Abstract Number: OC 10.3
Meeting: ISTH 2020 Congress
Background: The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) is unacceptably long exceeding 1 year, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies to diagnose CTEPH earlier are lacking. Importantly, performing echocardiography in all PE patients for this purpose has a low diagnostic yield, is associated with overdiagnosis and is not cost-effective. Moreover, expertise in performing high-quality PH-dedicated echocardiograms may not be available outside expert centers.
Aims: To validate a simple screening strategy aimed at identifying CTEPH early in the course after acute PE, avoiding echocardiography if possible (Figure 1).
Methods: In this prospective, international, multicenter management study, consecutive PE survivors were managed according to the predefined algorithm starting three months after acute PE. All were followed for a total period of two years. The study protocol was approved by all local IRBs and all patients provided informed consent.
Results: 424 patients were included across three European countries (Table 1). Following the algorithm, CTEPH was considered excluded in 343 (81%) patients based on clinical pre-test probability assessment by the ‘CTEPH prediction score’, evaluation of symptoms and application of the ‘CTEPH rule-out criteria’ (Figure 1); only 19% was subjected to echocardiography. One of 343 patients managed without echocardiography was diagnosed with CTEPH, 10 months after initial PE, for a failure rate of 0.29% (95%CI 0-1.6%). Overall, 13 patients were diagnosed with CTEPH (incidence 3.1%), of whom 10 within 4 months after PE diagnosis.
Conclusions: The algorithm accurately ruled out CTEPH and avoided echocardiography in 81% of patients. The vast majority of CTEPH cases were identified early in the course of acute PE which is a considerable improvement compared to current clinical practice with an economic use of healthcare resources.
To cite this abstract in AMA style:Boon GJAM, Ende-Verhaar YM, Bavalia R, El Bouazzaoui LH, Delcroix M, Dzikowska-Diduch O, Huisman MV, Kurnicka K, Mairuhu ATA, Middeldorp S, Pruszczyk P, Ruigrok D, Verhamme P, Vliegen HW, Vonk Noordegraaf A, Vriend JWJ, Klok FA. Accurate and Efficient Non-Invasive Strategy for Early Identification of Chronic Thromboembolic Pulmonary Hypertension after Acute Pulmonary Embolism (InShape II Study) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/accurate-and-efficient-non-invasive-strategy-for-early-identification-of-chronic-thromboembolic-pulmonary-hypertension-after-acute-pulmonary-embolism-inshape-ii-study/. Accessed September 24, 2021.
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