F A Klok1, C Tesche2, L Rappold2, C Dellas3, G Hasenfuß2, M V Huisman4, S Konstantinides1, M Lankeit5. 1. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany. 2. Department of Cardiology and Pulmonology, Heart Center, University of Göttingen, Germany. 3. Department of Cardiology and Pulmonology, Heart Center, University of Göttingen, Germany; Department of Paediatric Cardiology, Heart Center, University of Göttingen, Germany. 4. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 5. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany; Department of Cardiology and Pulmonology, Heart Center, University of Göttingen, Germany. Electronic address: mareike.lankeit@unimedizin-mainz.de.
Abstract
PURPOSE: International guidelines do not provide strong recommendations on the duration and intensity of follow-up after acute pulmonary embolism (PE), nor on screening-programs for chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to address this gab by performing an external validation of the easy "CTEPH rule-out-criteria" based on a normal NT-proBNP level and the absence of 3 ECG characteristics. METHODS: 134 patients underwent clinical follow-up 6months after PE. Predefined transthoracic echocardiographic (TTE) criteria were used to categorize patients as "PH unlikely" or "PH possible/likely". The latter patients underwent further (invasive) diagnostic procedures to confirm and classify the diagnosis of pulmonary hypertension. NT-proBNP and ECGs, both assessed at the day of echocardiography, were evaluated post-hoc. RESULTS: Sixty-three patients (47%) scored none of the "CTEPH rule-out criteria" positive, of whom 61 had normal TTE (97%). Twenty-five patients (19%) were categorized by TTE as "PH possible/likely"; of those, 6 were diagnosed with CTEPH. The sensitivity of rule-out criteria for CTEPH was 100% (95%CI 56-100%; 6/6 patients identified), and for "PH possible/likely" on TTE 92% (95%CI 74-99%; 23/25 patients identified): 2 asymptomatic patients with estimated systolic pulmonary arterial pressure of 36mmHg and 38mmHg, respectively, who remained stable during further 2-year follow-up, were not identified. Inter-observer agreement for the adjudication of the ECG characteristics was excellent (kappa-statistic 0.97). CONCLUSIONS: In this external validation cohort, we confirmed the diagnostic accuracy and reproducibility of the "CTEPH rule-out criteria". These results provide a solid ground for future outcome trials applying this algorithm.
PURPOSE: International guidelines do not provide strong recommendations on the duration and intensity of follow-up after acute pulmonary embolism (PE), nor on screening-programs for chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to address this gab by performing an external validation of the easy "CTEPH rule-out-criteria" based on a normal NT-proBNP level and the absence of 3 ECG characteristics. METHODS: 134 patients underwent clinical follow-up 6months after PE. Predefined transthoracic echocardiographic (TTE) criteria were used to categorize patients as "PH unlikely" or "PH possible/likely". The latter patients underwent further (invasive) diagnostic procedures to confirm and classify the diagnosis of pulmonary hypertension. NT-proBNP and ECGs, both assessed at the day of echocardiography, were evaluated post-hoc. RESULTS: Sixty-three patients (47%) scored none of the "CTEPH rule-out criteria" positive, of whom 61 had normal TTE (97%). Twenty-five patients (19%) were categorized by TTE as "PH possible/likely"; of those, 6 were diagnosed with CTEPH. The sensitivity of rule-out criteria for CTEPH was 100% (95%CI 56-100%; 6/6 patients identified), and for "PH possible/likely" on TTE 92% (95%CI 74-99%; 23/25 patients identified): 2 asymptomatic patients with estimated systolic pulmonary arterial pressure of 36mmHg and 38mmHg, respectively, who remained stable during further 2-year follow-up, were not identified. Inter-observer agreement for the adjudication of the ECG characteristics was excellent (kappa-statistic 0.97). CONCLUSIONS: In this external validation cohort, we confirmed the diagnostic accuracy and reproducibility of the "CTEPH rule-out criteria". These results provide a solid ground for future outcome trials applying this algorithm.
Authors: Nick H Kim; Marion Delcroix; Xavier Jais; Michael M Madani; Hiromi Matsubara; Eckhard Mayer; Takeshi Ogo; Victor F Tapson; Hossein-Ardeschir Ghofrani; David P Jenkins Journal: Eur Respir J Date: 2019-01-24 Impact factor: 16.671
Authors: Marieke J H A Kruip; Suzanne C Cannegieter; Hugo Ten Cate; Eric C M van Gorp; Nicole P Juffermans; Frederikus A Klok; Coen Maas; Anton Vonk-Noordegraaf Journal: Res Pract Thromb Haemost Date: 2021-03-08