Abstract
2788
Introduction: CTEPH has poor prognosis, but can possible be cured[1].Early and accurate prediction for chronic thromboembolic pulmonary hypertension (CTEPH) development after the first episode of acute pulmonary embolism (APE) is crucial for optimal treatment and favourable outcome, however, it has been proven to be a major clinical challenge as demonstrated by a median diagnostic delay of 14 months[2].There were no clear recommendations for specific follow-up programmes after APE to detect CTEPH early, especially for those without PH-related symptom[3,4]. The objective of the present study was to investigate the value of V/Q scan and CTPA in predicting CTEPH development, and to provide the imaging basis for APE patients follow-up.
Methods: This retrospective study between July 2011 and August 2020 was performed in patients with APE who had undergone both V/Q scan and CTPA 3-month after anticoagulation. A median follow-up period was 1-year, and patients' outcomes were CTEPH and non-CTEPH. The residual pulmonary obstructions were assessed based on V/Q and CTPA, and then recorded as pulmonary perfusion detects score (PPDs) and CT pulmonary artery obstruction index (PAOI), respectively. The differences of PPDs and CTPAOI in two groups were tested by using independent t test. Receiver operating characteristic (ROC) curves were generated to determine the predictive performance of PPDs and CTPAOI for developing CTEPH. Logistics regression analysis were used to identify residual pulmonary obstructions and other potential risk factors for predicting CTEPH development.
Results: A total of 229 patients with APE, including19 patients developed CTEPH. The mean PPDs in CTEPH group were significantly higher than those in non-CTEPH group (43.09±14.74 vs. 8.72±10.10, P<0.001), and the same trend was observed in CTPAOI (36.18±19.74 vs. 5.20±9.29, P<0.001).The ROC analysis showed the area under curve (AUC) of PPDs was 0.973 for predicting CTEPH, and the corresponding cut-off value was 20.50% with a sensitivity, specificity and accuracy of 100%, 88.57% and 88.65%, respectively. The AUC was 0.896 of CT PAOI with a cut-off value of 20%, the sensitivity, specificity and accuracy were 84.21%, 90.48% and 89.96%, respectively. Whereas the difference of AUCs between PPDs and CTPAOI was not significantly different (P=0.113). The sensitivity and specificity between these two variables had no significant difference (χ2=0.653, P=0.214). Multivariable logistic regression models showed, pulmonary arterial hypertension at initial APE diagnosis (OR,6.736; 95% CI:1.141,39.776; P=0.038), PPDs>20.50% (OR,20.439; 95% CI:1.877,222.59; P=0.013) and CTPAOI>20% (OR,7.172; 95% CI:1.219,42.203; P=0.029) remained significantly associated with increase in predicting CTEPH development.
Conclusions: Both V/Q and CTPA at 3 months' anticoagulation after APE showed great performance in predicting CTEPH, whereas V/P scan has a tendency to be more sensitive but less specificity than CTPA, and the optimal threshold value of residual vascular obstructions was 20.5%. The results of this study will allow for more complete recommendations with regarding to optimal follow-up of patients with development of CTEPH after APE.
[1] Papamatheakis DG, Poch DS, Fernandes TM, et al. Chronic Thromboembolic Pulmonary Hypertension: JACC Focus Seminar. J Am Coll Cardiol. 2020;3;76(18):2155-2169.
[2] Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124(18):1973-1981.
[3]Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.
[4] Rivera-Lebron B, McDaniel M, Ahrar K, et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb Hemost. 2019;25:1076029619853037.