Akut Pulmoner Emboli Sonrası Kronik Tromboembolik Pulmoner Hipertansiyonun İnsidansı ve Risk Faktörleri

Yıl 2025, Cilt: 47 Sayı: 6, 939 - 950, 26.09.2025

Seçim Kolak , Neşe Dursunoğlu , Dursun Dursunoğlu , Ozan Çetin

https://doi.org/10.20515/otd.1728528

Öz

Bu çalışma, akut pulmoner emboli (PE) sonrası kronik tromboembolik pulmoner hipertansiyon (KTEPH) gelişme insidansını ve ilişkili risk faktörlerini belirlemeyi amaçlamaktadır. 2018 ve 2019 yıllarında üçüncü basamak bir sağlık merkezinde akut PE tanısı alan 256 erişkin hasta retrospektif olarak değerlendirildi. Tanı ve takip sürecinde klinik skorlamalar, ekokardiyografi, bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ve/veya ventilasyon/perfüzyon (V/Q) sintigrafisi kullanıldı. KTEPH gelişimini değerlendirmek amacıyla her kohort için iki yıllık bir döneme ait başlangıç verileri ve takip bulguları analiz edildi: 2018’de tanı alan hastalar için 2018-2020, 2019’da tanı alanlar için ise 2019–2021 yılları arası incelendi. KTEPH tanısı için yapılan sağ kalp kateterizasyonu (SKK) sonuçları ile üçüncü ve altıncı aylarda yapılan görüntüleme sonuçları değerlendirildi. Demografik, klinik, laboratuvar ve radyolojik bulgular KTEPH gelişimi açısından karşılaştırıldı. KTEPH insidansı %7.8 (n=20) olarak saptandı. Başlangıç görüntülemelerinde sağ ventrikül dilatasyonu KTEPH grubunda anlamlı olarak daha sık izlendi (p=0,042). Üçüncü ve altıncı aylarda sistolik pulmoner arter basıncı (sPAB) >50 mmHg, triküspit yetersizliği (TY) ve triküspit yetersizlik hızı (TRV) >2.8 m/s KTEPH grubunda anlamlı olarak daha yaygındı (p<0,05). Genetik trombofili ile anlamlı bir ilişki bulunmazken, antifosfolipid antikorları ve lupus antikoagülanı daha sık gözlendi ancak istatistiksel olarak anlamlı değildi. KTEPH, nadir görülmesine rağmen yüksek morbidite ve mortaliteye sahip, ancak zamanında tanı konulursa potansiyel olarak tedavi edilebilir bir hastalıktır. Sağ ventrikül disfonksiyonu gibi erken dönemde saptanabilecek bulgular, yüksek riskli hastaların belirlenmesinde kritik rol oynar. Bu nedenle, akut PE sonrası düzenli ve çok yönlü izlem protokolleri uygulanmalı, olası KTEPH vakaları erken dönemde tanınarak uygun merkezlere yönlendirilmelidir.

Anahtar Kelimeler

Akut Pulmoner Emboli , Kronik Tromboembolik Pulmoner Hipertansiyon , İnsidans , Risk Faktörleri

Etik Beyan

Çalışma Pamukkale Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylandı (Karar no: E.28592, Tarih: 08.03.2021).

Destekleyen Kurum

Bu çalışmanın yürütülmesinde herhangi bir kurumdan özel bir destek alınmamıştır.

Teşekkür

Bu makale, Pamukkale Üniversitesi Tıp Fakültesi’nde tamamlanan tıpta uzmanlık tezime dayanmaktadır. Tez sürecinde bilgi, deneyim ve destekleriyle katkı sağlayan tüm hocalarıma içtenlikle teşekkür ederim.

Incidence and Risk Factors of Chronic Thromboembolic Pulmonary Hypertension Following Acute Pulmonary Embolism

Öz

This study aimed to determine the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) following acute pulmonary embolism (PE) and to identify associated risk factors. A total of 256 adult patients diagnosed with acute PE in 2018 and 2019 at a tertiary care center were retrospectively evaluated. Diagnostic and follow-up procedures included clinical scoring, echocardiography, computed tomography pulmonary angiography (CTPA), and/or ventilation/perfusion (V/Q) scintigraphy. To assess the development of CTEPH, we analyzed baseline characteristics and follow-up data for each cohort over a two-year period: 2018 to 2020 for patients diagnosed in 2018, and 2019 to 2021 for those diagnosed in 2019. Right heart catheterization (RHC) findings and follow-up imaging at the third and sixth months were reviewed. Demographic, clinical, laboratory, and radiological variables were compared between patients with and without CTEPH. The incidence of CTEPH was 7.8% (n=20). Right ventricular (RV) dilatation at initial imaging was significantly more frequent in the CTEPH group (p=0.042). At both the third and sixth months, elevated systolic pulmonary artery pressure (sPAP) >50 mmHg, tricuspid regurgitation (TR), and tricuspid regurgitation velocity (TRV) >2.8 m/s were significantly more common in CTEPH patients (p<0.05). No significant association was found with genetic thrombophilia, whereas antiphospholipid antibodies and lupus anticoagulant were more prevalent but not statistically significant. Although rare, CTEPH is associated with high morbidity and mortality but remains potentially curable if diagnosed early. Early signs such as RV dysfunction may help identify high-risk patients. Therefore, structured follow-up protocols are essential to ensure timely diagnosis and referral to specialized centers.

Anahtar Kelimeler

Acute Pulmonary Embolism , Chronic Thromboembolic Pulmonary Hypertension , Incidence , Risk Factors

Etik Beyan

The study was approved by Pamukkale University Noninterventional Clinical Research Ethical Committee (Decision no: E.28592, Date: 08.03.2021).

Destekleyen Kurum

No specific institutional support was received for the conduct of this study.

Teşekkür

This article is based on my medical specialty thesis completed at Pamukkale University Faculty of Medicine. I sincerely thank all my professors who contributed to the process with their knowledge, experience, and support.

Kaynakça

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