Cor Vasa 2006, 48(9):317-320 | DOI: 10.33678/cor.2006.103

Chronic sequels of acute pulmonary embolism

Jiří Widimský

Klinika kardiologie, Institut klinické a experimentální medicíny, Subkatedra kardiologie IPVZ, Praha, Česká republika

Our analysis suggests several facts. We have a poor understanding of the chronic sequels of acute pulmonary embolism. The long-term prognosis of patients after acute pulmonary embolism is often affected by concomitant diseases, particu-
larly by the presence of malignancies but, also, by co-existing cardiac deseases. Another factor affecting the long-term prognosis is the age of patients. The few prospective studies of patients after acute pulmonary embolism have furnished the following facts: 4-6% of patients develop chronic thromboembolic pulmonary hypertension, especially those patients whose pulmonary artery systolic pressure at the time of diagnosis of acute pulmonary embolism was over 50 mm Hg. Imaging techniques have shown that over 50% of patients have persistent defects on the pulmonary scan or spiral CT angiogram at 6 months after establishing the diagnosis.
Given the recent marked advances in the management of chronic thromboembolic hypertension, increased attention should be given to patients after acute pulmonary embolism. Before discharge, all patients with acute massive or submassive pulmonary embolism should undergo follow-up echocardiography in an effort to determine whether the signs of pulmonary hypertension and right ventricular dysfunction have disappeared. Should the signs persist, patients are to remain on follow-up, using also imaging techniques, for another 3 and 6 months. Attention should focus particularly on patients with idiopathic pulmonary embolism. Special care should is to be given to individuals with pulmonary artery systolic pressure greater than 50 mm Hg in the acute phase of pulmonary embolism.
Excluded from follow-up should be patients with advanced malignancies and individuals in advanced age unable to adhere to a regular schedule of outpatient follow-up.
Clearly, this policy would fail to identify patients with chronic thromboembolic pulmonary hypertension whose history does not include signs of acute pulmonary embolism. Still, it would be helpful in establishing a timely diagnosis in about half of patients developing chronic thromboembolic pulmonary hypertension.

Keywords: Acute pulmonary embolism; Chronic thromboembolic pulmonary hypertension; Chronic sequels of pulmonary embolism

Published: September 1, 2006  Show citation