Symptom-related screening programme for early detection of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the SYSPPE study.

Autor:	Marin-Romero S; Respiratory Unit, Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain., Ballaz-Quincoces A; Respiratory Unit, Hospital Galdakao-Usansolo, Galdacano, Spain., Gómez-Cuervo C; Internal Medicine, Hospital Universitario Doce de Octubre, Madrid, Spain., Marchena-Yglesias PJ; Internal Medicine Unit, Sant Joan de Deu Hospital, Barcelona, Spain., Lopez-Miguel P; Respiratory Unit, Albacete University Hospital Complex, Albacete, Spain., Francisco-Albesa I; Internal Medicine Unit, Doctor Josep Trueta University Hospital, Girona, Spain., Pedrajas-Navas JM; Internal Medicine Unit, San Carlos Clinic Hospital, Madrid, Spain., Lumbierres M; Respiratory Department, Arnau de Vilanova University Hospital, Lleida, Spain., Aibar-Arregui MA; Internal Medicine Unit, Lozano Blesa University Clinical Hospital, Zaragoza, Spain., Bosco Lopez-Saez J; Internal Medicine Unit, University Hospital of Puerto Real, Puerto Real, Spain., Perez-Pinar M; Internal Medicine Unit, Virgen de la Luz Hospital, Cuenca, Spain., Baeza-Martinez C; Respiratory Unit, Hospital General Universitario de Elche, Elche, Spain., Riera-Mestre A; Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.; Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain.; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain., Peris-Sifre M; Internal Medicine Unit, Hospital Provincial Castellon, Castellon de la Plana, Spain.; CEU Cardenal Herrera University, Moncada, Spain., Porras-Ledantes JA; Internal Medicine Unit, Joan XXIII University Hospital, Tarragona, Spain., Criado-Garcia J; Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, Spain., Elias-Hernandez T; Respiratory Unit, Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain., Otero R; Respiratory Unit, Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain.; Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Carlos III Health Institute, Madrid, Spain., Barca-Hernando M; Respiratory Unit, Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain., Muriel A; Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Carlos III Health Institute, Madrid, Spain.; Biostatistics Department, Hospital Universitario Ramon y Cajal, Madrid, Spain.; University of Alcala, Alcala de Henares, Spain., Klok FA; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., Jara-Palomares L; Respiratory Unit, Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain luisoneumo@hotmail.com.; Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Carlos III Health Institute, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2024 Jan 18; Vol. 79 (2), pp. 144-152. Date of Electronic Publication: 2024 Jan 18.
DOI:	10.1136/thorax-2023-220580
Abstrakt:	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. Competing Interests: Competing interests: SM-R was supported by two research grants from the Neumosur Association and SEPAR National Association. CG-C reports payment or honoraria from LEO Pharma. JMPN reports payment or honoraria from Bayer, ROVI and LEO Pharma; and support for attending meetings and/or travel from ROVI. ML reports support for attending meetings and/or travel from MSD. MAA-A reports grants or contracts from Pfizer, Alnylam and Akcea-Ionis; and participation on a Data Safety Monitoring Board or Advisory Board for Pfizer, Bayer and Alnylam. JC-G reports payment or honoraria from Sanofi, ROVI, Bristol, Aspen and Pfizer; and support for attending meetings and/or travel from Sanofi and ROVI. JAP-L reports payment or honoraria from ROVI; and support for attending meetings and/or travel from Pfizer. LJ-P obtained funding for this study from MSD. Grant outside this work and paid to Neumosur Foundation, received payment for lectures and presentations from Actelion Pharmaceuticals, Bayer HealthCare Pharmaceuticals, MSD, Leo Pharma, Pfizer, ROVI, Bristol-Myers Squibb. FAK has received research support from Bayer, Bristol-Myers Squibb, Actelion, Boston Scientific, Leo Pharma, PharmX, The Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Association, The Dutch Heart Foundation and the Horizon Europe program, all outside this work and paid to his institution. The remaining authors (AB-Q, PJM-Y, PL-M, IF-A, JBL-S, MP-P, CB-M, AR-M, MP-S, THE, RO, AM and MB-H) declare no conflict of interest. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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