Frequency of chronic thromboembolic pulmonary hypertension screening after pulmonary embolism in cancer patients.

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe condition which should be screened in patient with persistent dyspnea after pulmonary embolism (PE). After PE, CTEPH incidence was estimated between 0.1 and 9.1 % in overall patients. Although cancer is associated with an increased risk of CTEPH, CTEPH incidence is still unknown in cancer patients with PE. We aimed to estimate the frequency of screening for CTEPH after PE in cancer patients. Materials and Methods: We extracted data about cancer patients of our large monocentric prospective registry including consecutive patients with symptomatic PE. The primary outcome was the frequency of “CTEPH-likely” patients defined by the European Respiratory Society (ERS) guidelines (an accelerated tricuspid regurgitation more than 2.8m/s and at least 1–2 segmental or larger-sized defects, after more than 3 months of therapeutic anticoagulation). Results: We included 133 cancer patients with PE. Colorectal cancer (19.5%), breast cancer (17%) and prostate cancer (16.5%) were the most frequent cancers. PE occurred after surgery or medical immobilization in 21% of patients, while 27% of patients had history of venous thromboembolism. Only 2 patients (1.5%) had a clinical suspicion of CTEPH and only 1 patient with ovarian cancer (0.75% 95%CI [0.0%-2.2%]) was classified as “CTEPH-likely”, 6 months after PE. Conclusions: The frequency of screening for CTEPH seems negligible in PE patients with cancer. Concomitant cancer may affect the clinical suspicion of CTEPH.