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DOI: 10.1055/s-0034-1375930
Early screening for reperfusion and CTEPH after acute pulmonary embolism
Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with high mortality and few treatment options. The percentage of patients with acute PE who develop CTEPH is unknown but is believed to range from 0.6% to 8.8%. In this prospective, observational study we were interested in the reperfusion rate under routine anticoagulation therapy after acute central PE.
128 patients with acute PE were screened and 19 patients (mean age 63 ± 18yrs, 47% male/53% females) with central PE finally included in this observational study between 2011 and 2013. 4 patients had an idiopathic event while 15 patients presented with thrombosis at the time of diagnosis. 2 patients presented with a second hit. All patients received standard anticoagulation with accenocoumarol (INR 2 – 3). CT scans were performed at time of diagnosis and after 3 – 4 (4.0 ± 1.43) months. At diagnosis the mean D-dimer was 8212 ± 6077 µg/L and the NT-pro BNP levels elevated in 9 patients. After at least 3 months of standard anticoagulation a complete reperfusion was achieved in 10 patients (53%). In 9 patients no or only partial reperfusion was documented. 3 out of them presented with an elevated sPAP in the echo which was confirmed by right heart cathetherisation.
After 3 – 4 months of anticoagulation resolution of central emboli was observed in 58% of cases. 16% of patients initially presenting with central emboli developed CTEPH after this short observation period. Thus, screening of this special PE population might be helpful to detect CTPEH early.