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INFORM: CTEPH underdiagnosed in patients with PE
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As many as 4% of patients with pulmonary embolism may develop chronic thromboembolic pulmonary hypertension, but imaging studies in patients with pulmonary embolism and a symptom of pulmonary hypertension are underutilized, according to new research published in the American Journal of Medicine.
“Between 300,000 and 600,000 Americans experience [PE] every year, and our study shows that up to 4% of these patients may later go on to develop CTEPH,” Victor F. Tapson, MD, director of the Venous Thromboembolism and Pulmonary Vascular Disease Research Program at Cedars-Sinai Medical Center, said in a press release. “Furthermore, the results demonstrate that the risk of developing CTEPH after [PE] remains substantially underrecognized.”
Tapson and colleagues conducted the INFORM study to determine the prevalence of pulmonary hypertension after onset of PE. The retrospective claims database analysis included 7,068 patients with incident PE diagnosed between July 2010 and September 2011; the researchers analyzed data for each patient 1 year before and 2 years after the PE event.
Outcomes of interest were diagnoses and symptoms related to pulmonary hypertension, claims indicating other heart or lung diseases and diagnostic imaging tests performed.
In this cohort, 87% had at least one claim for a symptom related to pulmonary hypertension (82% in the first year, 53% in the second year) and 7.6% had a claim for pulmonary hypertension during follow-up.
However, only 55% of the overall cohort had claims for at least one diagnostic imaging procedure within 2 years after the PE event, according to the researchers. They wrote that 47% received an echocardiogram, 20% received CT angiography, 6% received a ventilation-perfusion scan and less than 1% received right heart catheterization or pulmonary angiography.
Among those with at least one claim for a symptom related to pulmonary hypertension, 61% underwent diagnostic imaging within 2 years (echocardiogram, 52%; CT angiography, 23%; ventilation-perfusion scan, 7%; right heart catheterization, 1%; pulmonary angiography, 0.3%), according to the researchers.
Because 7.6% of the overall cohort had pulmonary hypertension and 50% of those diagnosed with pulmonary hypertension also had left heart disease, the researchers estimated the incidence of CTEPH as 3.8%.
Mean time from diagnosis of PE to first screening test was 131 days, Tapson and colleagues wrote.
“This study suggests that physician education regarding the risk of pulmonary hypertension and [CTEPH] after pulmonary embolism may need to be improved,” they concluded. – by Erik Swain
Disclosure: The study was funded by Bayer. Tapson reports financial ties with Actelion, Bayer, BiO2, EKOS, Gilead Sciences, Inari, Janssen Pharmaceuticals and United Therapeutics. Another researcher reports consulting for Actelion, Bayer and United Therapeutics.
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