CTEPH Case Study 2
63-year-old man with progressively worsening dyspnea on exertion (DOE) over last 3 months
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Moderately active—had walked 30+ mins/day—until recent progression of dyspnea
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History of acute pulmonary embolism (PE) subsequent to appendectomy 15 years previous
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History of splenectomy for hereditary spherocytosis
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Body mass index (BMI): 31 kg/m2; weight: 238 lbs
Echocardiogram
Additional studies
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No evidence of acute PE on computed tomographic pulmonary angiogram (CTPA)
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N-terminal prohormone of brain natriuretic peptide (NT-proBNP): 1439 pg/mL
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6-minute walk distance (6MWD): 398 meters
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Assessed as WHO Functional Class II/III
Right heart catheterization
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Mean pulmonary arterial pressure (mPAP): 48 mmHg
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Right atrial pressure (RAP): 9.5 mmHg
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Pulmonary capillary wedge pressure (PCWP): 9.8 mmHg
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Cardiac output (CO): 3.1 L/min
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Cardiac index (CI): 1.9 L/min/m2
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ulmonary vascular resistance (PVR): 792 dyn∙sec∙cm-5
Key takeaways
Patients with confirmed PH should have a V/Q scan to rule out potentially curable (via pulmonary thromboendarterectomy) CTEPH1
A V/Q scan showing perfusion defects should prompt referral to an experienced center for further evaluation and, if CTEPH is confirmed, operability assessment1
References:
1. Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(suppl D):D92-D99.
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