors of CTEPH. In this retrospective cohort, patients with PE were followed for 10 years for the onset of CTEPH. The screening was initially conducted through echocardiography and confirmed by right heart catheterization. Also, transient and permanent risk factors were identified. Among 358 patients with PE, 8 patients (4%) were subsequently diagnosed with CTEPH at a median time of 36 months and 47 died during the follow-up period. Notably, both short- and long-term RV dilatation, hypertrophy, and increased pulmonary pressure increased the incidence of CTEPH. However, RV echocardiographic parameters failed to differentiate survivors from non-survivors. Instead, malignancy, respiratory, or chronic heart failure was strongly associated with post PE mortality in the multivariable analysis. According to our findings, post PE screening of CTEPH may facilitate early diagnosis and intervention for patients at high risk of developing CTEPH. Also, RV echocardiographic parameters are associated with subsequent CTEPH, but mortality is mainly dependent on underlying comorbidities.