Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature

The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown. We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as “all comers”, “survivors” or “survivors without major comorbidities”. CTEPH incidences were calculated using random effects models. We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1–1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0–4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5–4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7–5.9) and 4.1 (95% CI 2.1–8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1–8.4). The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ∼3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences. The incidence of CTEPH is 0.56% in all comers and ∼3% in survivors of acute pulmonary embolism http://ow.ly/PVEh306iNoD

[1]  K. Kerr,et al.  Chronic Thromboembolic Pulmonary Hypertension. Epidemiology and Risk Factors. , 2016, Annals of the American Thoracic Society.

[2]  P. Dorfmüller,et al.  The Pathobiology of Chronic Thromboembolic Pulmonary Hypertension. , 2016, Annals of the American Thoracic Society.

[3]  M. Humbert,et al.  A global view of pulmonary hypertension. , 2016, The Lancet. Respiratory medicine.

[4]  P. Eliáš,et al.  Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015; 159:XX , 2015 .

[5]  H. Vliegen,et al.  Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism , 2016, Journal of thrombosis and haemostasis : JTH.

[6]  Simon Gibbs,et al.  2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension , 2015, European Respiratory Journal.

[7]  G. Hasenfuss,et al.  External validation of a simple non-invasive algorithm to rule out chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. , 2015, Thrombosis research.

[8]  R. Condliffe,et al.  S118 Incidence And Severity Of Chronic Thromboembolic Pulmonary Hypertension Following The Introduction Of A One-stop Clinic For Acute Pulmonary Embolism , 2014, Thorax.

[9]  I. Floriani,et al.  Echocardiographic evolution of pulmonary artery pressure after acute pulmonary embolism. Results from IPER registry. , 2014, Thrombosis research.

[10]  P. Kolh,et al.  [2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism]. , 2014, Kardiologia polska.

[11]  P. Marino,et al.  Prevalence of undiagnosed chronic thromboembolic pulmonary hypertension after pulmonary embolism , 2014, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[12]  O. Ergene,et al.  The incidence of chronic thromboembolic pulmonary hypertension secondary to acute pulmonary thromboembolism. , 2014, Tuberkuloz ve toraks.

[13]  W. Seeger,et al.  Long-term screening for pulmonary hypertension after pulmonary embolism , 2014 .

[14]  Ying H. Shen,et al.  Risk factors of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism , 2014 .

[15]  Zhihong Liu,et al.  Red cell distribution width predicts chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism in a long-term follow-up , 2014, Clinical chemistry and laboratory medicine.

[16]  M. Ozcan,et al.  The incidence of chronic thromboembolic pulmonary hypertension in asympthomatic pulmonary embolism patients , 2014 .

[17]  H. Schäfers,et al.  A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study , 2014, BMC Pulmonary Medicine.

[18]  M. Revel,et al.  Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism , 2014, Thrombosis and Haemostasis.

[19]  A. Barros,et al.  Preditores de hipertensão pulmonar após tromboembolia pulmonar de risco intermédio a elevado , 2013 .

[20]  R. Teixeira,et al.  Predictors of pulmonary hypertension after intermediate-to-high risk pulmonary embolism ☆ , 2013 .

[21]  D. Shetty,et al.  Incidence of chronic thrombo-embolic pulmonary hypertension following acute pulmonary thrombo-embolism: an Indian perspective. , 2013, The Indian journal of chest diseases & allied sciences.

[22]  N. Ekim,et al.  Factors Affecting the Morbidity and Mortality of Pulmonary Thromboembolism Patients in Long Term Follow-up , 2013 .

[23]  F. Klok,et al.  Diagnostic management of acute deep vein thrombosis and pulmonary embolism , 2013, Journal of thrombosis and haemostasis : JTH.

[24]  D. C. Thomas,et al.  P145 Thrombolysis of Acute PE Patients Reduces Subsequent Development of CTEPH , 2012, Thorax.

[25]  J. Yuan,et al.  Risk factors and basic mechanisms of chronic thromboembolic pulmonary hypertension: a current understanding , 2012, European Respiratory Journal.

[26]  Zhonghua Sun,et al.  [Predictive factors of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary thromboembolism]. , 2012, Zhonghua xin xue guan bing za zhi.

[27]  I. Lang,et al.  Risk factors for chronic thromboembolic pulmonary hypertension. , 2006, Proceedings of the American Thoracic Society.

[28]  J. Barberà,et al.  Survival in pulmonary hypertension in Spain: insights from the Spanish registry , 2012, European Respiratory Journal.

[29]  W. von Scheidt,et al.  Echocardiographic evaluation for pulmonary hypertension after recurrent pulmonary embolism. , 2011, Thrombosis research.

[30]  L. Howard,et al.  S24 Incidence of persistent perfusion defects following pulmonary embolism: impact on pulmonary artery systolic pressure at 6 months , 2011, Thorax.

[31]  M. Wilczynska,et al.  P7 Are we screening survivors of pulmonary embolism (PE) for chronic thromboembolic pulmonary hypertension (CTEPH)? , 2011, Thorax.

[32]  J. Barberà,et al.  Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Results From an International Prospective Registry , 2011, Circulation.

[33]  Mi Jie,et al.  Risk factors for chronic thromboembolic pulmonary hypertension after acute pulmonary thromboembolism , 2011, Heart.

[34]  H. Vliegen,et al.  A simple non-invasive diagnostic algorithm for ruling out chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. , 2011, Thrombosis research.

[35]  J. Barberà,et al.  Echocardiographic assessment of pulmonary arterial pressure in the follow-up of patients with pulmonary embolism. , 2011, Thrombosis research.

[36]  W. Klepetko,et al.  Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. , 2011, The Journal of thoracic and cardiovascular surgery.

[37]  D. Jiménez,et al.  Incidencia de hipertensión pulmonar tromboembólica crónica sintomática y asintomática , 2010 .

[38]  R. Golpe,et al.  Right ventricle dysfunction and pulmonary hypertension in hemodynamically stable pulmonary embolism. , 2010, Respiratory medicine.

[39]  H. Vliegen,et al.  Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism , 2010, Haematologica.

[40]  B. Bouma,et al.  Active search for chronic thromboembolic pulmonary hypertension does not appear indicated after acute pulmonary embolism. , 2010, Thrombosis research.

[41]  H. Vliegen,et al.  Patient outcomes after acute pulmonary embolism. A pooled survival analysis of different adverse events. , 2010, American journal of respiratory and critical care medicine.

[42]  R. Abbate,et al.  Incidence of recurrent venous thromboembolism and of chronic thromboembolic pulmonary hypertension in patients after a first episode of pulmonary embolism , 2010, Journal of Thrombosis and Thrombolysis.

[43]  M. Gianni,et al.  Incidence of chronic pulmonary hypertension in patients with previous pulmonary embolism. , 2009, Thrombosis research.

[44]  D. Altman,et al.  Assessing Risk of Bias in Included Studies , 2008 .

[45]  D. Altman,et al.  Chapter 8: Assessing risk of bias in included studies , 2008 .

[46]  M. Bottai,et al.  Survival and Restoration of Pulmonary Perfusion in a Long-Term Follow-Up of Patients After Acute Pulmonary Embolism , 2006, Medicine.

[47]  W. Ageno,et al.  Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. , 2006, Chest.

[48]  Paolo Prandoni,et al.  Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. , 2004, The New England journal of medicine.

[49]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[50]  K. Kerr,et al.  Chronic thromboembolic pulmonary hypertension. , 2001, Clinics in chest medicine.

[51]  A. Wongsa,et al.  Clinical and laboratory findings in patients with pulmonary embolism in Phramongkutklao Hospital. , 2000, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[52]  L. Jorfeldt,et al.  Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. , 1999, Circulation.

[53]  D. Sackett,et al.  Cochrane Collaboration , 1994, BMJ.

[54]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[55]  J. Widimský,et al.  Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. , 1982, Chest.

[56]  R. Hall,et al.  Long-term prognosis of treated acute massive pulmonary embolism. , 1977, British heart journal.

[57]  A. Hemnes,et al.  Update on chronic thromboembolic pulmonary hypertension. , 2017, Trends in cardiovascular medicine.

[58]  Simon Gibbs,et al.  [2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension]. , 2015, Kardiologia polska.

[59]  Jeroen J. Bax,et al.  ESC Guidelines on the diagnosis and management of acute pulmonary embolism , 2014 .

[60]  R. Teixeira,et al.  Predictors of pulmonary hypertension after intermediate-to-high risk pulmonary embolism. , 2013, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[61]  M. Brodmann,et al.  Hyperlipidemia is associated with a higher pulmonary artery systolic pressure in patients after pulmonary embolism. , 2012, Thrombosis research.

[62]  D. Moher,et al.  Nonalcoholic Fatty Liver Disease and Acute Ischemic Stroke , 2010 .

[63]  J. Higgins Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration , 2011 .

[64]  D. Jiménez,et al.  [Incidence of symptomatic and asymptomatic chronic thromboembolic pulmonary hypertension]. , 2010, Archivos de bronconeumologia.

[65]  W. Auger,et al.  Chronic thromboembolic pulmonary hypertension. , 2009, Seminars in respiratory and critical care medicine.