open access

Vol 69, No 5 (2011)
Original articles
Published online: 2011-05-18
Submitted: 2012-12-28
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Clinical course of unoperated mild chronic thromboembolic pulmonary hypertension

Renata Romaszkiewicz, Jerzy Lewczuk, Piotr Piszko, Lucyna Lenartowska, Jacek Jagas, Andrzej Konieczny, Marta Cisowska
Kardiol Pol 2011;69(5):438-443.

open access

Vol 69, No 5 (2011)
Original articles
Published online: 2011-05-18
Submitted: 2012-12-28

Abstract


Background: Pulmonary endarterectomy is the treatment of choice for a majority of patients with chronic thromboembolic pulmonary hypertension (CTEPH), however, haemodynamic criteria for the surgery have not been established. It is still unknown whether patients with mild CTEPH should be operated on and what is the clinical course of unoperated, anticoagulated mild CTEPH.
Aim: To determine the clinical course in chronically anticoagulated, unoperated patients with mild CTEPH.
Methods: A single-centre, non-randomised, follow-up study involved 10 anticoagulated, unoperated patients (3 males and 7 females aged 46 to 77 years) with mild CTEPH (mean pulmonary artery pressure [MPAP] £ 30 mm Hg and pulmonary vascular resistance £ 300 dynes ¥ s ¥ cm–5, ≥ 2 METs achieved during symptom limited treadmill exercise test) selected from 73 consecutive patients with CTEPH. The 3-year follow up included yearly echocardiographic evaluation of pulmonary artery systolic pressure (PASP), right ventricular end-diastolic diameter (RVEDD) and acceleration time (AcT) as well as NYHA functional class and symptom-limited treadmill exercise test.
Results: All the patients survived the 3-year follow-up. The PASP, RVEDD and AcT (mean ± SD) at baseline and at the end of follow-up were 43.9 ± 6.1 mm Hg and 25.6 ± 8.0 mm Hg, p = 0.0017, 25.4 ± 4.9 mm and 17.8 ± 3.82 mm, p = 0.00006, 68.3 ± 10.0 ms and 104.4 ± 16.48 ms, p = 0.0004, respectively. The NYHA functional class improved from 2.1 ± 0.32 to 1.3 ± 0.48, p = 0.002 and was accompanied by the trend to improve results of exercise test.
Conclusions: The results of the study suggest that patients with mild CTEPH can be treated successfully by anticoagulation alone with excellent 3-year survival rate, improved functional status and with gradual decrease of pulmonary pressure and right ventricular overload.
Kardiol Pol 2011; 69, 5: 438–443

Abstract


Background: Pulmonary endarterectomy is the treatment of choice for a majority of patients with chronic thromboembolic pulmonary hypertension (CTEPH), however, haemodynamic criteria for the surgery have not been established. It is still unknown whether patients with mild CTEPH should be operated on and what is the clinical course of unoperated, anticoagulated mild CTEPH.
Aim: To determine the clinical course in chronically anticoagulated, unoperated patients with mild CTEPH.
Methods: A single-centre, non-randomised, follow-up study involved 10 anticoagulated, unoperated patients (3 males and 7 females aged 46 to 77 years) with mild CTEPH (mean pulmonary artery pressure [MPAP] £ 30 mm Hg and pulmonary vascular resistance £ 300 dynes ¥ s ¥ cm–5, ≥ 2 METs achieved during symptom limited treadmill exercise test) selected from 73 consecutive patients with CTEPH. The 3-year follow up included yearly echocardiographic evaluation of pulmonary artery systolic pressure (PASP), right ventricular end-diastolic diameter (RVEDD) and acceleration time (AcT) as well as NYHA functional class and symptom-limited treadmill exercise test.
Results: All the patients survived the 3-year follow-up. The PASP, RVEDD and AcT (mean ± SD) at baseline and at the end of follow-up were 43.9 ± 6.1 mm Hg and 25.6 ± 8.0 mm Hg, p = 0.0017, 25.4 ± 4.9 mm and 17.8 ± 3.82 mm, p = 0.00006, 68.3 ± 10.0 ms and 104.4 ± 16.48 ms, p = 0.0004, respectively. The NYHA functional class improved from 2.1 ± 0.32 to 1.3 ± 0.48, p = 0.002 and was accompanied by the trend to improve results of exercise test.
Conclusions: The results of the study suggest that patients with mild CTEPH can be treated successfully by anticoagulation alone with excellent 3-year survival rate, improved functional status and with gradual decrease of pulmonary pressure and right ventricular overload.
Kardiol Pol 2011; 69, 5: 438–443
Get Citation

Keywords

chronic thromboembolic pulmonary hypertension; anticoagulation; pulmonary endarterectomy

About this article
Title

Clinical course of unoperated mild chronic thromboembolic pulmonary hypertension

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 69, No 5 (2011)

Pages

438-443

Published online

2011-05-18

Bibliographic record

Kardiol Pol 2011;69(5):438-443.

Keywords

chronic thromboembolic pulmonary hypertension
anticoagulation
pulmonary endarterectomy

Authors

Renata Romaszkiewicz
Jerzy Lewczuk
Piotr Piszko
Lucyna Lenartowska
Jacek Jagas
Andrzej Konieczny
Marta Cisowska

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