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In this prospective multicenter observational study including 1017 patients with acute symptomatic pulmonary embolism (PE), the estimated 2-year cumulative incidence of chronic thromboembolic pulmonary hypertension (CTEPH) and post-PE impairment (PPEI) was 2.3% and 16%, respectively. Patients with PPEI had a higher risk of rehospitalization, death, and worse quality of life.
These findings reveal that, although CTEPH is infrequent after acute symptomatic PE, PPEI is common; thus, systematic follow-up after acute PE may help to identity PPEI and optimize patient care.
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.
METHODS AND RESULTS
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.
Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study
Eur Heart J 2022 Apr 28;[EPub Ahead of Print], L Valerio, AC Mavromanoli, S Barco, C Abele, D Becker, L Bruch, R Ewert, M Faehling, D Fistera, F Gerhardt, HA Ghofrani, A Grgic, E Grünig, M Halank, M Held, L Hobohm, MM Hoeper, FA Klok, M Lankeit, HH Leuchte, N Martin, E Mayer, FJ Meyer, C Neurohr, C Opitz, KH Schmidt, HJ Seyfarth, R Wachter, H Wilkens, PS Wild, SV Konstantinides, S Rosenkranz,