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BMC Pulmonary Medicine

, 14:141

COPD and occupational lung disease

Abstract

BackgroundChronic thromboembolic pulmonary hypertension CTEPH is a long-term complication following an acute pulmonary embolism PE. It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH.

This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing CPET as a diagnostic tool.

MethodsIn a prospective cohort study all consecutive patients with newly diagnosed PE n=170, 76 males, 94 females within 26 months were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH.

Results37.7%, 25.5% and 29.3% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4%, 11.5% and 18.8% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension PH. CTEPH with pathological imaging and a mean pulmonary artery pressure mPAP ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure PAOP. Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET.

ConclusionA follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.

KeywordsDyspnea Cardiopulmonary exercise testing Pulmonary artery Pulmonary artery pressure Chronic thromboembolic pulmonary hypertension Follow-up Pulmonary embolism Pulmonary hypertension Pulmonary circulation AbbreviationsACCPAmerican College of Chest Physicians

ATSAmerican Thoracic Society

CICardiac index

COCardiac output

CO2Carbon dioxide

COPDChronic obstructive pulmonary disease

CPETCardiopulmonary exercise testing

CTComputed tomography

CTEPHChronic thromboembolic pulmonary hypertension

EQ CO2Breathing equivalent for carbon dioxide

EQ O2Breathing equivalent for oxygen

mPAPMean pulmonary artery pressure

O2Oxygen

PA-aO2Alveolar-arterial oxygen gradient

PaETCO2Arterial – endtidal carbon dioxide gradient

PAHPulmonary arterial hypertension

PAPPulmonary artery pressure

PAWPPulmonary arterial wedge pressure

PAOPPulmonary arterial occlusion pressure

PEPulmonary embolism

PEAPulmonary thrombendarterectomy

PET CO2Partial pressure of endtidal CO2

PHPulmonary hypertension

SDStandard deviation

VE-VCO2Ratio of minute ventilation and carbon dioxide output

VQ scanVentilation-perfusion scan

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2466-14-141 contains supplementary material, which is available to authorized users.

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Autor: Matthias Held - Alexander Hesse - Franziska Gött - Regina Holl - Gudrun Hübner - Philipp Kolb - Heinz Jakob Langen - Tob

Fuente: https://link.springer.com/







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