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 VL - 8 IS - 2 SP - 00572-2021 AU - Oisín Butler AU - Shinyoung Ju AU - Soeren Hoernig AU - Kai Vogtländer AU - Sameer Bansilal AU - Gustavo A. Heresi Y1 - 2022/04/01 UR - http://openres.ersjournals.com/content/8/2/00572-2021.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 >3 months after PEA were reported in 89% of patients. Overall, 89% of patients underwent one 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 approximately two-fold increase in 6-min walk distance and N-terminal prohormone of brain natriuretic protein measurements and ventilation/perfusion scans, and a four-fold increase in RHCs.Conclusions Low RHC rates suggest that many patients with PH symptoms post-PEA are not being referred for full diagnostic workup. 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.Rates of residual PH symptoms are high after PEA but referral of patients with suspected persistent/recurrent CTEPH following PEA for CTEPH-specific diagnostic assessments is suboptimal, highlighting potential gaps in CTEPH patient care post-PEA https://bit.ly/3jfUZlO ER -