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Prevalence and predictors of chronic thromboembolic pulmonary hypertension following intermediate-high and high risk acute pulmonary embolism
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Introdução e Objetivo: A prevalência da Hipertensão Pulmonar Tromboembólica Crónica (HPTEC) após Embolia Pulmonar aguda (EP) na população portuguesa permanece desconhecida. O objetivo do nosso trabalho foi avaliar a prevalência e os fatores de risco de HPTEC dois anos após uma EP sintomática de alto risco (A) e risco intermédio-alto (IA) num centro de referência nacional para hipertensão pulmonar. Métodos: Este estudo de coorte retrospetivo incluiu doentes hospitalizados com EP entre 2014-2019 num hospital terciário. Resultados: Dos 969 doentes hospitalizados com EP entre 2014-2019 (incidência anual de 46/100.000 habitantes), 194 foram estratificados como EP de risco A (5.4%) e IA (14.7%), conforme recomendado pela Sociedade Europeia de Cardiologia. Destes, 129 doentes foram incluídos na análise. Durante um acompanhamento mediano de 41.0 (24.0-58.5) meses, a prevalência geral de HPTEC suspeita por avaliação clínica, ecocardiograma com Doppler e cintigrafia pulmonar de ventilação/perfusão foi de 6.2% (8 doentes). HPTEC foi confirmada por cateterismo cardíaco direito em 4 desses doentes (3.1%). A elevação da pressão sistólica da artéria pulmonar (PAPs) na admissão (OR 1.12; IC95% 1.04-1.22; p=0.005) e a presença de varizes nos membros inferiores (OR 7.47; IC95% 1.53-36.41; p=0.013) foram preditores de HPTEC. PAPs na admissão >60 mmHg identificou doentes com HPTEC no seguimento com valor de sensibilidade e especificidade de 83.3% e 76.3%, respetivamente. Todos os doentes com HPTEC tiveram pelo menos 2 achados radiológicos sugestivos de HPTEC no evento índice. Conclusões: Na nossa coorte, a prevalência de HPTEC nos sobreviventes de formas graves de EP aguda foi de 6,2%. A presença de varizes e PAPs no evento índice foram identificados como preditores de HPTEC e podem auxiliar no reconhecimento precoce do diagnóstico de HPTEC após EP. Uma PAPs acima de 60 mmHg e achados radiológicos de suporte na tomografia computadorizada do evento índice são altamente sugestivos de HPTEC pré-existente.
Introduction and Purpose: The true prevalence of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) after Pulmonary Embolism (PE) in the Portuguese population remains unknown. Therefore, we aimed to assess the prevalence and risk factors of CTEPH two years after a symptomatic high (HR) and intermediate-high risk (IHR) PE in a Portuguese referral centre for pulmonary hypertension. Methods: This retrospective cohort study included patients hospitalized with PE between 2014-2019 in a tertiary care hospital. Results: Of the 969 patients hospitalized with PE between 2014-2019 (annual incidence of 46/100.000 inhabitants), 194 were stratified as HR (5.4%) and IHR (14.7%) PE as recommended by European Society of Cardiology. Of them, 129 patients were included in the analysis. During a median follow-up of 41.0 (24.0-58.5) months, overall prevalence of suspected CTEPH by clinical, Doppler echocardiography and V/Q lung scan was 6.2% (8 patients) and confirmed by right heart catheterization in 4 of those patients (3.1%). Increased systolic pulmonary artery pressure (sPAP) at admission (OR 1.12; 95%CI 1.04-1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95%CI 1.53-36.41; p=0.013) were predictors of CTEPH in the multivariable regression analysis. sPAP at admission >60 mmHg identified patients with CTEPH at the follow-up with a sensitivity and specificity of 83.3% and 76.3%, respectively. All patients with CTEPH had at least two radiological findings suggestive of CTEPH at the index event. Conclusions: In our cohort, the prevalence of CTEPH in the survivors of severe forms of acute PE was 6.2%. The presence of varicose veins and sPAP at the admission of the index event were identified as early predictors of CTEPH and could assist to early recognition of CTEPH diagnosis after PE. A sPAP above 60 mmHg and supporting radiological findings at the index computer tomography is highly suggestive of acute on chronic CTEPH.
Introduction and Purpose: The true prevalence of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) after Pulmonary Embolism (PE) in the Portuguese population remains unknown. Therefore, we aimed to assess the prevalence and risk factors of CTEPH two years after a symptomatic high (HR) and intermediate-high risk (IHR) PE in a Portuguese referral centre for pulmonary hypertension. Methods: This retrospective cohort study included patients hospitalized with PE between 2014-2019 in a tertiary care hospital. Results: Of the 969 patients hospitalized with PE between 2014-2019 (annual incidence of 46/100.000 inhabitants), 194 were stratified as HR (5.4%) and IHR (14.7%) PE as recommended by European Society of Cardiology. Of them, 129 patients were included in the analysis. During a median follow-up of 41.0 (24.0-58.5) months, overall prevalence of suspected CTEPH by clinical, Doppler echocardiography and V/Q lung scan was 6.2% (8 patients) and confirmed by right heart catheterization in 4 of those patients (3.1%). Increased systolic pulmonary artery pressure (sPAP) at admission (OR 1.12; 95%CI 1.04-1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95%CI 1.53-36.41; p=0.013) were predictors of CTEPH in the multivariable regression analysis. sPAP at admission >60 mmHg identified patients with CTEPH at the follow-up with a sensitivity and specificity of 83.3% and 76.3%, respectively. All patients with CTEPH had at least two radiological findings suggestive of CTEPH at the index event. Conclusions: In our cohort, the prevalence of CTEPH in the survivors of severe forms of acute PE was 6.2%. The presence of varicose veins and sPAP at the admission of the index event were identified as early predictors of CTEPH and could assist to early recognition of CTEPH diagnosis after PE. A sPAP above 60 mmHg and supporting radiological findings at the index computer tomography is highly suggestive of acute on chronic CTEPH.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Hipertensão pulmonar tromboembólica crónica Embolia pulmonar Prevalência Preditores Cardiologia