PB0447 - Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: an update of the literature

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Dieuwke Luijten, MD, PhD candidate

Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Rosa Talerico, MD - PhD candidate

Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Lazio, Italy
Stefano Barco, MD, PhD, FESC (he/him/his)

MD, PhD
Department of Angiology, University Hospital of Zurich
Zurich, Zurich, Switzerland
SC

Suzanne C. Cannegieter, MD PhD

Professor
Department of Clinical Epidemiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
MD

Marion Delcroix

MD, PhD
Department of Respiratory Diseases, University Hospital of Leuven
Leuven, Vlaams-Brabant, Belgium
YE

Yvonne M. Ende-Verhaar

MD, PhD
Department of Internal Medicine, Haaglanden Medisch Centrum
the Hague, Zuid-Holland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
SK

Stavros Konstantinides

MD, PhD
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University
Mainz, Rheinland-Pfalz, Germany
AM

Albert T.A. Mairuhu

MD, PhD
Department of Vascular Medicine, Haga Hospital
the Hague, Zuid-Holland, Netherlands
MN

Maarten K. Ninaber

MD, PhD
Department of Pulmonology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
PP

Piotr Pruszcyk

MD, PhD
Department of Internal Medicine and Cardiology, Medical University of Warsaw
Warsaw, Mazowieckie, Poland
AV

Anton Vonk Noordegraaf

MD, PhD
Department of Pulmonology, Amsterdam UMC, VU University Medical Centre
Amsterdam, Noord-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is the most feared long-term complication of acute pulmonary embolism (PE). Its exact incidence is relevant for the design of optimal follow-up pathways for PE patients. A systematic review and meta-analysis (SRMA) published in 2017 estimated the CTEPH incidence to be 2.8-3.2% for PE survivors. Since then, several large studies reporting CTEPH incidence after PE have been published.

Aims: We aimed to update the 2017 SRMA by performing a literature search until 20-05-2022. The CTEPH diagnosis had to be confirmed by right heart catheterization.

Methods: The CTEPH incidence was estimated using random effects models in 3 patient categories: all-comers, survivors and survivors without comorbidities, depending on the design and selection criteria of the individual studies.

Results: 13 new studies were identified. Combined with the 16 studies included in the 2017 SRMA, we were able to study a total of 9709 acute PE patients who were subjected to CTEPH follow-up procedures with a duration of 3 to 105 months. The weighted pooled incidence of 1820 all-comers was 1.6% (95% confidence interval [95%CI] 0.38-2.8; I2=75.7%). In 2892 PE survivors, the weighted pooled incidence was 2.2% (95% CI 1.4-3.0; I2=36.1%). The weighted pooled incidence of CTEPH in 4910 PE survivors without major comorbidities was 2.7% (95%CI 1.8-3.5; I2=78.7%). Right ventricle (RV) overload and/or dysfunction at PE presentation was associated with an increased CTEPH incidence (odds ratio 6.8; 95%CI 3.2-14.6; I2=0.0%). Time-trend analysis based on the publication date showed no clear trend over time.

Conclusion(s): Overall, 1 in 63 PE patients is ultimately diagnosed with CTEPH. Although CTEPH remains a rare complication of PE, the incidence of 2.2-2.7% in survivors visiting the outpatient clinic -and especially those presenting with signs of RV dysfunction or overload- calls for dedicated, cost-effective follow-up algorithms aiming at early diagnosis and referral to CTEPH expertise centers.