TY - JOUR T1 - Assessment for residual disease after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00572-2021 SP - 00572-2021 AU - Oisín Butler AU - Shinyoung Ju AU - Soeren Hoernig AU - Kai Vogtländer AU - Sameer Bansilal AU - Gustavo A. Heresi Y1 - 2022/01/01 UR - http://openres.ersjournals.com/content/early/2022/04/07/23120541.00572-2021.abstract N2 - Objectives Pulmonary endarterectomy (PEA) is recommended for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is potentially curative. However, persistent/recurrent CTEPH post-PEA can occur. Here we describe symptom and diagnostic assessment rates for residual disease post-PEA and longitudinal diagnostic patterns before and after riociguat approval for persistent/recurrent CTEPH after PEA.Methods This US retrospective cohort study analysed MarketScan data (1 January 2002–30 September 2018) from patients who underwent PEA following a CTEPH/pulmonary hypertension (PH) claim with at least 730 days of continuous enrolment post-PEA. Data on pre-specified PH symptoms and the types and timings of diagnostic assessments were collected.Results Of 103 patients (pre-riociguat approval, n=55; post-riociguat approval, n=48), residual PH symptoms more than 3 months after PEA were reported in 89% of patients. Overall, 89% of patients underwent 1 or more diagnostic tests (mean 4.6 tests/patient), most commonly echocardiography (84%), with only 5% of patients undergoing right heart catheterisation (RHC). In the post- versus pre-riociguat approval subgroup, assessments were more specific for CTEPH with an approximate 2-fold increase in 6-minute walking distance and N-terminal prohormone of brain natriuretic protein measurements and ventilation/perfusion scans, and a 4-fold increase in RHCs.Conclusions Low RHC rates suggest that many patients with PH symptoms post-PEA are not being referred for full diagnostic work-up. Changes to longitudinal diagnostic patterns may indicate increased recognition of persistent/recurrent CTEPH post-PEA; however, there remains a need for greater awareness around the importance of continued follow-up for patients with residual PH symptoms post-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.Conflict of Interest: Oisin Butler is a current employee of Bayer AG.Conflict of Interest: Shinyoung Ju is a current employee of Bayer AG. Contracts have been received from GlaxoSmithKline, outside the submitted work.Conflict of Interest: Soeren Hoering is a current employee of Bayer AG.Conflict of Interest: Kai Vogtlander is a current employee of Bayer AG.Conflict of Interest: Sameer Bansilal is a current employee of Bayer HealthCare Pharmaceuticals.Conflict of Interest: Gustavo A. Heresi reports receiving advisory board fees from Bayer HealthCare and Janssen Pharmaceuticals, outside the submitted work. ER -