Early experience with chronic thromboembolic pulmonary hypertension in patients undergoing structured follow-up after Pulmonary Embolism Response Team evaluation

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of acute pulmonary embolism (PE) with an unknown incidence but estimated 10% mortality rate. While CTEPH is treatable, no consensus exists on structured surveillance after acute PE. Methods: We established a dedicated clinic within our pulmonary hypertension program to monitor patients evaluated by our PE response team. Patients were assessed 4 to 8 weeks and 3 months after acute PE and were offered right heart catheterization if imaging suggested CTEPH or persistent thromboemboli. We then conducted a retrospective review of outcomes. Results: Between July 2021 and December 2022, 80 of 185 (43%) patients evaluated by the PE response team completed both the baseline and 3-month follow-up assessments. Of these, 19 (24%) showed evidence of persistent thromboemboli on follow-up imaging. In 15 patients who completed right heart catheterization, CTEPH was confirmed in eight. Six of these patients with CTEPH underwent surgical thrombectomy, with complete resolution of pulmonary hypertension. All patients with CTEPH were alive at a median follow-up of 643 (range 487-737) days. Discussion: Our early experience shows that dedicated post-acute PE surveillance effectively identifies patients at risk for developing pulmonary hypertension, enabling timely diagnosis and treatment of CTEPH. Further evaluation is ongoing.