Modern algorithm for the diagnosis of chronic thromboembolic pulmonary hypertension


DOI: https://dx.doi.org/10.18565/therapy.2019.4.113-120

Shostak N.A., Klimenko A.A., Shemenkova V.S., Svet A.V.

1) N.I. Pirogov Russian National research medical University of the Ministry of Healthcare of Russia, Moscow; 2) N.I. Pirogov City clinical hospital № 1, Moscow
In a number of cases after pulmonary embolism a complete recanalization does not occur, the embolic masses are partially lysed and replaced by a connective tissue, which leads to a change in the lumen of the pulmonary vessels and the formation of chronic thromboembolic pulmonary hypertension, which is a remote complication of pulmonary embolism and occurs in the 5–10 cases per 1 million population. Rarer causes of the formation of this type of pulmonary hypertension may be vascular tumors (most often angiosarcoma), pulmonary artery stenosis, and some parasitic infections. Symptoms of the disease are nonspecific (dyspnea, chest pain, cough, hemoptysis) and a history of thromboembolism of the pulmonary artery is not always that complicates early diagnosis and timely treatment of patients. Despite the existing recommendations and ongoing studies, there is no single timeframe and research method for screening patients to assess the formation of pulmonary hypertension. This review covers the main possible methods for diagnosing chronic thromboembolic pulmonary hypertension, their advantages and disadvantages, accessibility in the practice of a clinician. The combination of several diagnostic studies allows not only to diagnose this disease, but to choose the further tactics of treatment. Examination of patients with chronic thromboembolic pulmonary hypertension according to the presented algorithm allows timely diagnosis and refer the patient to a specialized center for pulmonary hypertension for specific treatment (pulmonary trombendarterectomy, balloon angioplasty or the appointment of PAH-specific drug).
Keywords: right ventricular heart failure, chronic thromboembolic disease, pulmonary embolism, chronic thromboembolic pulmonary hypertension, pulmonary hypertension, diagnostic methods
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About the Autors

Nadezhda A. Shostak, MD, professor, the Head of the Department of faculty therapy of N.I. Pirogov Russian National research medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityaninova Str. Tel.: +7 (499) 237-69-17. E-mail: shostakkaf@yandex.ru
Alesya A. Klimenko, PhD, associate professor of the Department of faculty therapy of N.I. Pirogov Russian National research medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityaninova Str. Tel.: +7 (499) 237-69-17.
Victoria S. Shemenkova, PhD, candidate of the Department of faculty therapy of N.I. Pirogov Russian National research medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityaninova Str.
Tel.: +7 (915) 319-55-35. E-mail: vshemenkova@mail.ru
Alexey V. Svet, PhD, Chief physician of N.I. Pirogov City clinical hospital No 1 of Moscow Department of Healthcare. Address: 117049, Moscow, 8 Leninsky prospect. Tel.: +7 (499) 764-50-02. E-mail: gkb1@zdrav.mos.ru


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