作者
Alexandre Fauché,Emilie Presles,Olivier Sanchez,Xavier Jaïs,Raphael Le Mao,Philippe Robin,Gilles Pernod,Laurent Bertoletti,Patrick Jego,Florence Parent,Catherine A. Lemarié,Florent Leven,Pierre-Yves Le Roux,Pierre-Yves Salaun,Michel Nonent,Philippe Girard,Karine Lacut,Laurent Savale,Solen Mélac,Marie Guégan,Patrick Mismetti,Silvy Laporte,Christophe Leroyer,David Montani,Francis Couturaud,Cécile Tromeur,Francis Couturaud,Patrick Mismetti,Christophe Leroyer,Guy Meyer,Olivier Sanchez,Patrick Jego,Gilles Pernod,Elisabeth Duhamel,Karine Provost,Florence Parent,Laurent Bertoletti,Cécile Tromeur,Dominique Mottier,Marie Guégan,Solen Mélac,Aurélia Le Hir,Philippe Girard,Stéphane Lenoir,Christian Lamer,Jean François Bergmann,Denis Wahl,Ludovic Drouet,Emilie Presles,Silvy Laporte,Patrick Chevarier,Nicolas Monte,Florence Morvan,Véronique Kouassi,Nabahats Ibrir,Gaid El Asri,Pierre Yves Salaun,Philippe Robin,Pierre Yves Le Roux,Luc Bressollette,Philippe Quéhé,Simon Gestin,Michel Nonent,Jérôme Bahuon,Lucille Deloire,Benjamin Planquette,Yannick Jobic,Yves Etienne,Romain Didier,Florent Leven,Loic Leroux,Hubert Galinat,Cédric Le Maréchal,Lénaïck Gourhant,Fanny Mingant,Karine Lacut,Emmanuelle Lemoigne,Luc De Saint Martin,Aurélien Delluc,Grégoire Le Gal,Nicolas Paleiron,Raphaël Le Mao,Christophe Pison,Philippe Guéret,Hervé Décousus,Sandrine Accassat
摘要
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication of a pulmonary embolism (PE) whose incidence and predictors are not precisely determined. Objective To determine the frequency and predictors for CTEPH after a first unprovoked PE. Patients/Methods In a randomized trial comparing an additional 18-month warfarin versus placebo in patients after a first unprovoked PE initially treated with vitamin K antagonist for 6 months, we applied recommended CTEPH screening strategies through an 8-year follow-up to determine cumulative incidence of CTEPH. CTEPH predictors were estimated using Cox models. Pulmonary vascular obstruction (PVO) and systolic pulmonary arterial pressure (sPAP) at PE diagnosis and 6 months were studied by receiver operating curves analysis. All CTEPH cases and whether they were incident or prevalent were adjudicated. Results During a median follow-up of 8.7 years, nine CTEPH cases were diagnosed among 371 patients, with a cumulative incidence of 2.8% (95% confidence interval [CI] 0.95–4.64), and of 1.31% (95% CI 0.01–2.60) after exclusion of five cases adjudicated as prevalent. At PE diagnosis, PVO > 45% and sPAP > 56 mmHg were associated with CTEPH with a hazard ratio (HR) of 33.00 (95% CI 1.64–667.00, p = .02) and 12.50 (95% CI 2.10–74.80, p < .01), respectively. Age > 65 years, lupus anticoagulant antibodies and non-O blood groups were also predictive of CTEPH. PVO > 14% and sPAP > 34 mmHg at 6 months were associated with CTEPH (HR 63.90 [95% CI 3.11–1310.00, p < .01]and HR 17.2 [95% CI 2.75–108, p < .01]). Conclusion After a first unprovoked PE, CTEPH cumulative incidence was 2.8% during an 8-year follow-up. PVO and sPAP at PE diagnosis and at 6 months were the main predictors for CTEPH diagnosis.