Recommendations for the diagnosis and pre-operative assessment of chronic thromboembolic pulmonary hypertension (CTEPH)
| Statement | Class# | Level¶ |
| The diagnosis of CTEPH is based on the presence of pre-capillary PH (P̄pa ≥25 mmHg, PWP ≤15 mmHg, PVR >2 Wood units) in patients with multiple chronic/organised occlusive thrombi/emboli in the elastic pulmonary arteries (main, lobar, segmental, subsegmental) | I | C |
| Once perfusion scanning and/or CT angiography show signs compatible with CTEPH, the patient should be referred to a centre with expertise in surgical pulmonary endarterectomy | IIa | C |
| The selection of patients for surgery should be based on the extent and location of the organised thrombi, on the degree of PH and on the presence of comorbidities | IIa | C |
PH: pulmonary hypertension; P̄pa: mean pulmonary arterial pressure; PWP: pulmonary wedge pressure; PVR: pulmonary vascular resistance; CT, computed tomography. #: I: evidence and/or general agreement that a given treatment or procedure is beneficial, useful or effective; II: conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure (IIa, weight of evidence/opinion is in favour of usefulness/efficacy); ¶: C: consensus of opinion of the experts and/or small studies, retrospective studies or registries. Modified from [14].