Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19.

Chronic Thromboembolic Pulmonary Hypertension: JACC Focus Seminar

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jth.14016

Chronic thromboembolic pulmonary hypertension from the perspective of patients with pulmonary embolism.

PET/CT Lung Ventilation and Perfusion Scanning using Galligas and Gallium-68-MAA.

In addition to among others major bleeding from anticoagulant therapy and recurrent venous thromboembolism (VTE), patients who survived acute pulmonary embolism (PE) face an increased risk of chronic functional limitations and decreased quality of life. In recent years, this latter complications have been better framed within the evolving definition of “post-PE syndrome” of which chronic thromboembolic pulmonary hypertension (CTEPH) represents the most extreme presentation. The post-PE syndrome in all its aspects is a frequent and clinically relevant long-term complication of PE but -except for CTEPH- has been largely understudied. There is great need to better define and understand the natural course of acute PE, to predict the development of the post-PE syndrome and to evaluate the potential benefits evolving treatments such as cardiopulmonary rehabilitation.

/pdf/follow-up-after-acute-pulmonary-embolism-4p7g6p2udu.pdf

Follow-up after acute Pulmonary Embolism

The impact of residual pulmonary obstruction on the outcome of patients with pulmonary embolism is uncertain We recruited 647 consecutive symptomatic patients with a first episode of pulmonary embolism, with or without concomitant deep venous thrombosis They received conventional anticoagulation, were assessed for residual pulmonary obstruction through perfusion lung scanning after 6 months and then were followed up for up to 3 years Recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension were assessed according to widely accepted criteria Residual pulmonary obstruction was detected in 324 patients (501%, 95% CI 462–540%) Patients with residual pulmonary obstruction were more likely to be older and to have an unprovoked episode After a 3-year follow-up, recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension developed in 34 out of the 324 patients (105%) with residual pulmonary obstruction and in 15 out of the 323 patients (46%) without residual pulmonary obstruction, leading to an adjusted hazard ratio of 226 (95% CI 123–416) Residual pulmonary obstruction, as detected with perfusion lung scanning at 6 months after a first episode of pulmonary embolism, is an independent predictor of recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension

https://erj.ersjournals.com/content/erj/49/5/1601980.full.pdf

Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism

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Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism