TY - JOUR
T1 - Non-invasive early exclusion of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: The InShape II study
AU - Boon, Gudula J. A. M.
AU - Ende-Verhaar, Yvonne M.
AU - Bavalia, Roisin
AU - el Bouazzaoui, Lahassan H.
AU - Delcroix, Marion
AU - Dzikowska-Diduch, Olga
AU - Huisman, Menno V.
AU - Kurnicka, Katarzyna
AU - Mairuhu, Albert T. A.
AU - Middeldorp, Saskia
AU - Pruszczyk, Piotr
AU - Ruigrok, Dieuwertje
AU - Verhamme, Peter
AU - Vliegen, Hubert W.
AU - Vonk Noordegraaf, Anton
AU - Vriend, Joris W. J.
AU - Klok, Frederikus A.
N1 - Funding Information:
Funding GJAMB en FAK were supported by the Dutch Heart Foundation (2017T064). This work was supported by unrestricted grants from Bayer/Merck Sharp &Dohme (MSD) and Actelion Pharmaceuticals Ltd.
Funding Information:
Competing interests GJAMB was supported by the Dutch Heart Foundation (2017T064). MH reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo, grants from Leo Pharma, outside the submitted work. SM reports grants and personal fees from Daiichi Sankyo, grants and personal fees from Bayer, personal fees from BMS-Pfizer, personal fees from Boehringer-Ingelheim, personal fees from Portola, personal fees from AbbVie, outside the submitted work. PV reports grants from Bayer, grants from Boehringer, grants from BMS, grants from Daiichi-Sankyo, grants from Pfizer, grants from Leo-Pharma, grants from Sanofi, grants from Anthos Therapeutics, outside the submitted work. AVN reports grants from Netherlands CardioVascular Research Initiative, grants from Netherlands Organization for Scientific Research, other from Johnson & Johnson and Ferrer in the past 3 years, non-financial support from member of scientific advisory board of Morphogen-XI, outside the submitted work. FAK reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart foundation (2017T064) and the Dutch Thrombosis association, all outside the submitted work.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is unacceptably long, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies for early CTEPH diagnosis are lacking. Echocardiographic screening among all PE survivors is associated with overdiagnosis and cost-ineffectiveness. We aimed to validate a simple screening strategy for excluding CTEPH early after acute PE, limiting the number of performed echocardiograms. Methods In this prospective, international, multicentre management study, consecutive patients were managed according to a screening algorithm starting 3 months after acute PE to determine whether echocardiographic evaluation of pulmonary hypertension (PH) was indicated. If the 'TEPH prediction score' indicated high pretest probability or matching symptoms were present, the 'TEPH rule-out criteria' were applied, consisting of ECG reading and N-terminalpro-brain natriuretic peptide. Only if these results could not rule out possible PH, the patients were referred for echocardiography. Results 424 patients were included. Based on the algorithm, CTEPH was considered absent in 343 (81%) patients, leaving 81 patients (19%) referred for echocardiography. During 2-year follow-up, one patient in whom echocardiography was deemed unnecessary by the algorithm was diagnosed with CTEPH, reflecting an algorithm failure rate of 0.29% (95% CI 0% to 1.6%). Overall CTEPH incidence was 3.1% (13/424), of whom 10 patients were diagnosed within 4 months after the PE presentation. Conclusions The InShape II algorithm accurately excluded CTEPH, without the need for echocardiography in the overall majority of patients. CTEPH was identified early after acute PE, resulting in a substantially shorter diagnostic delay than in current practice.
AB - Background The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is unacceptably long, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies for early CTEPH diagnosis are lacking. Echocardiographic screening among all PE survivors is associated with overdiagnosis and cost-ineffectiveness. We aimed to validate a simple screening strategy for excluding CTEPH early after acute PE, limiting the number of performed echocardiograms. Methods In this prospective, international, multicentre management study, consecutive patients were managed according to a screening algorithm starting 3 months after acute PE to determine whether echocardiographic evaluation of pulmonary hypertension (PH) was indicated. If the 'TEPH prediction score' indicated high pretest probability or matching symptoms were present, the 'TEPH rule-out criteria' were applied, consisting of ECG reading and N-terminalpro-brain natriuretic peptide. Only if these results could not rule out possible PH, the patients were referred for echocardiography. Results 424 patients were included. Based on the algorithm, CTEPH was considered absent in 343 (81%) patients, leaving 81 patients (19%) referred for echocardiography. During 2-year follow-up, one patient in whom echocardiography was deemed unnecessary by the algorithm was diagnosed with CTEPH, reflecting an algorithm failure rate of 0.29% (95% CI 0% to 1.6%). Overall CTEPH incidence was 3.1% (13/424), of whom 10 patients were diagnosed within 4 months after the PE presentation. Conclusions The InShape II algorithm accurately excluded CTEPH, without the need for echocardiography in the overall majority of patients. CTEPH was identified early after acute PE, resulting in a substantially shorter diagnostic delay than in current practice.
KW - Pulmonary Embolism
UR - http://www.scopus.com/inward/record.url?scp=85103220688&partnerID=8YFLogxK
U2 - 10.1136/thoraxjnl-2020-216324
DO - 10.1136/thoraxjnl-2020-216324
M3 - Article
C2 - 33758073
VL - 76
SP - 1002
EP - 1009
JO - Thorax
JF - Thorax
SN - 0040-6376
IS - 10
ER -