Abstract
Aim: To summarize the incidence of right heart catheter diagnosed chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) in a meta-analysis.Methods: Cohort studies reporting the incidence of CTEPH after acute PE were identified via search of Medline, Embase, China National Knowledge Infrastructure and WanFang databases.Results: Twenty-two cohort studies with 5,834 acute PE patients were included. Pooled results showed that the overall incidence of CTEPH was 2.82% (95% CI: 2.11–3.53%). Subgroup analyses showed higher incidence of CTEPH in Asians than Europeans (5.08 vs. 1.96%, p = 0.01), in retrospective cohorts than prospective cohorts (4.75 vs. 2.47%, p = 0.02), and in studies with smaller sample size than those with larger sample size (4.57 vs. 1.71%, p < 0.001). Stratified analyses showed previous venous thromboembolic events and unprovoked PE were both significantly associated with increased risk of CTEPH (OR = 2.57 and 2.71, respectively; both p < 0.01).Conclusions: The incidence of CTEPH after acute PE is ~3% and the incidence is higher in Asians than Europeans. Efforts should be made for the early diagnosis and treatment of CTEPH in PE patients, particularly for high-risk population.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) characterized by the fibrotic transformation of a pulmonary arterial thrombus, fixed obstruction of pulmonary arteries, and high pulmonary vascular resistance (1)
It remains undetermined whether routine screening for CTEPH in patients with pulmonary embolism (PE) is of rationale and the incidence of CTEPH in patients after acute PE remains varying according to the previous studies (7, 8)
We systematically searched PubMed, Embase, China National Knowledge Infrastructure, and WanFang databases with the terms of (1) “chronic thromboembolic pulmonary hypertension” odds ratio (OR) “CTEPH,” (2) “pulmonary embolism” OR “PE”; and (3) “incidence” OR “risk” OR “occurrence” OR “occur” OR “mortality” OR “prognosis” OR “predict” OR “predictor” OR “prevalence” OR “epidemiology” OR “follow” OR “followed” OR “follow-up” OR “cohort.” The search was limited to human studies published in English or Chinese
Summary
Twenty-two cohort studies with 5,834 acute PE patients were included. Pooled results showed that the overall incidence of CTEPH was 2.82% (95% CI: 2.11–3.53%). Subgroup analyses showed higher incidence of CTEPH in Asians than Europeans (5.08 vs 1.96%, p = 0.01), in retrospective cohorts than prospective cohorts (4.75 vs 2.47%, p = 0.02), and in studies with smaller sample size than those with larger sample size (4.57 vs 1.71%, p < 0.001). Stratified analyses showed previous venous thromboembolic events and unprovoked PE were both significantly associated with increased risk of CTEPH (OR = 2.57 and 2.71, respectively; both p < 0.01)
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