Chronic Thromboembolic Pulmonary Hypertension: Risk Factors and Clinical Determinants in Adult Nigerian Patients

A bstract Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism defined by mean pulmonary arterial pressure greater than 20 mm Hg in the presence of organized, non-acute, thromboembolic by-products and altered vascular remodeling in the pulmonary vasculature. Data on this life-threatening but potentially treatable disease condition are lacking in Sub-Saharan African. Objectives: This study was designed to evaluate the clinical symptoms and signs associated with CTEPH and to determine their discriminatory value in predicting CTEPH among adult Nigerian patients with PH. Materials and Methods: The case notes of patients who had moderate to severe PH on transthoracic echocardiography in the absence of left heart disease were used for the study from July 2015 to April 2022. All the patients had computer tomography (CT) pulmonary angiography to determine the cause of the PH. Demographic data, presenting complaints, physical signs, and associated clinical conditions were extracted from the case notes. Results: A total of 46 patients with echocardiographic findings of PH were identified. These comprised 38 females and eight males with a mean age of 47.76 ± 13.37 years. On subsequent CT angiography, 30 patients had radiological evidence of CTEPH. A significant female preponderance for CTEPH was observed ( Χ 2 = 6.73; P < 0.01). Age, the presence of obesity (body mass index > 30), diabetes, and uterine fibroids were significantly found in patients with CTEPH. Conclusion: The presence of suggestive symptoms in obese, young, or middle-aged diabetic women should raise a high index of suspicion for CTEPH for prompt investigation and intervention. Early primary prevention is recommended in this category of patients to prevent or halt disease progression.