Study on the Clinical Course Of Pulmonary Embolism (SCOPE)
The course of both pulmonary embolism (PE) and one of its more relevant late complications, i.e. chronic thromboembolic pulmonary hypertension (CTEPH) is still substantially unknown.
Recent evidence has shown that the incidence of CTEPH is higher than previously believed, but this has not been confirmed by other studies. A clear link between PE and CTEPH has been questioned by some experts. A great number of patients affected by PE persistently have residual chronic thromboembolic material the meaning of which is a matter of debate. The evidence sustaining a link between chronic residual PE and subsequent PE recurrences or CTEPH is insufficient.
Thus, a nationwide, multicentre, prospective cohort study was designed with the following aims:
- to ascertain the actual incidence of symptomatic CTEPH after a first episode of acute PE;
- to ascertain the actual incidence of venous thromboembolic (VTE) recurrences after a first episode of acute PE;
- to evaluate whether a relation exists between chronic residual PE and CTEPH
- to evaluate whether a relation exists between chronic residual PE and VTE recurrences;
- to evaluate whether a relation exists between persistent right ventricular dysfunction and CTEPH;
- to evaluate whether a relation exists between persistent right ventricular dysfunction and PE recurrences.
For each enrolling centre, consecutive outpatients or inpatients with an objectively diagnosed first acute PE episode are considered eligible.
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Study on the Clinical Course Of Pulmonary Embolism|
- Incidence of chronic thromboembolic pulmonary hypertension [ Time Frame: within the first 5 years ] [ Designated as safety issue: No ]
- Incidence of recurrent venous thromboembolic events [ Time Frame: whitin 5 years ] [ Designated as safety issue: No ]
- Incidence of all-cause mortality [ Time Frame: whitin 5 years ] [ Designated as safety issue: No ]
- Incidence of Pulmonary Embolism - related mortality [ Time Frame: within 5 years ] [ Designated as safety issue: No ]
|Study Start Date:||January 2008|
|Estimated Study Completion Date:||March 2015|
|Estimated Primary Completion Date:||December 2014 (Final data collection date for primary outcome measure)|
Consecutive outpatients and inpatients with first episode of acute pulmonary embolism
All patients enrolled in the study receive a diagnosis of PE by means of chest CT scan, lung scanning or pulmonary angiography. All patients should undergo an echocardiographic examination during the acute phase of PE, when this is possible. All patients are treated according to current international guidelines and local protocols. All surviving patients undergo an echocardiographic examination after 6 weeks and 6 months. All surviving patients undergo a perfusional pulmonary scintigraphy at 6 months and are subsequently followed up every 6 months for at least 3 years.
In case of clinical suspicion of VTE recurrence a diagnostic procedure is performed in order to confirm the recurrent VTE episode ( Chest CT scan, lung scan, Pulmonary angiography, compressive ultrasound, phlebography, vein CT scan).
In case of clinical suspicion of CTEPH, a further diagnostic workup is performed, consisting in echocardiography, ventilation/perfusion lung scanning, multidetector chest CT scanning, and pulmonary angiography, with direct measurement of the pulmonary-artery pressure.
The extension of pulmonary embolism during the acute phase is graded according to a standardized scoring system by local investigators while the extension of chronic residual pulmonary embolism is graded according to a standardized scoring system by both local investigators and an independent committee. All outcome events are centrally adjudicated by an independent committee.
All clinical data ( initial data on medical history, clinical symptoms, presence of risk factors, diagnoses, diagnostic tests results, treatment type and duration, outcome events and other) are collected by the local investigators in an electronic medical database. Related data will be sent to the coordinating centre on a regular basis. All recruiting centres will be regularly monitored by the coordinating Centre.
|Study Director:||Raffaele Pesavento, MD||University of Padua|
|Study Chair:||Paolo Prandoni, MD,PHD||University of Padua|
|Study Chair:||Antonio Pagnan, MD||University of Padua|
|Study Chair:||Gualtiero Palareti, MD||University of Bologna - Italy|
|Study Chair:||Antonio Palla, MD||University of Pisa - Italy|
|Study Chair:||Vittorio Pengo, MD||University of Padua|
|Study Chair:||Franco Piovella, MD||University of Pavia - Italy|