Chest
Volume 81, Issue 2, February 1982, Pages 151-158
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Clinical Investigations
Longterm Follow-up of Patients with Pulmonary Thromboembolism: Late Prognosis and Evolution of Hemodynamic and Respiratory Data

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Seventy-six patients with various forms of pulmonary thromboembolic disease were followed-up for 1 to 15 years. All were free of other cardiopulmonary disease at the time of the first examination which was performed at least two months after the last pulmonary embolism. Catheterization was repeated in all survivors on average 4.8 years later. Severe chronic pulmonary hypertension (mean pulmonary artery pressure (PPA > 30 mm Hg) did not occur after a single episode of acute embolism, was infrequent after single subacute or recurrent emboli (8 of 9 patients), and was common after occult emboli (12 of 13 patients). Mortality in all clinical groups correlated with PPA and with the presence of right heart failure. In survivors, no correlation was found between the longterm changes of PPA and age, duration of disease, interval between catheterizations, PaO2, or cardiac output. Pulmonary hypertension progressed further in patients with initial PPA > 30 mm Hg. In contrast, none of the patients with normal or borderline PPA at the initial examination developed severe pulmonary hypertension during the follow-up. Since the future course of patients could be predicted from the first examination, repeated hemodynamic investigation proved to be of minor prognostic value.

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Patients and Methods

The present series is a review of all patients with TED who met the following criteria: (1) a diagnosis of TED confirmed by lung angiography and/or scintigraphy; (2) the absence of any other heart or lung disease (excluded on the basis of history, clinical examination, ECG, chest x-ray film findings, lung function tests, and cardiac catheterization); (3) hemodynamic investigation performed at least two months after the last clinically manifest episode of PE.

These criteria were met by 76

Clinical and Hemodynamic Data

Acute PE. Two patients had borderline PPA (21 and 22 mm Hg) and 12 had normal resting PPA (<20 mm Hg) on the first examination.

Two patients died seven years after the first examination-one of rupture of an aortic aneurysm, the other of an acute PE complicating biventricular heart failure. This patient suffered two myocardial infarctions and at least two recurrent PEs after the first examination. The remaining 12 patients were re-examined on an average 4.2 years after the first examination (Fig 1

Discussion

Pulmonary thromboembolic disease has a wide variety of clinical presentations. The definition of subgroups facilitates the understanding of the clinical pattern, the hemodynamic disturbance, the effect of treatment and the long-term prognosis in these patients.7 We have therefore defined four groups in terms of their clinical presentations. As longterm prognosis after PE is influenced by concomitant cardiorespiratory disease,3,5 patients with other heart or lung disease at the time of the first

Acknowledgments

The authors thank Drs. D. Dantzker, R. Hall, and E. Weitzenblum for their suggestions and critical reading of this manuscript.

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