Open AccessAn expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for chronic thromboembolic pulmonary hypertension patients after acute pulmonary embolism: Update
Author(s) -
Michał Ciurzyński,
Marcin Kurzyna,
Grzegorz Kopeć,
Piotr Błaszczak,
Łukasz Chrzanowski,
Karol Kamiński,
Katarzyna Mizia−Stec,
Tatiana MularekKubzdela,
Andrzej Biederman,
Dariusz Zieliński,
Piotr Pruszczyk,
Adam Torbicki,
Ewa Mroczek
Publication year - 2022
Publication title -
kardiologia polska
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.527
H-Index - 34
eISSN - 1897-4279
pISSN - 0022-9032
DOI - 10.33963/kp.a2022.0141
Subject(s) - medicine , pulmonary embolism , chronic thromboembolic pulmonary hypertension , pulmonary hypertension , expert opinion , cardiology , intensive care medicine
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism (APE). Both pharmacological and invasive treatments for CTEPH are available in Poland, and awareness of the disease among physicians is growing. It has been suggested that the COVID-19 pandemic may increase the incidence of CTEPH and facilitate disease detection during more advanced stages of the illness. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation, in cooperation with independent experts in this field, launched the updated statement on the algorithm to guide a CTEPH diagnosis in patients with previous APE. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months of effective anticoagulation, particularly when specific risk factors are present. Echocardiography is the main screening tool for CTEPH. A diagnostic workup of patients with significant clinical suspicion of CTEPH and right ventricular overload evident on echocardiography should be performed in reference centers. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Computed tomography pulmonary angiography with precise detection of thromboembolic residues in the pulmonary circulation is important for the planning of a pulmonary thromboendarterectomy. Right heart catheterization definitively confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for the identification of lesions suitable for thromboendarterectomy or balloon pulmonary angioplasty. In this document, we propose a diagnostic algorithm for patients with suspected CTEPH. With an individualized and sequential diagnostic strategy, each patient can be provided with suitable and tailored therapy provided by a dedicated CTEPH Heart Team.