Is Echocardiography Missing Mild CTEPH Cases That May Benefit From Endarterectomy?

Pulmonary endarterectomy is an effective treatment for patients with chronic thromboembolic pulmonary hypertension.

Pulmonary endarterectomy (PEA) is an effective and durable treatment strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH), according to findings from a retrospective review published in the Annals of Thoracic Surgery.1

Researchers analyzed 3 groups of patients with abnormal ventilation-perfusion (VQ) scans: typical CTEPH (n=188), transthoracic echocardiogram (TTE)-neg CTEPH (n=15), and chronic thromboembolic disease (CTED; n=22). A total of 179 patients underwent PEA.

Mean pulmonary arterial pressures significantly improved immediately after PEA in the typical CTEPH  (47±11 mm Hg vs 25±11 mm Hg, P <.0001), TTE-neg CTEPH (36±8 mm Hg vs 23±4 mm Hg, P <.0001), and CTED (21±3 mm Hg vs 17±5 mm Hg, P =.02) patient groups.

There was also a significant improvement in the mean New York Heart Association functional class in the typical CTEPH (3.1±0.5 to 1.4±0.6, P <.0001), TTE-neg CTEPH (2.5±0.5 to 1.5±0.5, P <.0001), and CTED (2.4±0.5 to 1.4±0.5, P <.0001) groups. In addition, right ventricular systolic pressure also improved following PEA in all 3 groups. The 90-day mortality rate was 4% in patients in the typical CTEPH group and 0% in the CTED patient group.

Despite the traditional use of TTE to screen for CTEPH, the investigators note that their findings demonstrate that “caution should be used in ruling out patients who are symptomatic with mismatched perfusion defects on VQ scan from TTE alone.”

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Donahoe L, Vanderlaan R, Thenganatt J, et al. Symptoms are more useful than echocardiography in patient selection for pulmonary endarterectomy [published online August 16, 2017]. Ann Thorac Surg. doi:10.1016/j.athoracsur.2017.05.024