Echocardiographic assessment of pulmonary arterial pressure in the follow-up of patients with pulmonary embolism

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• 作者：Remedios Otero^a ; ^{rotero@separ.es} ; Mikel Oribe^b ; Aitor Ballaz^b ; David Jimenez^c ; Fernando Uresandi^d ; Dolores Nauffal^e ; Francisco Conget^f ; Consolació ; n Rodriguez^g ; Teresa Elias^a ; Luis Jara^a ; Aurelio Cayuela^h ; Isabel Blancoⁱ ; Joan Barber&#xe1 ; ⁱ
• 关键词：Pulmonary embolism ; Echocardiography ; Chronic thromboembolic pulmonary hypertension ; Multicenter study ; Screening
• 刊名：Thrombosis Research
• 出版年：2011
• 出版时间：April 2011
• 年：2011
• 卷：127
• 期：4
• 页码：303-308
• 全文大小：213 K

文摘

Background

Echocardiography remains a clinically useful screening test for chronic thromboembolic pulmonary hypertension (CTEPH) in patients with a history of pulmonary embolism (PE). To devise an effective screening strategy, the definition of a high-risk group is necessary.

Methods

We examined a total of 744 patients with acute symptomatic pulmonary embolism (PE) who were enrolled in a Spanish multicenter study. Patients were monitored every 6 months during the first two years, and then once a year thereafter. Transthoracic echocardiography was used to screen patients with a clinical suspicion of CTEPH during follow-up. Pulmonary arterial hypertension was defined as an estimated pulmonary artery systolic pressure (PAP) > 50 mm Hg. The index thromboembolic episode was considered severe if: (a) the patient was immobilized for medical reasons; or (b) systolic blood pressure was less than 90 mm Hg; or (c) troponin T values were above the reference range.

Results

The incidence of PAP > 50 mm Hg at 36 months was 8.3 % (95 % confidence interval = 4.6 % –14.5 % ). Statistical analysis showed a highly significant association between a severe index thromboembolic episode and the subsequent detection of PAP > 50 mm Hg on echocardiography, with high positive likelihood ratio (2.40) and negative predictive value (> 0.97).

Conclusions

Patients with a severe index thromboembolic episode would constitute a high-risk group for the development of CTEPH. This group of patients should be subjected to a strict follow-up protocol.