External validation of a simple non-invasive algorithm to rule out chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

Thrombosis Research
Frederikus A KlokM Lankeit

Abstract

International guidelines do not provide strong recommendations on the duration and intensity of follow-up after acute pulmonary embolism (PE), nor on screening-programs for chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to address this gab by performing an external validation of the easy "CTEPH rule-out-criteria" based on a normal NT-proBNP level and the absence of 3 ECG characteristics. 134 patients underwent clinical follow-up 6months after PE. Predefined transthoracic echocardiographic (TTE) criteria were used to categorize patients as "PH unlikely" or "PH possible/likely". The latter patients underwent further (invasive) diagnostic procedures to confirm and classify the diagnosis of pulmonary hypertension. NT-proBNP and ECGs, both assessed at the day of echocardiography, were evaluated post-hoc. Sixty-three patients (47%) scored none of the "CTEPH rule-out criteria" positive, of whom 61 had normal TTE (97%). Twenty-five patients (19%) were categorized by TTE as "PH possible/likely"; of those, 6 were diagnosed with CTEPH. The sensitivity of rule-out criteria for CTEPH was 100% (95%CI 56-100%; 6/6 patients identified), and for "PH possible/likely" on TTE 92% (95%CI 74-99%; 23/25 patients identified): 2 asympt...Continue Reading

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Citations

Apr 3, 2018·Journal of Thrombosis and Haemostasis : JTH·F A KlokH J Bogaard
Jan 5, 2019·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Gurbey OcakMerel van Diepen
Jun 2, 2015·European Respiratory Review : an Official Journal of the European Respiratory Society·Andrea M D'Armini
Mar 23, 2018·The European Respiratory Journal·Nicolas CoquozJohn-David Aubert
Mar 31, 2017·European Respiratory Review : an Official Journal of the European Respiratory Society·Gérald SimonneauNick Kim
Dec 14, 2018·The European Respiratory Journal·Nick H KimDavid P Jenkins
Jul 26, 2019·Journal of Thrombosis and Haemostasis : JTH·Karsten KellerMareike Lankeit
Mar 19, 2020·The European Respiratory Journal·Fredrikus A KlokMarc Humbert
May 18, 2018·Nature Reviews. Disease Primers·Menno V HuismanFrederikus A Klok
Aug 31, 2020·Research and Practice in Thrombosis and Haemostasis·Gudula J A M BoonFrederikus A Klok
Dec 22, 2020·Seminars in Thrombosis and Hemostasis·Gudula J A M BoonFrederikus A Klok
Dec 12, 2020·Breathe·Kunal DeokarNishant Chauhan
Mar 19, 2021·Research and Practice in Thrombosis and Haemostasis·Marieke J H A KruipUNKNOWN Dutch COVID Thrombosis Coalition study group
Aug 24, 2021·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Marc de PerrotWilliam R Auger
Aug 26, 2021·Current Opinion in Cardiology·Esther J NossentFrederikus A Klok

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