TY  - JOUR
A1  - Held, Matthias
A1  - Hesse, Alexander
A1  - Gött, Franziska
A1  - Holl, Regina
A1  - Hübner, Gudrun
A1  - Kolb, Philipp
A1  - Langen, Heinz Jakob
A1  - Romen, Tobias
A1  - Walter, Franziska
A1  - Schäfers, Hans Joachim
A1  - Wilkens, Heinrike
A1  - Jany, Berthold
T1  - A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study
JF  - BMC Pulmonary Medicine
N2  - Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH.
This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool.

Methods
In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH.

Results
37.7%, 25.5% and 29.3% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4%, 11.5% and 18.8% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET.

Conclusion
A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.
KW  - follow-up
KW  - pulmonary embolism
KW  - pulmonary hypertension
KW  - pulmonary circulation
KW  - chronic thromboembolic pulmonary hypertension
KW  - pulmonary artery pressure
KW  - pulmonary artery
KW  - cardiopulmonary exercise testing
KW  - dyspnea
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119281
VL  - 14
ER  -