Usefulness of a refined computed tomography imaging method to assess the prevalence of residual pulmonary thrombi in patients 1 year after acute pulmonary embolism: The Nagoya PE study. (23rd January 2022)

• Record Type: Journal Article
• Authors: Nakano, Yoshihisa; Adachi, Shiro; Nishiyama, Itsumure; Yasuda, Kenichiro; Imai, Ryo; Yoshida, Masahiro; Iwano, Shingo; Kondo, Takahisa; Murohara, Toyoaki
• Other Names: Ando M. investigator.; Izawa H. investigator.; Okumura N. investigator.; Watanabe E. investigator.; Tsutsumi Y. investigator.; Shinoda M. investigator.; Tatami Y. investigator.; Oguri M. investigator.; Tomita Y. investigator.; Yamamoto T. investigator.; Ishiki R. investigator.; Kobayashi K. investigator.; Kawaguchi K. investigator.; Suzuki S. investigator.; Shimizu K. investigator.; Oshima S. investigator.; Kamiya H. investigator.; Kada K. investigator.; Sakai S. investigator.; Akaboshi M. investigator.; Ohno O. investigator.; Kimura A. investigator.; Mitani Y. investigator.; Watarai M. investigator.; Kobayashi S. investigator.; Tsuboi H. investigator.; Tanaka T. investigator.; Miura M. investigator.; Mokuno S. investigator.; Kondo T. investigator.; Yumiko Y. investigator.; Muto M. investigator.; Takada Y. investigator.; Ajioka M. investigator.; Shimizu A. investigator.; Kaneshiro M. investigator.; Ohno J. investigator.; Makino M. investigator.; Matsui H. investigator.; Shumiya T. investigator.; Harada S. investigator.; Hayashi K. investigator.; Awaji Y. investigator.; Somura F. investigator.; Yoshida Y. investigator.; Matsubara K. investigator.; Nishimura H. investigator.; Tanaka T. investigator.; Morikawa S. investigator.;
• Is Part Of: Journal of thrombosis and haemostasis. Volume 20:Number 4(2022)
• Page Start: 888
• Page End: 898
• Publication Date: 2022-01-23
• Subjects: chronic thromboembolic pulmonary hypertension -- computed tomography obstruction index -- post‐pulmonary embolism syndrome -- pulmonary embolism -- residual pulmonary thrombus; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.15636
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract: Background: Post‐pulmonary embolism (PE) syndrome is an important clinical condition that can affect the long‐term prognosis after acute PE. Objective: We aimed to evaluate the prevalence of residual pulmonary thrombi and the thrombotic burden 1 year after acute PE, by using our refined computed tomography (CT) imaging method. Patients/Methods: In this prospective study, patients diagnosed with acute PE were recruited and examinations were conducted at 1 month, 6 months, and 1 year. Especially at 1 year, patients were evaluated multifacetedly, including by laboratory tests, quality‐of‐life, 6‐min walking test, and enhanced CT. Results: Fifty‐two patients were enrolled. Two patients (3.8%) developed chronic thromboembolic pulmonary hypertension. A total of 43 patients completed evaluation at 1 year, among whom (74%) had residual thrombi, with a median modified CT obstruction index (mCTOI) of 10.7%. In multivariate analysis, residual thrombi at 1 month was the only factor significantly related to residual thrombi at 1 year (odds ratio, 103.4; 95% confidence interval, 4.2–2542.1). The tricuspid regurgitation pressure gradient ≥60 mmHg and left ventricular end‐diastolic dimension at diagnosis were significantly related to mCTOI at 1 year ( β = 0.367, P = .003; and β = –0.435, P = .001, respectively). Conclusions: Using our improved CT imaging protocol, we found a high prevalence of residual thrombi 1 year after acute PE. Furthermore, right ventricular overload was related to the thrombotic burden. The long‐term treatment strategy of acute PE could be modified to include precise CT imaging.