Journal
THROMBOSIS RESEARCH
Volume 135, Issue 5, Pages 796-801Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.thromres.2014.12.009
Keywords
Pulmonary embolism; Pulmonary hypertension; NT-proBNP; ECG; Screening; Echocardiography
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Funding
- Federal Ministry of Education and Research (BMBF) [01EO1003]
- Niels Stensen fellowship
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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.
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