CTPER-index May Be a Potential CTEPH Diagnostic Tool

Researchers have developed a computer tomography pulmonary embolism residua index (CTPER-index) that may prove to be a useful tool for diagnosis and treatment decisions regarding chronic thromboembolic pulmonary hypertension and dyspnea. The research paper, “Computed tomography pulmonary embolism residua index (CTPER-index): a simple tool for pulmonary embolism residua description,” was published in The Anatolian Journal of Cardiology.

Chronic pulmonary thromboembolic disease is a leading cause of severe pulmonary hypertension (PH), associated with a high incidence of morbidity and mortality. It is also the only cause of severe PH that is potentially curable, without the need for lung transplantation, through the pulmonary endarterectomy (PEA) procedure. This procedure removes the obstructing thromboembolic mass and often leads to a normalization of lung function. Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to arise from thrombotic pulmonary embolism (PE), where unresolved thromboembolic material leads to increased pulmonary artery pressure and, in a worst-case scenario, right ventricle failure.

Though it varies between studies, CTEPH has been shown to complicate 3.8% of acute pulmonary embolism events. Early diagnosis of this condition — often under diagnosed — is of extreme importance to avoid progression to right ventricle overload and dysfunction, and to improve prognosis and quality of life. The standard approach for diagnosing CTEPH and assessing eligibility for surgery usually involves invasive pulmonary angiography.

Here, the researchers aimed to evaluate the morphological changes involved in CTEPH development in the pulmonary artery’s vascular bed six months after diagnosis of acute PE through computer tomography pulmonary arteriography (CTA). CTA was chosen due to its noninvasive character, to both diagnosis CTEPH and estimate a patient’s suitability for pulmonary endarterectomy. The study involved 87 patients with a confirmed PE diagnosis, and the presence of thrombotic material and abnormalities were assessed through multidetector CTA, performed six months after acute PE. Furthermore, to quantify the individual totality of morphological abnormalities, the scientists constructed a computer tomography pulmonary embolism residua index (CTPER-index) to compare patients with and without CTEPH. Follow-up was at 24 months, with echocardiography performed 6, 12, and 24 months after PE. Morphological abnormalities, attributed to thrombotic residual material or pulmonary hypertension on CTA, were found in 68% of patients. Moreover, during the two-year follow-up, the CTPER-index reached significantly higher values in patients with CTEPH.

Researchers concluded that, “Our CTPER-index may provide useful information for a clinician performing CTA for differential diagnosis of dyspnea in a patient with a history of PE.”