External validation of a simple non-invasive algorithm to rule out chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

2015 | journal article; research paper. A publication with affiliation to the University of Göttingen.

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​External validation of a simple non-invasive algorithm to rule out chronic thromboembolic pulmonary hypertension after acute pulmonary embolism​
Klok, F. A.; Tesche, C.; Rappold, L.; Dellas, C. ; Hasenfuß, G. ; Huisman, M. V. & Konstantinides, S. et al.​ (2015) 
Thrombosis Research135(5) pp. 796​-801​.​ DOI: https://doi.org/10.1016/j.thromres.2014.12.009 

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Authors
Klok, F. A.; Tesche, C.; Rappold, L.; Dellas, Claudia ; Hasenfuß, Gerd ; Huisman, M. V.; Konstantinides, Stavros; Lankeit, Mareike 
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 6 months 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 36 mmHg and 38 mmHg, 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. (C) 2014 Published by Elsevier Ltd.
Issue Date
2015
Publisher
Pergamon-elsevier Science Ltd
Journal
Thrombosis Research 
ISSN
0049-3848

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