The predictive value of echocardiography for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism in Korea
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (19)
- Lewczuk J, "Prognostic factors in medically treated patients with chronic pulmonary embolism", Chest, 119, pp.818~823 (2001)
- Hoeper MM, "Chronic thromboembolic pulmonary hypertension", Circulation, 113, pp.2011~2020 (2006)
- Pengo V, "Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism", N Engl J Med, 350, pp.2257~2264 (2004)
- Galie N, "Guidelines for the diagnosis and treatment of pulmonary hypertension:the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)", Eur Heart J, 30, pp.2493~2537 (2009)
- Rudski LG, "Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography", J Am Soc Echocardiogr, 23, pp.685~713 (2010)
- McConnell MV, "Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism", Am J Cardiol, 78, pp.469~473 (1996)
- Kukulski T, "A comparison of regional myocardial velocity information derived by pulsed and color Doppler techniques: an in vitro and in vivo study", Echocardiography, 17, pp.639~651 (2000)
- Yasui T, "Multidetector-row computed tomography management of acute pulmonary embolism", Circ J, 71, pp.1948~1954 (2007)
- Auger WR, "Chronic major-vessel thromboembolic pulmonary artery obstruction: appearance at angiography", Radiology, 182, pp.393~398 (1992)
- Torbicki A, "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)", Eur Heart J, 29, pp.2276~2315 (2008)
- Shigeta A, "Gender differences in chronic thromboembolic pulmonary hypertension in Japan", Circ J, 72, pp.2069~2074 (2008)
- Egermayer P, "Is pulmonary embolism a common cause of chronic pulmonary hypertension? Limitations of the embolic hypothesis", Eur Respir J, 15, pp.440~448 (2000)
- Becattini C, "Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism", Chest, 130, pp.172~175 (2006)
- Ribeiro A, "Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis", Circulation, 99, pp.1325~1330 (1999)
- Lang I, "Risk factors for chronic thromboembolic pulmonary hypertension", Proc Am Thorac Soc, 3, pp.568~570 (2006)
- Suntharalingam J, "Fibrinogen Aalpha Thr312Ala polymorphism is associated with chronic thromboembolic pulmonary hypertension", Eur Respir J, 31, pp.736~741 (2008)
- Lang IM, "Risk factors and basic mechanisms of chronic thromboembolic pulmonary hypertension: a current understanding", Eur Respir J, 41, pp.462~468 (2013)
- Galie N, "Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (EARLY study): a double-blind, randomised controlled trial", Lancet, 371, pp.2093~2100 (2008)
- Riedel M, "Longterm follow-up of patients with pulmonary thromboembolism:late prognosis and evolution of hemodynamic and respiratory data", Chest, 81, pp.151~158 (1982)