Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature
Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature
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DOI：
10.1183/13993003.01792-2016
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发表时间：
2017-02-01
影响因子：
24.3
通讯作者：
Klok, Frederikus A.
中科院分区：
文献类型：
--
作者：
Ende-Verhaar, Yvonne M.;Cannegieter, Suzanne C.;Klok, Frederikus A.
肺栓塞（PE）后慢性血栓栓塞性肺动脉高压（CTEPH）的发生率与管理决策相关，但目前尚不清楚。我们对包括连续PE患者的CTEPH研究进行了荟萃分析。研究队列预先定义为“所有参与者”、“幸存者”或“无重大合并症的幸存者”。采用随机效应模型计算CTEPH发生率，我们选择了16项研究，共计4047例PE患者，大多数随访时间>2年。在1186例所有来院者（2项研究）中，合并CTEPH发生率为0.56%（95% CI 0.1-1.0）。在999例存活者（4项研究）中，CTEPH发生率为3.2%（95% CI 2.0-4.4）。在1775例无重大合并症的幸存者中（9项研究），CTEPH发生率为2.8%（95% CI 1.5-4.1）。复发性静脉血栓栓塞和无诱因PE均与CTEPH的较高风险显著相关，比值比分别为3.2（95% CI 1.7-5.9）和4.1（95% CI 2.1-8.2）。未使用右心导管作为诊断标准的12项研究中的合并CTEPH发生率为6.3%（95%CI 4.1-8.4），全来者组的0.56%发生率可能最好地反映了人群水平上PE后CTEPH的发生率。幸存者类别中类似于3%的发生率可能与日常临床实践更相关。通过右心导管以外的检查评估CTEPH诊断的研究高估了CTEPH的发生率。
The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown.We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as "all comers", "survivors" or "survivors without major comorbidities". CTEPH incidences were calculated using random effects model.We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1-1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0-4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5-4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7-5.9) and 4.1 (95% CI 2.1-8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1-8.4).The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The similar to 3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.