ABSTRACT
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). We aimed to evaluate the impact of a symptom screening programme to detect CTEPH in PE survivors. METHODS: This was a multicentre cohort study of patients diagnosed with acute symptomatic PE between January 2017 and December 2018 in 16 centres in Spain. Patients were contacted by phone 2 years after the index PE diagnosis. Those with dyspnoea corresponding to a New York Heart Association (NYHA)/WHO scale≥II, visited the outpatient clinic for echocardiography and further diagnostic tests including right heart catheterisation (RHC). The primary outcome was the new diagnosis of CTEPH confirmed by RHC. RESULTS: Out of 1077 patients with acute PE, 646 were included in the symptom screening. At 2 years, 21.8% (n=141) reported dyspnoea NYHA/WHO scale≥II. Before symptom screening protocol, five patients were diagnosed with CTEPH following routine care. In patients with NYHA/WHO scale≥II, after symptom screening protocol, the echocardiographic probability of pulmonary hypertension (PH) was low, intermediate and high in 76.6% (n=95), 21.8% (n=27) and 1.6% (n=2), respectively. After performing additional diagnostic test in the latter 2 groups, 12 additional CTEPH cases were confirmed. CONCLUSIONS: The implementation of this simple strategy based on symptom evaluation by phone diagnosed more than doubled the number of CTEPH cases. Dedicated follow-up algorithms for PE survivors help diagnosing CTEPH earlier. TRIAL REGISTRATION NUMBER: NCT03953560.
Subject(s)
Hypertension, Pulmonary , Pulmonary Embolism , Humans , Acute Disease , Chronic Disease , Cohort Studies , Dyspnea/diagnosis , Dyspnea/etiology , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/complications , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Risk FactorsSubject(s)
Histiocytosis, Sinus/pathology , Thyroid Gland/pathology , Thyroid Nodule/pathology , Diagnosis, Differential , Emperipolesis , Encephalitis/diagnosis , Female , Histiocytes/ultrastructure , Histiocytosis, Sinus/diagnosis , Histiocytosis, Sinus/drug therapy , Humans , Hypothyroidism/complications , Hypothyroidism/drug therapy , Leukoencephalopathies/diagnostic imaging , Leukoencephalopathies/etiology , Leukoencephalopathies/pathology , Lymphocytes/ultrastructure , Middle Aged , Prednisone/therapeutic use , Thyroid Gland/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/etiology , Thyroiditis, Autoimmune/diagnosis , Thyroxine/therapeutic useABSTRACT
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