CTEPH Case Study 1

58-year-old woman with dyspnea on exertion (DOE), fatigue, and mild intermittent chest pain

• Patient initially referred to local cardiologist

• Mild hypertension, well-controlled Type II diabetes mellitus

• No history of deep vein thrombosis or pulmonary embolism (PE)

• Body mass index (BMI): 28 kg/m²; weight: 168 lbs

Echocardiogram

• Normal left ventricular systolic function; grade 1 diastolic dysfunction

• Mildly dilated right ventricle (RV), with mildly decreased RV function

• Mild biatrial dilation

• No significant valvular disease

• Right ventricular systolic pressure: 64.3 mmHg

Additional studies

• No evidence of acute PE on computed tomographic pulmonary angiogram (CTPA)

• NT-proBNP, 1602 pg/mL

• 6-minute walk distance (6MWD): 402 meters

• Assessed as WHO Functional Class II

Right heart catheterization

• Mean pulmonary arterial pressure (mPAP): 44 mmHg

• Right atrial pressure (RAP): 8.5 mmHg

• Pulmonary capillary wedge pressure (PCWP): 9.3 mmHg

• Cardiac output (CO): 3.65 L/min

• Cardiac index (CI): 2.3 L/min/m²

• Pulmonary vascular resistance (PVR): 785 dyn∙sec∙cm^-5

Key takeaways