Skip to main content
ISTH 2024 Main banner
Back
CME Evaluation

Oral Communication Session

Venous Thromboembolism

Session: Chronic thromboembolic pulmonary hypertension

OC 42.1 - Optimizing the InShape algorithm for non-invasive exclusion of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the InShape IV study

Monday, June 24, 2024
14:45 – 15:00 ICT
Room: Ballroom B2

    Presenting Author(s)

  • Dieuwke Luijten, MD, PhD cadidate

    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

    • Co-Author(s)

  • LV

    Luca Valerio

    MD, PhD
    Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    Mainz, Rheinland-Pfalz, Germany

  • GB

    Gudula J.A.M. Boon

    MD, PhD
    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

  • Stefano Barco

    MD, PhD
    Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
    Zurich, Zurich, Switzerland

  • HB

    Harm Jan Boogaard

    MD, PhD, prof
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • MD

    Marion Delcroix

    MD, PhD, prof
    Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • KK

    Karl-Friedrich Kreitner

    MD, PhD
    Department of Radiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    Mainz, Rheinland-Pfalz, Germany

  • MH

    Menno V. Huisman

    Professor of Medicine
    Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, The Netherlands.
    Leiden, Zuid-Holland, Netherlands

  • LJ

    Luis Jara-Palomares

    MD, PhD
    Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla
    Sevilla, Andalucia, Spain

  • LK

    Lucia J.M. Kroft

    MD, PhD
    Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • AM

    Albert T.A. Mairuhu

    MD, PhD
    Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
    the Hague, Zuid-Holland, Netherlands

  • LM

    Lilian J. Meijboom

    MD, PhD
    Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • Tv

    Thijs E. van Mens

    MD, PhD
    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

  • MN

    Maarten K. Ninaber

    MD, PhD
    Department of pulmonology, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • EN

    Esther J. Nossent

    MD, PhD
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • PP

    Piotr Pruszcyk

    MD, PhD, prof
    Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
    Warsaw, Mazowieckie, Poland

  • SR

    Stephan Rosenkranz

    MD, PhD, prof
    Department of Cardiology, Heart Center at the University Hospital Cologne, and Cologne Cardiovascular Research Center, Cologne, Germany
    Cologne, Nordrhein-Westfalen, Germany

  • AV

    Anton Vonk Noordegraaf

    MD, PhD, prof
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • SK

    Stavros Konstantinides

    MD, PhD, prof
    Center for Thrombosis and Hemostasis (CTH), University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
    Mainz, Rheinland-Pfalz, Germany

  • Erik Klok, MD, PhD, FESC

    Leiden University Medical Center

Background: The most accurate and efficient sequence of tests for the early diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in pulmonary embolism (PE) survivors is unknown. The InShape II algorithm safely rules out CTEPH (failure rate 0.34%) while requiring echocardiography in only 15% of patients, but may be improved by adding imaging data.

Aims: We aimed to improve the InShape II algorithm by incorporating detailed computed tomography pulmonary angiogram (CTPA) assessment of clot morphology and signs of pulmonary hypertension.

Methods: Twelve hypothetical new algorithms were considered based on the CTEPH prediction score, ECG reading, NTproBNP assessment, echocardiography and dedicated CTPA reading, and post-hoc evaluated two acute PE follow-up cohorts: the international InShape II cohort (n=341) and German FOCUS cohort (n=171) (figure 1). We evaluated the failure rate of each algorithm, defined as the incidence of confirmed CTEPH in patients with PE in whom echocardiography was deemed unnecessary by the algorithm at baseline, as well as the overall net reclassification index (NRI) compared to the InShape II algorithm.

Results: Algorithm B, starting with reading the index CTPA, on which the PE was diagnosed, for 6 signs of CTEPH, followed by ECG/BNP assessment and echocardiography resulted in the most beneficiary change compared to the InShape II strategy. In the InShape II cohort, this new algorithm would have resulted in a need for echocardiography in 20% with a failure rate of 0%, for a NRI of +3.5, reflecting improved performance compared to the InShape II algorithm (table 1). In the FOCUS cohort, based on this new algorithm 23% would have required echocardiography, no CTEPH would have been missed and the NRI would have been +7.2.

Conclusion(s): Dedicated CTPA reading improved the performance of the InShape II algorithm and may be a valuable test to select acute PE survivors who require echocardiography to rule out CTEPH.