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Sistema de puntuación por TC para la distribución definida de trombos en la hipertensión pulmonar tromboembólica
Lojain L Abdulaal1,2, Michael M J Sharkey1, Ahmed A Maiter3,4
1Division of Cardiovascular Medicine, University of Sheffield.
The British journal of radiology
|September 5, 2025
Resumen
Un nuevo sistema de puntuación para la hipertensión pulmonar tromboembólica crónica (CTEPH) en la angiografía pulmonar por TC (CTPA) identifica la ubicación de la enfermedad como un predictor de la mortalidad. La CTEPH central está relacionada con una peor supervivencia, especialmente en pacientes que no se sometieron a endarterectomía pulmonar.
Área de la Ciencia:
- Cardiología
- Radiología
- Medicina de los pulmones
Sus antecedentes:
- La caracterización del trombo es crucial para el tratamiento de la hipertensión pulmonar tromboembólica crónica (HTPT).
- Es posible que los métodos de evaluación actuales no reflejen completamente el impacto pronóstico de la distribución de la enfermedad.
Objetivo del estudio:
- Desarrollar y validar un nuevo sistema de puntuación para la evaluación visual de la CTEPH en la angiografía pulmonar por TC (CTPA).
- Evaluar el impacto de la localización y extensión de trombos en los resultados de supervivencia en pacientes con PTEC.
Principales métodos:
- Análisis retrospectivo de 208 pacientes con EPIC del registro de ASPIRE.
- Desarrollo de un sistema de puntuación basado en la ubicación predominante de la enfermedad: central, segmental y distal.
- Análisis de la supervivencia mediante la regresión de Cox y las curvas de Kaplan-Meier.
Principales resultados:
- Los pacientes con EPEC central y distal presentaron una hemodinámica pulmonar más severa y una menor transferencia de gases (TLCO) en comparación con la enfermedad segmentaria.
- La enfermedad central se asoció de forma independiente con un aumento de la mortalidad en pacientes que no se sometieron a endarterectomía pulmonar (HR 1,9, p<0,01).
- El nuevo sistema de puntuación demostró un excelente acuerdo entre los observadores.
Conclusiones:
- La localización de la enfermedad tromboembólica es un predictor significativo de la mortalidad en la EPTC.
- La localización central de CTEPH está relacionada de forma independiente con una supervivencia más corta, particularmente en pacientes que no son elegibles para endarterectomía pulmonar.
- Este sistema de puntuación ofrece un nuevo marco para estratificar a los pacientes con PTEC y guiar las decisiones clínicas.
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