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Eur Respir J. 2018 Apr 4;51(4). pii: 1702505. doi: 10.1183/13993003.02505-2017. Print 2018 Apr.

Multicentre observational screening survey for the detection of CTEPH following pulmonary embolism.

Author information

1
Service de Pneumologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
2
Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland.
3
Klinik für Kardiologie, Kantonsspital St Gallen, St Gallen, Switzerland.
4
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
5
Innere Medizin, Pneumologie und Schlafmedizin, Lungenzentrum Hirslanden, Zürich, Switzerland.
6
Pneumologia e Medicina Intensiva, Ospedale Civico, Lugano, Switzerland.
7
Service de Pneumologie, Hôpital de Pourtalès, Neuchâtel, Switzerland.
8
Servizio di Angiologia, Ospedale La Carità, Locarno, Switzerland.
9
Reparto di Medecina Intensiva, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland.
10
Klinik für Pneumologie, Universitätsspital (Inselspital) und Universität Bern, Bern, Switzerland.
11
Klinik für Pneumologie, Universitätsspital Zürich, Zürich, Switzerland.
12
Servizio di Pneumologia, Ospedale Bellinzona e Valli, Bellinzona, Switzerland.
13
Institut de Médecine Sociale et Préventive, Université de Lausanne, Lausanne, Switzerland.
14
Centre de Transplantation d'Organes, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of pulmonary embolism. Its incidence following pulmonary embolism is debated. Active screening for CTEPH in patients with acute pulmonary embolism is yet to be recommended.This prospective, multicentre, observational study (Multicentre Observational Screening Survey for the Detection of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Following Pulmonary Embolism (INPUT on PE); ISRCTN61417303) included patients with acute pulmonary embolism from 11 centres in Switzerland from March 2009 to November 2016. Screening for possible CTEPH was performed at 6, 12 and 24 months using a stepwise algorithm that included a dyspnoea phone-based survey, transthoracic echocardiography, right heart catheterisation and radiological confirmation of CTEPH.Out of 1699 patients with pulmonary embolism, 508 patients were assessed for CTEPH screening over 2 years. CTEPH incidence following pulmonary embolism was 3.7 per 1000 patient-years, with a 2-year cumulative incidence of 0.79%. The Swiss pulmonary hypertension registry consulted in December 2016 did not report additional CTEPH cases in these patients. The survey yielded 100% sensitivity and 81.6% specificity. The second step echocardiography in newly dyspnoeic patients showed a negative predictive value of 100%.CTEPH is a rare but treatable disease. A simple and sensitive way for CTEPH screening in patients with acute pulmonary embolism is recommended.

PMID:
29563171
DOI:
10.1183/13993003.02505-2017
[Indexed for MEDLINE]

Conflict of interest statement

Conflict of interest: N. Coquoz received travel support for the international CTEPH conference 2017 (Leuven) from MSD Switzerland, and grants from Swiss society for pulmonary hypertension, during the conduct of the study. Conflict of interest: S. Ulrich has received grants from the Swiss National Science Foundation, Zurich Lung and Orpha Swiss, grants and personal fees from Actelion SA, Switzerland, and personal fees from MSD SA, Switzerland, outside the submitted work. Conflict of interest: J-D. Aubert received grants from the Swiss Society for Pulmonary Hypertension, during the conduct of the study; and personal fees from Bayer and Actelion Switzerland for advisory board participation, and travel expenses from Actelion Switzerland, outside the submitted work.

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