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      Chronic thromboembolic pulmonary hypertension and clot resolution after COVID-19-associated pulmonary embolism

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          Abstract

          The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) in coronavirus disease 2019 (COVID-19) survivors who were diagnosed with acute pulmonary embolism (PE) is currently unknown. Considering the high PE incidence reported in COVID-19 and its potentially unique pathophysiology, it may be hypothesised that thrombus resolution occurs to a lesser extent after COVID-19-associated PE, and that the prevalence of CTEPH is higher compared to non-COVID-19-associated PE populations. CTEPH could therefore be a treatable cause of long COVID, which captures a broad range of post-acute COVID-19 sequelae, in those with PE during acute COVID-19 [1]. In this multicentre cross-sectional study, we aimed to establish the prevalence of CTEPH and recurrent venous thromboembolism (VTE), and evaluate thrombus resolution in COVID-19-associated PE survivors.

          Abstract

          The results of this study suggest that CTEPH is not a more common long-term complication after COVID-19-associated PE than after PE in non-COVID-19 patients, and thrombus resolution did not seem to be different from non-COVID-19-associated PE https://bit.ly/3IjvWL3

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          Most cited references15

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          Post-acute COVID-19 syndrome

          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
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            2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

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              ERS statement on chronic thromboembolic pulmonary hypertension

              Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, either symptomatic or not. The occlusion of proximal pulmonary arteries by fibrotic intravascular material, in combination with a secondary microvasculopathy of vessels <500 µm, leads to increased pulmonary vascular resistance and progressive right heart failure. The mechanism responsible for the transformation of red clots into fibrotic material remnants has not yet been elucidated. In patients with pulmonary hypertension, the diagnosis is suspected when a ventilation/perfusion lung scan shows mismatched perfusion defects, and confirmed by right heart catheterisation and vascular imaging. Today, in addition to lifelong anticoagulation, treatment modalities include surgery, angioplasty and medical treatment according to the localisation and characteristics of the lesions. This statement outlines a review of the literature and current practice concerning diagnosis and management of CTEPH. It covers the definitions, diagnosis, epidemiology, follow-up after acute pulmonary embolism, pathophysiology, treatment by pulmonary endarterectomy, balloon pulmonary angioplasty, drugs and their combination, rehabilitation and new lines of research in CTEPH. It represents the first collaboration of the European Respiratory Society, the International CTEPH Association and the European Reference Network-Lung in the pulmonary hypertension domain. The statement summarises current knowledge, but does not make formal recommendations for clinical practice.
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                Author and article information

                Journal
                Eur Respir J
                Eur Respir J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                April 2023
                20 April 2023
                : 61
                : 4
                : 2300171
                Affiliations
                [1 ]Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
                [2 ]Department of Haematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
                [3 ]Department of Internal Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
                [4 ]Department of Pulmonology, North West Hospital Alkmaar, Alkmaar, The Netherlands
                [5 ]Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
                [6 ]Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
                [7 ]Thrombosis Expertise Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
                [8 ]Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht, The Netherlands
                [9 ]Department of Internal Medicine, Hospital St. Jansdal, Harderwijk, The Netherlands
                [10 ]Department of Intensive Care, Wilhelmina Hospital Assen, Assen, The Netherlands
                [11 ]Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
                [12 ]Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
                [13 ]Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
                [14 ]Department of Internal Medicine, Tergooi Hospital, Hilversum, The Netherlands
                [15 ]Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
                [16 ]Department of Intensive Care, Zaans Medical Centre, Zaandam, The Netherlands
                [17 ]Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
                [18 ]Department of Pulmonology, Spaarne Hospital, Haarlem, The Netherlands
                [19 ]Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
                [20 ]Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
                [21 ]Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
                [22 ]Department of Intensive Care, Ikazia Hospital, Rotterdam, The Netherlands
                [23 ]Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
                Author notes
                Frederikus A. Klok ( f.a.klok@ 123456lumc.nl )
                Author information
                https://orcid.org/0000-0002-2310-5820
                https://orcid.org/0000-0002-2025-1734
                https://orcid.org/0000-0002-4597-2722
                https://orcid.org/0000-0003-4707-2303
                https://orcid.org/0000-0002-6666-5027
                https://orcid.org/0000-0002-0564-1064
                https://orcid.org/0000-0003-1423-5348
                https://orcid.org/0000-0001-6667-6714
                https://orcid.org/0000-0002-4734-8616
                https://orcid.org/0000-0003-3356-3910
                https://orcid.org/0000-0002-4057-758X
                https://orcid.org/0000-0002-0265-4871
                https://orcid.org/0000-0001-9961-0754
                Article
                ERJ-00171-2023
                10.1183/13993003.00171-2023
                10116061
                37080574
                e30a2e90-4110-466d-a7e8-b6e7e590f150
                Copyright ©The authors 2023.

                This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org

                History
                : 3 January 2023
                : 20 February 2023
                Funding
                Funded by: Trombosestichting Nederland, doi 10.13039/501100012028;
                Award ID: 2020_A
                Funded by: Johnson and Johnson, doi 10.13039/100004331;
                Funded by: ZonMw, doi 10.13039/501100001826;
                Award ID: 10430012010004
                Categories
                Research Letters

                Respiratory medicine
                Respiratory medicine

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