PV reports grants from Bayer, grants from Boehringer, grants from BMS, grants from Daiichi-Sankyo, grants from Pfizer, grants from Leo-Pharma, grants from Sanofi, grants from Anthos Therapeutics, outside the submitted work. SM reports grants and personal fees from Daiichi Sankyo, grants and personal fees from Bayer, personal fees from BMS-Pfizer, personal fees from Boehringer-Ingelheim, personal fees from Portola, personal fees from AbbVie, outside the submitted work. MH reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo, grants from Leo Pharma, outside the submitted work. Published by BMJ.Ĭompeting interests: GJAMB was supported by the Dutch Heart Foundation (2017T064). CTEPH was identified early after acute PE, resulting in a substantially shorter diagnostic delay than in current practice. The InShape II algorithm accurately excluded CTEPH, without the need for echocardiography in the overall majority of patients. Overall CTEPH incidence was 3.1% (13/424), of whom 10 patients were diagnosed within 4 months after the PE presentation. During 2-year follow-up, one patient in whom echocardiography was deemed unnecessary by the algorithm was diagnosed with CTEPH, reflecting an algorithm failure rate of 0.29% (95% CI 0% to 1.6%). Based on the algorithm, CTEPH was considered absent in 343 (81%) patients, leaving 81 patients (19%) referred for echocardiography. Only if these results could not rule out possible PH, the patients were referred for echocardiography.Ĥ24 patients were included. If the 'CTEPH prediction score' indicated high pretest probability or matching symptoms were present, the 'CTEPH rule-out criteria' were applied, consisting of ECG reading and N-terminalpro-brain natriuretic peptide. In this prospective, international, multicentre management study, consecutive patients were managed according to a screening algorithm starting 3 months after acute PE to determine whether echocardiographic evaluation of pulmonary hypertension (PH) was indicated.
We aimed to validate a simple screening strategy for excluding CTEPH early after acute PE, limiting the number of performed echocardiograms. Echocardiographic screening among all PE survivors is associated with overdiagnosis and cost-ineffectiveness. Validated screening strategies for early CTEPH diagnosis are lacking.
7 Department of Pulmonology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands.6 Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands.5 Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland.4 Department of Pneumology, KU Leuven University Hospitals Leuven, Leuven, Belgium.3 Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands.2 Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.1 Department of Thrombosis and Hemostasis, Leiden Universitair Medisch Centrum, Leiden, The Netherlands.