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A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study
Please always quote using this URN: urn:nbn:de:bvb:20-opus-119281
- 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 symptomaticBackground 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.…
Author: | Matthias Held, Alexander Hesse, Franziska Gött, Regina Holl, Gudrun Hübner, Philipp Kolb, Heinz Jakob Langen, Tobias Romen, Franziska Walter, Hans Joachim Schäfers, Heinrike Wilkens, Berthold Jany |
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URN: | urn:nbn:de:bvb:20-opus-119281 |
Document Type: | Journal article |
Faculties: | Medizinische Fakultät |
Medizinische Fakultät / Missionsärztliche Klinik | |
Language: | English |
Parent Title (English): | BMC Pulmonary Medicine |
Year of Completion: | 2014 |
Volume: | 14 |
Pagenumber: | 141 |
Source: | Pulmonary Medicine 2014 14:141. doi:10.1186/1471-2466-14-141 |
DOI: | https://doi.org/10.1186/1471-2466-14-141 |
Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 616 Krankheiten |
Tag: | cardiopulmonary exercise testing; chronic thromboembolic pulmonary hypertension; dyspnea; follow-up; pulmonary artery; pulmonary artery pressure; pulmonary circulation; pulmonary embolism; pulmonary hypertension |
Release Date: | 2015/10/21 |
Licence (German): | CC BY: Creative-Commons-Lizenz: Namensnennung |