RESUMEN
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). We aimed to evaluate the impact of a symptom screening programme to detect CTEPH in PE survivors. METHODS: This was a multicentre cohort study of patients diagnosed with acute symptomatic PE between January 2017 and December 2018 in 16 centres in Spain. Patients were contacted by phone 2 years after the index PE diagnosis. Those with dyspnoea corresponding to a New York Heart Association (NYHA)/WHO scale≥II, visited the outpatient clinic for echocardiography and further diagnostic tests including right heart catheterisation (RHC). The primary outcome was the new diagnosis of CTEPH confirmed by RHC. RESULTS: Out of 1077 patients with acute PE, 646 were included in the symptom screening. At 2 years, 21.8% (n=141) reported dyspnoea NYHA/WHO scale≥II. Before symptom screening protocol, five patients were diagnosed with CTEPH following routine care. In patients with NYHA/WHO scale≥II, after symptom screening protocol, the echocardiographic probability of pulmonary hypertension (PH) was low, intermediate and high in 76.6% (n=95), 21.8% (n=27) and 1.6% (n=2), respectively. After performing additional diagnostic test in the latter 2 groups, 12 additional CTEPH cases were confirmed. CONCLUSIONS: The implementation of this simple strategy based on symptom evaluation by phone diagnosed more than doubled the number of CTEPH cases. Dedicated follow-up algorithms for PE survivors help diagnosing CTEPH earlier. TRIAL REGISTRATION NUMBER: NCT03953560.
Asunto(s)
Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Enfermedad Aguda , Enfermedad Crónica , Estudios de Cohortes , Disnea/diagnóstico , Disnea/etiología , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/complicaciones , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Factores de RiesgoAsunto(s)
Histiocitosis Sinusal/patología , Glándula Tiroides/patología , Nódulo Tiroideo/patología , Diagnóstico Diferencial , Emperipolesis , Encefalitis/diagnóstico , Femenino , Histiocitos/ultraestructura , Histiocitosis Sinusal/diagnóstico , Histiocitosis Sinusal/tratamiento farmacológico , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/tratamiento farmacológico , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/etiología , Leucoencefalopatías/patología , Linfocitos/ultraestructura , Persona de Mediana Edad , Prednisona/uso terapéutico , Glándula Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/etiología , Tiroiditis Autoinmune/diagnóstico , Tiroxina/uso terapéuticoRESUMEN
No disponible