Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an\nacute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed\ntreatment has important implications for favourable clinical outcome. Performing a follow-up examination of\npatients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures\nwould be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic\npatients may be a practical approach for detecting relevant CTEPH.\nThis study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of\nsymptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the\nrole of cardiopulmonary exercise testing (CPET) as a diagnostic tool.\nMethods: In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females\nwithin 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via\ntelephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130\npatients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET\nand complete work-up for CTEPH.\nResults: 37.7%, 25.5% and 29.3% of the patients reported symptoms after three, six, and twelve months respectively.\nSubsequent clinical evaluation of these symptomatic patients saw 20.4%, 11.5% and 18.8% of patients at the respective\nthree, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH).\nCTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ? 25 mm Hg at rest was\nconfirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced\nincrease of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary\nhypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion\ndefects without echocardiographic signs of PH but a suspicious CPET.\nConclusion: A follow-up program based on telephone monitoring of symptoms and further structured evaluation\nof symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.
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