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Heuts S, Kawczynski MJ, Leus A, Godinas L, Belge C, van Empel V, Meyns B, Maessen JG, Delcroix M, Verbelen T. The volume-outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. Eur Respir J 2025; 65:2401865. [PMID: 39572220 PMCID: PMC11865742 DOI: 10.1183/13993003.01865-2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 11/01/2024] [Indexed: 03/01/2025]
Abstract
BACKGROUND We conducted a volume-outcome meta-analysis of pulmonary endarterectomy procedures for chronic thromboembolic pulmonary hypertension to objectively determine the minimum required annual case load that can define a high-volume centre. METHODS Three electronic databases were systematically queried up to 1 May 2024. Centres were divided in volume tertiles. The primary outcomes were early mortality and long-term survival. Restricted cubic splines were used to demonstrate the volume-outcome relationship and the elbow-method was applied to define high-volume centres. Long-term survival was assessed using Cox frailty models. RESULTS We included 51 centres (52 consecutive cohorts) and divided them into tertiles (T1: <6 cases per year; T2: 6-15 cases per year, T3: >15 cases per year), comprising a total 11 345 patients (mean age 52.3 years). Overall early mortality was 6.0% (T1: 11.6%; T2: 7.2%; T3: 5.2%; p<0.001), for which a significant nonlinear volume-outcome relationship was observed (p=0.0437) with a statistically determined minimal required volume of 33 cases per year (95% CI 29-35 cases), and a modelled volume of 40 cases per year corresponding to a 5.0% mortality rate. Nevertheless, early mortality still progressively declined in higher volume centres (from 6.7% to 5.4% to 2.9% in centres performing 16-50, 51-100 and >100 procedures annually). In addition, a significant volume effect was observed for long-term survival (adjusted hazard ratio per tertile 0.75, 95% CI 0.63-0.89; p=0.001). CONCLUSION There is a significant association between procedural volume and early mortality in pulmonary endarterectomy. An annual procedural volume of >33-40 cases per year may be used to define a high‑volume centre, although higher volumes still lead to progressively lower mortality rates.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- These authors contributed equally
| | - Michal J Kawczynski
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- These authors contributed equally
| | - Arthur Leus
- Faculty of Medicine, KU Leuven-University of Leuven, Leuven, Belgium
| | - Laurent Godinas
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven-University of Leuven, Leuven, Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven-University of Leuven, Leuven, Belgium
| | - Vanessa van Empel
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven-University of Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
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Gonzalez-Hermosillo LM, Cueto-Robledo G, Navarro-Vergara DI, Torres-Rojas MB, García-Cesar M, Pérez-Méndez O, Escobedo G. Molecular Pathophysiology of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Update from a Basic Research Perspective. Adv Respir Med 2024; 92:485-503. [PMID: 39727495 PMCID: PMC11673787 DOI: 10.3390/arm92060044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 11/19/2024] [Accepted: 11/26/2024] [Indexed: 12/28/2024]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but severe condition characterized by persistent obstruction and vascular remodeling in the pulmonary arteries following an acute pulmonary embolism (APE). Although APE is a significant risk factor, up to 25% of CTEPH cases occur without a history of APE or deep vein thrombosis, complicating the understanding of its pathogenesis. Herein, we carried out a narrative review discussing the mechanisms involved in CTEPH development, including fibrotic thrombus formation, pulmonary vascular remodeling, and abnormal angiogenesis, leading to elevated pulmonary vascular resistance and right heart failure. We also outlined how the disease's pathophysiology reveals both proximal and distal pulmonary artery obstruction, contributing to the development of pulmonary hypertension. We depicted the risk factors predicting CTEPH, including thrombotic history, hemostatic disorders, and certain medical conditions. We finally looked at the molecular mechanisms behind the role of endothelial dysfunction, gene expression alterations, and inflammatory processes in CTEPH progression and detection. Despite these insights, there is still a need for improved diagnostic tools, biomarkers, and therapeutic strategies to enhance early detection and management of CTEPH, ultimately aiming to reduce diagnostic delay and improve patient outcomes.
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Affiliation(s)
- Leslie Marisol Gonzalez-Hermosillo
- Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico;
- Cardiorespiratory Emergency Department, Pulmonary Hypertension Clinic, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (G.C.-R.); (D.I.N.-V.); (M.B.T.-R.); (M.G.-C.)
- Doctorate Program in Biomedical Sciences, Postgraduate Unit, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergency Department, Pulmonary Hypertension Clinic, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (G.C.-R.); (D.I.N.-V.); (M.B.T.-R.); (M.G.-C.)
| | - Dulce Iliana Navarro-Vergara
- Cardiorespiratory Emergency Department, Pulmonary Hypertension Clinic, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (G.C.-R.); (D.I.N.-V.); (M.B.T.-R.); (M.G.-C.)
| | - Maria Berenice Torres-Rojas
- Cardiorespiratory Emergency Department, Pulmonary Hypertension Clinic, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (G.C.-R.); (D.I.N.-V.); (M.B.T.-R.); (M.G.-C.)
| | - Marisol García-Cesar
- Cardiorespiratory Emergency Department, Pulmonary Hypertension Clinic, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (G.C.-R.); (D.I.N.-V.); (M.B.T.-R.); (M.G.-C.)
| | - Oscar Pérez-Méndez
- Tecnológico de Monterrey, School of Engineering and Sciences, Mexico City 14380, Mexico;
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Galileo Escobedo
- Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico;
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Zhang ZJ, Wang HF, Lian TY, Zhou YP, Xu XQ, Guo F, Wei YP, Li JY, Sun K, Liu C, Pan LR, Ren M, Nie L, Dai HL, Jing ZC. Human Plasma IgG N-Glycome Profiles Reveal a Proinflammatory Phenotype in Chronic Thromboembolic Pulmonary Hypertension. Hypertension 2023; 80:1929-1939. [PMID: 37449418 DOI: 10.1161/hypertensionaha.123.21408] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The pathological mechanism of chronic thromboembolic pulmonary hypertension (CTEPH) is not fully understood, and inflammation has been reported to be one of its etiological factors. IgG regulates systemic inflammatory homeostasis, primarily through its N-glycans. Little is known about IgG N-glycosylation in CTEPH. We aimed to map the IgG N-glycome of CTEPH to provide new insights into its pathogenesis and discover novel markers and therapies. METHODS We characterized the plasma IgG N-glycome of patients with CTEPH in a discovery cohort and validated our results in an independent validation cohort using matrix-assisted laser desorption/ionization time of flight mass spectrometry. Thereafter, we correlated IgG N-glycans with clinical parameters and circulating inflammatory cytokines in patients with CTEPH. Furthermore, we determined IgG N-glycan quantitative trait loci in CTEPH to reveal partial mechanisms underlying glycan changes. RESULTS Decreased IgG galactosylation representing a proinflammatory phenotype was found in CTEPH. The distribution of IgG galactosylation showed a strong association with NT-proBNP (N-terminal pro-B-type natriuretic peptide) in CTEPH. In line with the glycomic findings, IgG pro-/anti-inflammatory N-glycans correlated well with a series of inflammatory markers and gene loci that have been reported to be involved in the regulation of these glycans or inflammatory immune responses. CONCLUSIONS This is the first study to reveal the full signature of the IgG N-glycome of a proinflammatory phenotype and the genes involved in its regulation in CTEPH. Plasma IgG galactosylation may be useful for evaluating the inflammatory state in patients with CTEPH; however, this requires further validation. This study improves our understanding of the mechanisms underlying CTEPH inflammation from the perspective of glycomics.
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Affiliation(s)
- Ze-Jian Zhang
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Medical Research Center (Z.-J.Z., T.-Y.L., K.S.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Fang Wang
- Department of Biochemistry and Molecular Biology, the School of Basic Medicine Sciences, Hebei Medical University, Shijiazhuang, China (H.-F.W., L.N.)
| | - Tian-Yu Lian
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Medical Research Center (Z.-J.Z., T.-Y.L., K.S.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Ping Zhou
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Qi Xu
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Guo
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Peng Wei
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Yi Li
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Sun
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Medical Research Center (Z.-J.Z., T.-Y.L., K.S.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Liu
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu-Rong Pan
- Global Health Drug Discovery Institute, Beijing, China (L.-R.P.)
| | - Ming Ren
- Department of Cardiology, Affiliated Hospital of Qinghai University, Xining, China (M.R.)
| | - Lei Nie
- Department of Biochemistry and Molecular Biology, the School of Basic Medicine Sciences, Hebei Medical University, Shijiazhuang, China (H.-F.W., L.N.)
| | - Hai-Long Dai
- Department of Cardiology, Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, China (H.-L.D.)
| | - Zhi-Cheng Jing
- Department of Cardiology (Z.-J.Z., T.-Y.L., Y.-P.Z., X.-Q.X., F.G., Y.-P.W., J.-Y.L., K.S., C.L., Z.-C.J.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Andersen S, Reese-Petersen AL, Braams N, Andersen MJ, Mellemkjær S, Andersen A, Bogaard HJ, Genovese F, Nielsen-Kudsk JE. Biomarkers of collagen turnover and wound healing in chronic thromboembolic pulmonary hypertension patients before and after pulmonary endarterectomy. Int J Cardiol 2023; 384:82-88. [PMID: 37178803 DOI: 10.1016/j.ijcard.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND In chronic thromboembolic pulmonary hypertension (CTEPH), fibrotic remodeling of tissue and thrombi contributes to disease progression. Removal of the thromboembolic mass by pulmonary endarterectomy (PEA) improves hemodynamics and right ventricular function, but the roles of different collagens before as well as after PEA are not well understood. METHODS In this study, hemodynamics and 15 different biomarkers of collagen turnover and wound healing were evaluated in 40 CTEPH patients at diagnosis (baseline) and 6 and 18 months after PEA. Baseline biomarker levels were compared with a historical cohort of 40 healthy subjects. RESULTS Biomarkers of collagen turnover and wound healing were increased in CTEPH patients compared with healthy controls, including a 35-fold increase in the PRO-C4 marker of type IV collagen formation and a 55-fold increase in the C3M marker of type III collagen degradation. PEA reduced pulmonary pressures to almost normal levels 6 months after the procedure, with no further improvement at 18 months. There were no changes in any of the measured biomarkers after PEA. CONCLUSIONS Biomarkers of collagen formation and degradation are increased in CTEPH suggesting a high collagen turnover. While PEA effectively reduces pulmonary pressures, collagen turnover is not significantly modified by surgical PEA.
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Affiliation(s)
- Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark.
| | | | - Natalia Braams
- Department of Pulmonology, Amsterdam University Medical Center, the Netherlands
| | | | | | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Harm Jan Bogaard
- Department of Pulmonology, Amsterdam University Medical Center, the Netherlands
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Oleksiuk-Bójko M, Lisowska A. Venous thromboembolism: Why is it still a significant health problem? Adv Med Sci 2023; 68:10-20. [PMID: 36368288 DOI: 10.1016/j.advms.2022.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/08/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) remains the third leading cause of acute cardiovascular syndrome following myocardial infarction and ischemic stroke. The global burden of disease worldwide is high and shows a steady upward trend in recent years with an incidence of 1-2 per 1000 adults per year. The overarching goal of the initial management of VTE is to prevent early and late adverse outcomes. Rapid evaluation and therapeutic intervention is vital to improving prognosis. METHODS We searched PubMed, Science Direct and Scopus databases for articles published in the last 10 years. Additionally, some earlier articles were analyzed. RESULTS For the purposes of this review, we discussed how understanding the epidemiology of VTE and the current knowledge of early and late complications of this disease have shaped the current approach to VTE prevention. We also analyzed the current knowledge and the most up-to-date information about VTE in COVID-19 infection. Contemporary perspective presented in this article on mortality in VTE, the incidence of recurrences, the risk of major bleeding during therapy and the chronic complications indicate why this is a major challenge for today's medicine and a current target for further research. CONCLUSIONS Understanding the interaction between environmental and genetic factors appears to be crucial in the diagnostic process. It can provide insight into the pathophysiology of VTE, potentially identifying options for targeted prevention and treatment. However, due to differences in clinical presentation, diagnosing pulmonary embolism may not be an easy task which perfectly illustrates the scale and complexity of the disease.
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Affiliation(s)
- Monika Oleksiuk-Bójko
- Department of Cardiology, University Clinical Hospital in Bialystok, Bialystok, Poland
| | - Anna Lisowska
- Department of Cardiology, University Clinical Hospital in Bialystok, Bialystok, Poland.
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Ruaro B, Confalonieri P, Caforio G, Baratella E, Pozzan R, Tavano S, Bozzi C, Lerda S, Geri P, Biolo M, Cortale M, Confalonieri M, Salton F. Chronic Thromboembolic Pulmonary Hypertension: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081094. [PMID: 36013561 PMCID: PMC9415110 DOI: 10.3390/medicina58081094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 01/29/2023]
Abstract
Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) has a high mortality. The treatment of CTEPH could be balloon pulmonary angioplasty (BPA), medical (MT) or pulmonary endarterectomy (PEA). This study aims to assess the clinical characteristics of CTEPH patients, surgically or medically treated, in a pulmonology referral center. Materials and Methods: A total of 124 patients with PH with suspected CTEPH (53 male subjects and 71 female subjects; mean age at diagnosis 67 ± 6) were asked to give informed consent and then were evaluated. The presence of CTEPH was ascertained by medical evaluations, radiology and laboratory tests. Results: After the evaluation of all clinical data, 65 patients met the inclusion criteria for CTEPH and they were therefore enrolled (22 males and 43 females; mean age at diagnosis was 69 ± 8). 26 CTEPH patients were treated with PEA, 32 with MT and 7 with BPA. There was a statistically significant age difference between the PEA and MT groups, at the time of diagnosis, the PEA patients were younger than the MT patients, whereas there was no statistically significant difference in other clinical characteristics (e.g., smoking habit, thrombophilia predisposition), as well as functional and hemodynamic parameters (e.g., 6-min walk test, right heart catheterization). During three years of follow-up, no patients in the PEA groups died; conversely, eleven patients in the MT group died during the same period (p < 0.05). Furthermore, a significant decrease in plasma BNP values and an increase in a meter at the six-minute walk test, 1 and 3 years after surgery, were observed in the PEA group (p < 0.05). Conclusions: This study seems to confirm that pulmonary endarterectomy (PEA) can provide an improvement in functional tests in CTEPH.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-4871
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gaetano Caforio
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- 24ore Business School, Via Monte Rosa, 91, 20149 Milan, Italy
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Marco Biolo
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maurizio Cortale
- Department of Medical, Surgical, & Health Sciences, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Chronic Thromboembolic Pulmonary Hypertension: An Update. Diagnostics (Basel) 2022; 12:diagnostics12020235. [PMID: 35204326 PMCID: PMC8871284 DOI: 10.3390/diagnostics12020235] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 12/31/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease observed in a small proportion of patients after acute pulmonary embolism (PE). CTEPH has a high morbidity and mortality rate, related to the PH severity, and a poor prognosis, which mirrors the right ventricular dysfunction involvement. Pulmonary endarterectomy (PEA) reduces pulmonary vascular resistance, making it the treatment of choice and should be offered to operable CTEPH patients, as significant symptomatic and prognostic improvement has been observed. Moreover, these patients may also benefit from the advances made in surgical techniques and pulmonary hypertension-specific medication. However, not all patients are eligible for PEA surgery, as some have either distal pulmonary vascular obstruction and/or significant comorbidities. Therefore, surgical candidates should be carefully selected by an interprofessional team in expert centers. This review aims at making an overview of the risk factors and latest developments in diagnostic tools and treatment options for CTEPH.
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