Simple test confirms chronic thromboembolic pulmonary hypertension
MedWire News: Researchers have constructed an algorithm that simply and accurately rules out chronic thromboembolic pulmonary hypertension (CTEPH), without the need for invasive testing, in acute pulmonary embolism patients.
CTEPH affects up to 3.8% of patients who have suffered acute pulmonary embolism and is associated with poor prognosis unless an early diagnosis is made and pulmonary endarterectomy quickly performed.
"There is great need for more simple, easily available, less invasive and less expensive tests to safely rule out CTEPH," write Frederikus Klok (Leiden University, The Netherlands) and co-workers in the journal Thrombosis Research.
In this study, Klok and colleagues examined whether CTEPH could be confidently ruled out as a diagnosis based only on the results of conventional 12-lead echocardiography and the measurement of biomarkers.
They enrolled 82 consecutive patients with confirmed CTEPH and 160 consecutive patients with a history of pulmonary embolism who had symptoms suggesting CTEPH but who had had that diagnosis definitively ruled out.
The authors report that electrocardiography detected right ventricular hypertrophy more frequently in patients with confirmed CTEPH (77%) than in those without (11%).
Furthermore, levels of multiple biomarkers, including clotting factor FVIII, NT-pro-BNP, GDF-15, CRP, and urate, but not D-dimer levels, were higher in patients with CTEPH than in those without.
After entering the most predictive of these biomarkers into a diagnostic algorithm, the authors showed that the combination of conventional electrocardiography and NT-pro-BNP levels diagnosed CTEPH with a sensitivity of 94% and a specificity of 65%.
"Our results demonstrate that a simple diagnostic model based on electrocardiogram evaluation and NT-pro-BNP measurements can rule out CTEPH with a high level of confidence in patients with a documented history of acute pulmonary embolism and clinically suspected CTEPH," said the researchers
"Additional more expensive and invasive testing in these patients to rule out CTEPH seems therefore not necessary."
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By Philip Ford