Respiratory Failure in Pregnancy (ARDS [acute respiratory distress syndrome] during pregnancy; ALI [acute lung injury] during pregnancy; Ventilatory failure during pregnancy; Severe pneumonia during pregnancy; pulmonary embolus [PE] during pregnancy;

CTEPH Predictors Following Pulmonary Embolism

Risk for chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is associated with gender, delayed PE diagnosis, hypoxemia, heart load, D-dimer levels, and PE etiology. These findings were published in the Journal of the American Heart Association.

One of the most serious post-PE syndromes is CTEPH. A large variation in the rate of CTEPH has been reported and risk factors are not well understood.

The Contemporary Management and Outcomes in Patients With Venous Thromboembolism (COMMAND VTE) Registry-2 is a large cohort that recruited patients in Japan. In this study, patients (N=5197) with acute symptomatic venous thromboembolism between 2015 and 2020 at 31 sites were evaluated for CTEPH after acute PE (n=2787). The primary outcomes were the incidence of and risk factors for CTEPH.

Following a diagnosis of acute PE, the cumulative rates of CTEPH increased from 1.0% at 180 days to 1.7% at 1 year, 2.0% at 2 years, 2.3% at 3 years, and 2.4% at 4 and 5 years.

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Several independent risk factors for CTEPH were identified, which could be useful for screening a high-risk population for CTEPH after acute PE.

The patients with (n=48) and without (n=2739) CTEPH comprised 77.1% and 56.3% women (P =.004), their mean ages were 65.2±15.0 and 66.6±15.4 years, and they had a BMI of 23.4±4.4 and 23.8±4.7, respectively.

At PE, patients who went on to develop CTEPH were more likely to have unprovoked PE (79.2% vs 40.2%; P <.001), to present with hypoxemia (70.8% vs 44.0%; P <.001), they had higher right heart load (91.7% vs 40.5%; P <.001), and they had lower D-dimer levels (median, 6.0 vs 11.4 mg/mL; P <.001) compared with patients who did not develop CTEPH.

Most patients with CTEPH (97.9%) were diagnosed within 3 years of PE. A total of 7 patients with CTEPH died, due to malignant diseases (n=4), infection (n=1), chronic obstructive pulmonary disease (n=1), and unknown reasons (n=1). The survival rates after CTEPH were 95.7%, 93.5%, 88.4%, 85.0%, 85.0%, and 72.9% at years 1 through 6, respectively.

Risk for CTEPH was associated with right heart load (adjusted hazard ratio [aHR], 9.28; 95% CI, 3.19-27.00; P <.001), unprovoked PE (aHR, 2.77; 95% CI, 1.22-6.30; P =.02), hypoxemia (aHR, 2.52; 95% CI, 1.26-5.04; P =.009), female gender (aHR, 2.09; 1.05-4.14; P =.04), per day delay in diagnosis from symptom onset (aHR, 1.04; 95% CI, 1.01-1.07; P =.01), and D-dimer levels per 1 mg/mL (aHR, 0.96; 95% CI, 0.92-0.99; P =.02).

This study was limited by the lack of diversity in the study cohort, which may limit the generalizability of these findings.

The study authors concluded, "In this large real-world VTE registry in the DOAC [direct oral anticoagulation] era, the cumulative detection of CTEPH after acute PE was 2.3% at 3 years. Several independent risk factors for CTEPH were identified, which could be useful for screening a high-risk population for CTEPH after acute PE."

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.

This article originally appeared on The Cardiology Advisor

New Drug, New Combinations Improve Outlook In PAH, Pulmonary Arterial Hypertension

AMBLER, Pa. (WPVI) -- High blood pressure doesn't just mean the kind measured by an arm cuff.

There's another form in the lungs that's also very dangerous.

A longtime athlete and physical education teacher explains how it impacts his life and the new medication helping him get back to his old self.

"You were in really good shape, and now all of a sudden, you're not," John Smith of Ambler, Pa., notes.

After a lifetime of sports and teaching physical education, John was blindsided 16 years ago to learn he had Pulmonary Arterial Hypertension, or PAH.

It appeared suddenly after a heart defect was corrected.

"Both sides of my heart were enlarged. After they fixed the bridge, only one side went down," he remembers.

Dr. Paul Forfia, a Temple Health heart failure specialist, says in PAH, very small blood vessels in the lungs become narrowed.

"That puts a lot of resistance back onto the right side of the heart, and a lot of resistance for the passage of blood flow from the right heart through the lungs," Dr. Forfia says.

Normal lung blood pressures balloon over time.

"It could be 10 or 15 times higher than it should be, that will cause the right side of the heart to become dysfunctional," he says.

Dr. Forfia says PAH is three to four times more common in women, usually between the ages of 30 and 60, and more common in African American and Hispanic women.

Hallmark signs include increasing shortness of breath even with light activities; fatigue; edema, or swelling; and dizziness and fainting spells.

It gets worse over time, so aggressive treatment is a must.

"Seek out a Center of Comprehensive Care where there's a dedicated program," Dr. Forfia says.

Temple Health has that certification.

A combination of drugs has been used to control PAH.

But a new drug, Winrevair, could change the landscape.

"It's the first one that can actually fix the heart," John says, adding, "I actually went and ran, which is amazing. I haven't run in 10 years."

"The outlook for patients with PAH is very, very different and much more favorable now than it was two decades ago, or even one decade ago," Dr. Forfia says.

"I have two young kids, and I want to be around for them. That's my goal," John says.

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