SPC365

From PE to CTEPH: Still Lost in Translation.

Session: Sessão de Posters 27 - Abordagem e avanços terapêuticos na hipertensão pulmonar
Speaker: Lourenço Aguiar

Congress: CPC 2026
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Lourenço Aguiar; Tiago Lobão; João Luz; Mário Ferraz; Débora Repolho; Bárbara Ferreira; Sofia Alegria; Otília Simões; Filipa Ferreira; Hélder Pereira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable cause of pulmonary hypertension. It has been hypothesized that a prior episode of acute pulmonary embolism (PE) may facilitate earlier recognition and diagnosis of CTEPH at a less severe stage.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We conducted a single-center retrospective study that included </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>95 consecutive patients</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> diagnosed with CTEPH between 2005 and 2024. Data were collected on prior PE events, CTEPH risk factors (hypothyroidism, splenectomy, inflammatory bowel disease, myeloproliferative disorders, antiphospholipid syndrome, and cancer), WHO class, echocardiographic parameters (right atrial and ventricular size, sPAP, TAPSE), and hemodynamic variables (mPAP, PAWP, CI, PVR, arterial O2 saturation). Patients were stratified by the presence of prior PE, and among those with prior PE, according to time from PE to CTEPH diagnosis (&lt;12 vs &ge;12 months).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Of the 95 patients included, 66 (69%) had a documented history of PE. The median time from PE to CTEPH diagnosis was 21.5 months in patients with prior PE and 19.0 months from first symptoms to CTEPH diagnosis in those without prior PE (p=ns), indicating that prior PE did not lead to a significantly earlier diagnosis. Clinical, echocardiographic and hemodynamic characteristics were also comparable, suggesting that prior PE did not identify a lower-risk phenotype (table 1).The prevalence of established CTEPH risk factors (hypothyroidism, splenectomy, inflammatory bowel disease, myeloproliferative disorders, antiphospholipid syndrome, cancer) was also similar between groups. Among patients with prior PE, 21 (32%) were diagnosed within 12 months and 45 (68%) after &ge;12 months. No significant differences were found between these groups regarding NYHA class, right atrial size, right ventricular dilatation, sPAP, cardiac index, mPAP, PAWP, PVR, or arterial oxygen saturation. The only significant difference was observed in TAPSE, which was lower in patients diagnosed &lt;12 months (16.2 [14&ndash;20] vs 19.0 [16&ndash;22] mm, p=0.049) (table 2).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The diagnosis of CTEPH in our cohort was still late and at a high-risk stage. Having a prior PE did not result in a shorter time to CTEPH diagnosis or a less severe phenotype at presentation. The presence of PE in the medical history does not appear to enable earlier recognition of CTEPH or diagnosis at a lower-risk stage. Among patients with prior PE, only TAPSE was significantly lower in those diagnosed within 12 months, suggesting that post-PE investigations are likely performed mainly in more symptomatic patients rather than as part of systematic screening. Systematic post-PE screening strategies might be needed to detect CTEPH patients at an earlier and potentially lower-risk stage.</span></span></span></p>

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