Korean J Intern Med.  2017 Jan;32(1):85-94. 10.3904/kjim.2014.175.

The predictive value of echocardiography for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism in Korea

• Park JS
• Ahn J
• Choi JH
• Lee HW
• Oh JH
• Lee HC
• Cha KS
• Hong TJ

• KMID: 2365982
• DOI: http://doi.org/10.3904/kjim.2014.175

Abstract

BACKGROUND/AIMS
Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication after acute pulmonary embolism (APE) and is associated with substantial morbidity and mortality. This study aimed to investigate the incidence of CTEPH after APE in Korea and to determine echocardiographic predictors of CTEPH.
METHODS
Among 381 patients with APE confirmed by chest computed tomography (CT) between January 2007 and July 2013, 246 consecutive patients with available echocardiographic data were enrolled in this study. CTEPH was defined as a persistent right ventricular systolic pressure (RVSP) greater than 35 mmHg on echocardiography during follow-up and persistent pulmonary embolism on the follow-up CT.
RESULTS
Fifteen patients (6.1%) had CTEPH. The rate of right ventricular (RV) dilatation (66.7% vs. 28.1%, p = 0.002) and the RVSP (75.5 mmHg vs. 39.0 mmHg, p < 0.001) were significantly higher in the CTEPH group. D-dimers, RV dilatation, RV hypertrophy, RVSP, and intermediate-risk APE were associated with the risk of CTEPH after APE (odds ratio [OR] 0.59, 5.11, 7.82, 1.06, and 4.86, respectively) on univariate analysis. RVSP remained as a significant predictor of CTEPH on multivariate analysis (OR, 1.056; 95% confidence interval, 1.006 to 1.109; p = 0.029).
CONCLUSIONS
This study showed that the incidence of CTEPH after APE in Korea was 6.1% and that initial RVSP by echocardiography was a strong prognostic factor for CTEPH.

Keyword

Hypertension, pulmonary; Pulmonary embolism; Echocardiography

MeSH Terms

Blood Pressure
Dilatation
Echocardiography*
Follow-Up Studies
Hominidae
Humans
Hypertension, Pulmonary*
Hypertrophy
Incidence
Korea*
Mortality
Multivariate Analysis
Pulmonary Embolism*
Thorax