Echocardiographic follow-up results in patients with massive and submassive pulmonary thromboembolism

Objective: Pulmonary thromboembolism (PTE) is a common disease that is difficult to diagnose and causes significant morbidity and mortality. However, PTE treatment is quite effective. But despite treatment, a minority of patients are at risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). (If left untreated, the risk of developing CTEPH, which is seen in a minority of patients, increases). It is recommended that patients diagnosed with acute PTE must be evaluated by echocardiography (ECO) for CTEPH after at least 3 months of anticoagulant therapy. In our study, we aimed to evaluate the echocardiographic results of massive and submassive PTE patients at admission and during follow-up, to determine whether pulmonary hypertension (PH) and echocardiographic findings of right heart involvement persist in the follow-up. Materials and Methods: The control echocardiographic findings of 137 patients diagnosed with massive and submassive PTE, who applied to the Dicle University Medical Faculty Hospital Chest Diseases Department and the emergency service between January 2015 and September 2020, were evaluated retrospectively. Results: CTEPH developed in 6 of the all patients, and in only 1 of the alive 8 patients who were given thrombolytics. Of the patients who developed CTEPH, 2 had a history of PTE, 4 had a history of VTE, 5 had non-0 blood group, 2 had thrombophilia. The right atrium diameter (RAD) and right ventricle diameter (RVD) values of all patients participating in the study at least 3 months after the treatment (median values of 3.7 cm and 3.6 cm, respectively) were found to be significantly lower than their values at the first admission (median values of 4.4 cm and 4.2 cm, respectively) (p<0.05). The pulmonary artery systolic pressure (PABS) values of the patients at least 3 months after the treatment (median value 30.0 mmHg) were statistically significantly lower than the values at admission (median value 45.0 mmHg) (p<0.05). Similar results for RAD, RVD and PABS were obtained when massive and submassive patient groups were evaluated separately. Conclusion: At least 3 months after the anticoagulant and thrombolytic treatment, signs of right heart involvement regress in PTE patients, and PABS values return to normal. PTE treatment is effective in preventing the development of CTEPH and mortality. However, at least one ECO control is required in patients with massive and submassive PTE, especially those with risk factors for CTEPH. Non-0 blood group and previous history of venous thromboembolism (VTE) are the most common risk factors in patients who develop CTEPH. Keywords: Echocardiography, massive pulmonary embolism, submassive pulmonary embolism