Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE).

Eftychia Demerouti,Stylianos E Orfanos,Athanassios Manginas,Iraklis Tsangaris,Alexandra Arvanitaki,Ioanna Mitrouska,Haralambos Karvounis,Anastasia Anthi,George Karatasakis,Katerina K Naka,Panagiotis Karyofyllis,George Athanassopoulos,Adina Thomaidis,Frantzeska Frantzeskaki,Christos Feloukidis,Styliani Brili,Evangelia Panagiotidou,Dimitrios Tsiapras,Dimitrios Konstantonis,Georgia Pitsiou,George Anastasiadis,George Giannakoulas,Vagia Stamatopoulou,Ioannis Stanopoulos,Maria Boutsikou,Sophia-Anastasia Mouratoglou ,Vasilios Voudris ,Antonios Pitsis ,A Avgeropoulou

doi:10.3390/jcm10194547

Abstract

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if left untreated, characterized by pulmonary vascular bed obstruction due to unresolving thromboembolic material. The Hellenic pulmonary hypertension registry (HOPE) was launched in Greece in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. In total, 98 patients with CTEPH were enrolled from January 2015 until November 2019. Of these patients, 55.1% represented incident population, 50% were classified in the World Health Organization functional class II and 49% had a history of acute pulmonary embolism. The median values of pulmonary vascular resistance (PVR) and cardiac index were 7.4 (4.8) WU and 2.4 (1.0) L/min/m2, respectively, the mean diffusing capacity for carbon monoxide was 74.8 ± 20.6%, the median 6-minute walk distance was 347 (220) meters and the median value of N Terminal-pro brain natriuretic peptide was 506.0 (1450.0) pg/mL. In total, 60.2% of the patients were under pulmonary arterial hypertension-targeted therapy at the time of enrolment; specifically, riociguat was received by 35.7% of the patients and combination therapy was the preferred strategy for 16% of the patients. In total, 74 patients were evaluated for pulmonary endarterectomy (PEA), 34 (45.9%) were assessed as operable but only 23 of those (31.1%) finally underwent PEA. The remaining 40 patients were ineligible for PEA according to the operability assessment and 13 (17.6%) of them underwent balloon pulmonary angioplasty. The age of the non-operable patients was significantly higher than the operable patients (p < 0.001), while there was no significant difference with regard to the history of coagulopathies between the operable and non-operable patients (p = 0.33).

Highlights

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined by increased pulmonary vascular resistance (PVR) due to unresolved thromboembolic material in the pulmonary vascular bed, leading to right ventricular failure and death [1]
Between January 2015 and November 2019, 98 patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH) were enrolled from 10 Greek PH centers
We found distinct regional differences in management decisions concerning the treatment modalities of pulmonary endarterectomy (PEA)

Summary

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined by increased pulmonary vascular resistance (PVR) due to unresolved thromboembolic material in the pulmonary vascular bed, leading to right ventricular failure and death [1]. According to the pulmonary hypertension (PH) Guidelines [2], CTEPH is a precapillary PH according to the hemodynamic definition, as the mean pulmonary arterial pressure (mPAP) is more than 25 mmHg and the pulmonary arterial wedge pressure (PAWP) lower than 15 mmHg. A Task Force from the sixth World Symposium on PH recently proposed [3] a new definition of pre-capillary PH, with mPAP > 20 mmHg, PAWP < 15 mmHg and pulmonary vascular resistance (PVR) > 3 Wood Units. The patients are enrolled in the Hellenic Pulmonary Hypertension Registry (HOPE)

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Discussion

Conclusion