"Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism
- Authors: Chazova I.E.1, Martynyuk T.V.1,2, Gorbachevskii S.V.3,4, Gramovich V.V.1, Danilov N.M.1, Panchenko E.P.1, Chernyavskiy A.M.5, Shmalts A.A.3,4, Yavelov I.S.6
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Affiliations:
- Chazov National Medical Research Center of Cardiology
- The Russian National Research Medical University named after N.I. Pirogov
- Bakoulev Scientific Center for Cardiovascular Surgery
- Russian Medical Academy of Continuous Professional Education
- E. Meshalkin National Medical Research Center
- National Medical Research Center for Therapy and Preventive Medicine
- Issue: Vol 94, No 9 (2022)
- Pages: 1052-1056
- Section: Consensuns
- URL: https://journals.rcsi.science/0040-3660/article/view/112063
- DOI: https://doi.org/10.26442/00403660.2022.09.201836
- ID: 112063
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Abstract
On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.
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##article.viewOnOriginalSite##About the authors
Irina E. Chazova
Chazov National Medical Research Center of Cardiology
Email: trukhiniv@mail.ru
ORCID iD: 0000-0002-9822-4357
акад. РАН, д-р мед. наук, проф., зам. ген. дир. по научно-экспертной работе, рук. отд. гипертонии
Russian Federation, MoscowTamila V. Martynyuk
Chazov National Medical Research Center of Cardiology; The Russian National Research Medical University named after N.I. Pirogov
Author for correspondence.
Email: trukhiniv@mail.ru
ORCID iD: 0000-0002-9022-8097
д-р мед. наук, рук. отд. легочной гипертензии и заболеваний сердца Института клинической кардиологии им. А.Л. Мясникова; проф. каф. кардиологии фак-та дополнительного профессионального образования
Russian Federation, Moscow; MoscowSergey V. Gorbachevskii
Bakoulev Scientific Center for Cardiovascular Surgery; Russian Medical Academy of Continuous Professional Education
Email: trukhiniv@mail.ru
ORCID iD: 0000-0002-4193-3320
д-р мед. наук, проф., зав. отд-нием хирургического лечения заболеваний сердца с прогрессирующей легочной гипертензией; проф. каф. сердечно-сосудистой хирургии
Russian Federation, Moscow; MoscowVladimir V. Gramovich
Chazov National Medical Research Center of Cardiology
Email: trukhiniv@mail.ru
ORCID iD: 0000-0003-3292-0912
канд. мед. наук, ст. науч. сотр. отд. легочной гипертензии и заболеваний сердца Института клинической кардиологии им. А.Л. Мясникова
Russian Federation, MoscowNikolay M. Danilov
Chazov National Medical Research Center of Cardiology
Email: trukhiniv@mail.ru
ORCID iD: 0000-0001-9853-9087
д-р мед. наук, вед. науч. сотр. отд. гипертонии Института клинической кардиологии им. А.Л. Мясникова
Russian Federation, MoscowElizaveta P. Panchenko
Chazov National Medical Research Center of Cardiology
Email: trukhiniv@mail.ru
ORCID iD: 0000-0002-1174-2574
д-р мед. наук., проф., рук-ль отд. клинических проблем атеротромбоза
Russian Federation, MoscowAleksandr M. Chernyavskiy
E. Meshalkin National Medical Research Center
Email: trukhiniv@mail.ru
ORCID iD: 0000-0001-9818-8678
чл.-кор. РАН, д-р мед. наук, проф., рук-ль Центра кардиохирургии аорты и коронарных артерий
Russian Federation, NovosibirskAnton A. Shmalts
Bakoulev Scientific Center for Cardiovascular Surgery; Russian Medical Academy of Continuous Professional Education
Email: trukhiniv@mail.ru
ORCID iD: 0000-0001-8937-1796
д-р мед. наук, вед. науч. сотр. отд-ния хирургического лечения заболеваний сердца с прогрессирующей легочной гипертензией; доц. каф. сердечно-сосудистой хирургии
Russian FederationIgor S. Yavelov
National Medical Research Center for Therapy and Preventive Medicine
Email: trukhiniv@mail.ru
ORCID iD: 0000-0003-2816-1183
д-р мед. наук, проф., вед. науч. сотр. отд. клинической кардиологии и молекулярной генетики, рук. отд. фундаментальных и клинических проблем тромбоза при неинфекционных заболеваниях
Russian Federation, MoscowReferences
- Чазова И.Е., Мартынюк Т.В., Валиева З.С., и др. Евразийские рекомендации по диагностике и лечению легочной гипертензии. Евразийский кардиологический журнал. 2020;1:78-122 [Chazova IE, Martynyuk TV, Valieva ZS, et al. Eurasian clinical guidelines on diagnosis and treatment of pulmonary hypertension. Eurasian Heart Journal. 2020;1:78-122 (in Russian)]. doi: 10.38109/2225-1685-2020-1-78-122
- Delcroix M, Kerr K, Fedullo P. Chronic Thromboembolic Pulmonary Hypertension Epidemiology and Risk Factors. Ann Am Thorac Soc. 2016;13(Suppl. 3):S201-6. doi: 10.1513/AnnalsATS.201509-621AS
- Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124(18):1973-81. doi: 10.1161/CIRCULATIONAHA.110.015008
- Чазова И.Е., Мартынюк Т.В., Валиева З.С., и др. Оценка бремени ХТЭЛГ в Российской Федерации. Терапевтический архив. 2018;90(9):101-9 [Chazova IE, Martynyuk TV, Valieva ZS. The economic burden of chronic thromboembolic pulmonary hypertension in Russian Federation. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(9):101-9 (in Russian)]. doi: 10.26442/terarkh2018909101-109
- Чазова И.Е., Мартынюк Т.В. от имени рабочей группы по разработке и подготовке текста Российских рекомендаций по диагностике и лечению ХТЭЛГ. Клинические рекомендации по диагностике и лечению хронической тромбоэмболической легочной гипертензии. Терапевтический архив. 2016;88(10):63-73 [Chazova IE, Martynyuk TV on behalf of the Working Group on Text Preparation for Russian Guidelines for the Diagnosis and Treatment of CTEPH. Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension. Terapevticheskii Arkhiv (Ter. Arkh.). 2016;88(10):63-73 (in Russian)]. doi: 10.17116/terarkh201688663-73
- Валиева З.С., Мартынюк Т.В., Наконечников С.Н., Чазова И.Е. Характеристика пациентов с ХТЭЛГ по данным Российского национального регистра. Терапевтический архив. 2021;93(9):1058-65 [Valieva ZS, Martynyuk TV, Nakonechnikov SN, Chazova IE. Characteristics of patients with chronic thromboembolic pulmonary hypertension according to the Russian National Registry. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(9):1058-65 (in Russian)]. doi: 10.26442/00403660.2021.09.201037
- Klok FA, Barco S, Konstantinides SV, et al. Determinants of diagnostic delay in chronic thromboembolic pulmonary hypertension: results from the European CTEPH Registry. Eur Respir J. 2018;52:180167. doi: 10.1183/13993003.01687-2018
- Halawa S, Pullamsetti SS, Bangham CRM, et al. Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: a global perspective. Nat Rev Cardiol. 2022;19(5):314-31. doi: 10.1038/s41569-021-00640-2
- Konstantinides SV, Vicaut E, Danays T, et al. Impact of thrombolytic therapy on the long-term outcome of intermediate-risk pulmonary embolism. J Am Coll Cardiol. 2017;69(12):1536-44. doi: 10.1016/j.jacc.2016.12.039
- Sharifi M, Bay C, Skrocki L, et al. Moderate pulmonary embolism treated with thrombolysis (from the MOPETT Trial). Am J Cardiol. 2013;111(2):273-7. doi: 10.1016/j.amjcard.2012.09.027
- Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis andmanagement of acute pulmonary embolismdeveloped in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603. doi: 10.1093/eurheartj/ehz405
- Prandoni P, Noventa F, Ghirarduzzi A. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica. 2007;92(2):199-205. doi: 10.3324/haematol.10516
- Baglin T, Luddington R, Brown K. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003;362(9383):523-6. doi: 10.1016/S0140-6736(03)14111-6
- Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-510. doi: 10.1056/NEJMoa1007903
- Weitz JI, Lensing AWA, Prins MH, et al; EINSTEIN CHOICE Investigators. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017;376(13):1211-22. doi: 10.1056/NEJMoa1700518
- Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013;368(8):709-18. doi: 10.1056/NEJMoa1113697
- Klok FA, Dzikowska-Diduch O, Kostrubiec M, et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost. 2016;14(1):121-8. doi: 10.1111/jth.13175
- Douillet D, Riou J, Penaloza A, et al. Risk of symptomatic venous thromboembolism in mild and moderate COVID-19: A comparison of two prospective European cohorts. Thromb Res. 2021;208:4-10. doi: 10.1016/j.thromres.2021.10.001
- Al-Samkari A, Karp Leaf R, Dzik W, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500. doi: 10.1182/blood.2020006520
- Roberts LN, Whyte MB, Georgiou L, et al. Postdischarge venous thromboembolism following hospital admission with COVID-19. Blood. 2020;136(11):1347-50. doi: 10.1182/blood.2020008086
- Порембская О.Я., Лобастов К.В., Кравчук В.Н., и др. Легочная эмболия – разрозненные части несобранной мозаики. Флебология. 2021;15(3):188-98 [Porembskaya OYa, Lobastov KV, Kravchuk VN, et al. Pulmonary embolism – scattered elements of incomplete puzzle. Flebologiya. 2021;15(3):188-98 (in Russian)]. doi: 10.17116/flebo202115031188
- Chernysh IN, Nagaswami C, Kosolapova S, et al. The distinctive structure and composition of arterial and venous thrombi and pulmonary emboli. Sci Rep. 2020;10(1):5112. doi: 10.1038/s41598-020-59526-x
- Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124(18):1973-81. doi: 10.1161/CIRCULATIONAHA.110.015008
- Чазова И.Е., Валиева З.С., Наконечников С.Н., и др. Особенности клинико-функционального и гемодинамического профиля, лекарственной терапии и оценка прогноза у пациентов с неоперабельной ХТЭЛГ и идиопатической легочной гипертензией по данным Российского регистра. Терапевтический архив. 2019;91(9):77-87 [Chazova IE, Valieva ZS, Nakonechnikov SN, et al. Features of clinical, functional and hemodynamics profile, medical treatment and prognosis evaluation in patients with inoperable chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension according to the Russian registry. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(9):77-87 (in Russian)]. doi: 10.26442/00403660.2019.09.000343
- Tiede H, Hoeper MM, Richter M, et al. Global burden of chronic thromboembolic pulmonary hypertension (CTEPH): An epidemiological analysis. Eur Respir J. 2014;44:P2326.
- Delcroix M, Torbicki A, Gopalan D. ERS Statement on Chronic Thromboembolic Pulmonary Hypertension. Eur Respir J. 2021;57(6):2002828. doi: 10.1183/13993003.02828-2020
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