PT - JOURNAL ARTICLE AU - Dieuwertje Ruigrok AU - M. Louis Handoko AU - Lilian J. Meijboom AU - Esther J. Nossent AU - Anco Boonstra AU - Natalia J. Braams AU - Jessie van Wezenbeek AU - Robert Tepaske AU - Pieter Roel Tuinman AU - Leo M.A. Heunks AU - Anton Vonk Noordegraaf AU - Frances S. de Man AU - Petr Symersky AU - Harm-Jan Bogaard TI - Non-invasive follow-up strategy after pulmonary endarterectomy for CTEPH AID - 10.1183/23120541.00564-2021 DP - 2022 Jan 01 TA - ERJ Open Research PG - 00564-2021 4099 - http://openres.ersjournals.com/content/early/2022/02/18/23120541.00564-2021.short 4100 - http://openres.ersjournals.com/content/early/2022/02/18/23120541.00564-2021.full AB - Background The success of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is usually evaluated by performing a right heart catheterisation (RHC). Here, we investigate whether residual pulmonary hypertension (PH) can be sufficiently excluded without the need for a RHC, by making use of early postoperative hemodynamics, or NT-proBNP, cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) 6 months after PEA.Methods In an observational analysis, residual PH after PEA measured by RHC was related to hemodynamic data from the postoperative ICU time and data from a 6-month follow-up assessment including NT-proBNP, TTE and CPET. After dichotomisation and univariate analysis, sensitivity, specificity, positive predictive value, negative predictive value (NPV) and likelihood ratios were calculated.Results Thirty-six out of 92 included patients had residual PH 6 months after PEA (39%). Correlation between early postoperative and 6-month follow-up mean pulmonary artery pressure was moderate (Spearman rho 0.465, p<0.001). Early hemodynamics did not predict late success. NT-proBNP>300 ng L−1 had insufficient NPV (0.71) to exclude residual PH. Probability for PH on TTE had a moderate NPV (0.74) for residual PH. Peak oxygen consumption (VO2)<80% predicted had the highest sensitivity (0.85) and NPV (0.84) for residual PH.Conclusions CPET 6 months after PEA, and to a lesser extent TTE can be used to exclude residual CTEPH, thereby safely reducing the number of patients needing to undergo re-RHC after PEA.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.