J Catella-Chatron1, A Merah2, E De Magalhaes2, N Moulin1, S Accassat2, C Duvillard1, P Mismetti3, L Bertoletti4. 1. Service de médecine vasculaire et thérapeutique, faculté de médecine de Saint-Etienne, hôpital universitaire de Saint-Etienne, 42055 Saint-Etienne, France. 2. Service de médecine vasculaire et thérapeutique, faculté de médecine de Saint-Etienne, hôpital universitaire de Saint-Etienne, 42055 Saint-Etienne, France; Inserm, CIC1408, 42055 Saint-Etienne, France. 3. Service de médecine vasculaire et thérapeutique, faculté de médecine de Saint-Etienne, hôpital universitaire de Saint-Etienne, 42055 Saint-Etienne, France; Inserm, CIC1408, 42055 Saint-Etienne, France; Inserm, Sainbiose U1059, 42055 Saint-Etienne, France. 4. Service de médecine vasculaire et thérapeutique, faculté de médecine de Saint-Etienne, hôpital universitaire de Saint-Etienne, 42055 Saint-Etienne, France; Inserm, CIC1408, 42055 Saint-Etienne, France; Inserm, Sainbiose U1059, 42055 Saint-Etienne, France. Electronic address: laurent.bertoletti@gmail.com.
Abstract
INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe condition which should be screened in patient with persistent dyspnea after pulmonary embolism (PE). After PE, CTEPH incidence was estimated between 0.1 and 9.1% in overall patients. Although cancer is associated with an increased risk of CTEPH, CTEPH incidence is still unknown in cancer patients with PE. We aimed to estimate the frequency CTEPH-likely patients after PE, in cancer patients. MATERIALS: We individualized cancer patients of a monocentric prospective registry including consecutive patients with symptomatic PE. The primary outcome was the frequency of "CTEPH-likely" patients defined by the European Respiratory Society (ERS) guidelines (an accelerated tricuspid regurgitation more than 2.8m/s and at least 1-2 segmental or larger-sized defects, after more than 3 months of therapeutic anticoagulation). RESULTS: We included 129 cancer patients with PE. Colorectal cancer (19%), breast cancer (17%) and prostate cancer (15%) were the most frequent cancers. PE occurred after surgery or medical immobilization in 17% of patients, while 26% of patients had history of venous thromboembolism. During the follow-up, 2 patients (1.5%) had a clinical suspicion of CTEPH and only 1 patient with ovarian cancer (0.75% 95%CI [0.0%-2.2%]) was classified as "CTEPH-likely", 6 months after PE. CONCLUSION: The frequency of screening for CTEPH seems negligible in PE patients with cancer. Concomitant cancer may affect the clinical suspicion of CTEPH.
INTRODUCTION:Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe condition which should be screened in patient with persistent dyspnea after pulmonary embolism (PE). After PE, CTEPH incidence was estimated between 0.1 and 9.1% in overall patients. Although cancer is associated with an increased risk of CTEPH, CTEPH incidence is still unknown in cancerpatients with PE. We aimed to estimate the frequency CTEPH-likely patients after PE, in cancerpatients. MATERIALS: We individualized cancerpatients of a monocentric prospective registry including consecutive patients with symptomatic PE. The primary outcome was the frequency of "CTEPH-likely" patients defined by the European Respiratory Society (ERS) guidelines (an accelerated tricuspid regurgitation more than 2.8m/s and at least 1-2 segmental or larger-sized defects, after more than 3 months of therapeutic anticoagulation). RESULTS: We included 129 cancerpatients with PE. Colorectal cancer (19%), breast cancer (17%) and prostate cancer (15%) were the most frequent cancers. PE occurred after surgery or medical immobilization in 17% of patients, while 26% of patients had history of venous thromboembolism. During the follow-up, 2 patients (1.5%) had a clinical suspicion of CTEPH and only 1 patient with ovarian cancer (0.75% 95%CI [0.0%-2.2%]) was classified as "CTEPH-likely", 6 months after PE. CONCLUSION: The frequency of screening for CTEPH seems negligible in PE patients with cancer. Concomitant cancer may affect the clinical suspicion of CTEPH.