Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies

TY - JOUR

T1 - Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19

T2 - UK national surveillance and observational screening cohort studies

AU - Reddy, S. Ashwin

AU - Newman, Joseph

AU - Leavy, Olivia C.

AU - Ghani, Hakim

AU - Pepke-Zaba, Joanna

AU - Cannon, John E.

AU - Sheares, Karen K.

AU - Taboada, Dolores

AU - Bunclark, Katherine

AU - Lawrie, Allan

AU - Sudlow, Cathie L.

AU - Berry, Colin

AU - Wild, James M.

AU - Mitchell, Jane A.

AU - Quint, Jennifer

AU - Rossdale, Jennifer

AU - Price, Laura

AU - Howard, Luke S.

AU - Wilkins, Martin

AU - Sattar, Naveed

AU - Chowienczyk, Philip

AU - Thompson, Roger

AU - Wain, Louise V.

AU - Horsley, Alexander

AU - Ho, Ling Pei

AU - Chalmers, James D.

AU - Marks, Michael

AU - Poinasamy, Krisnah

AU - Raman, Betty

AU - Harris, Victoria C.

AU - Houchen-Wolloff, Linzy

AU - Brightling, Christopher E.

AU - Evans, Rachael A.

AU - Toshner, Mark R.

AU - PHOSP-COVID Collaborative Group

A2 - George, J

N1 - Publisher Copyright: Copyright © The authors 2024.

PY - 2024/8/1

Y1 - 2024/8/1

N2 - Background Pulmonary embolism (PE) is a well-recognised complication of coronavirus disease 2019 (COVID-19) infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/ CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. Methods We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017–2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post-hospital discharge according to existing risk scores using symptoms, ECG and N-terminal pro-brain natriuretic peptide. Results By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23.1 versus 27.8 cases per month; p=0.252). Of 334 confirmed CTEPD/CTEPH cases, four (1.2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further three (0.9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60.4% male) hospitalised with COVID-19 screened across the UK, 11 (1.0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. Conclusion A priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.

AB - Background Pulmonary embolism (PE) is a well-recognised complication of coronavirus disease 2019 (COVID-19) infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/ CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. Methods We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017–2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post-hospital discharge according to existing risk scores using symptoms, ECG and N-terminal pro-brain natriuretic peptide. Results By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23.1 versus 27.8 cases per month; p=0.252). Of 334 confirmed CTEPD/CTEPH cases, four (1.2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further three (0.9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60.4% male) hospitalised with COVID-19 screened across the UK, 11 (1.0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. Conclusion A priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.

UR - https://www.scopus.com/pages/publications/85202906908

U2 - 10.1183/13993003.01742-2023

DO - 10.1183/13993003.01742-2023

M3 - Article

C2 - 39060016

AN - SCOPUS:85202906908

SN - 0903-1936

VL - 64

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 2

M1 - 2301742

ER -