Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study

To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. A...

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Published in:European heart journal 2022-09, Vol.43 (36), p.3387-3398
Main Authors: Valerio, Luca, Mavromanoli, Anna C, Barco, Stefano, Abele, Christina, Becker, Dorothea, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Fistera, David, Gerhardt, Felix, Ghofrani, Hossein-Ardeschir, Grgic, Aleksandar, Grünig, Ekkehard, Halank, Michael, Held, Matthias, Hobohm, Lukas, Hoeper, Marius M, Klok, Frederikus A, Lankeit, Mareike, Leuchte, Hanno H, Martin, Nadine, Mayer, Eckhard, Meyer, F Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Jürgen, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S, Konstantinides, Stavros V, Rosenkranz, Stephan
Format: Article
Language:English
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Clinical Research
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Summary:To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2-4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8-20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73-2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care.
ISSN:0195-668X
1522-9645
1522-9645
DOI:10.1093/eurheartj/ehac206