Functional and Exercise Limitations After a First Episode of Pulmonary Embolism

Kahn, Susan R.; Hirsch, Andrew; Akaberi, Arash; Hernández, Paul; Anderson, David R.; Wells, Philip S.; Rodger, Marc; Solymoss, Susan; Kovacs, Michael J.; Rudski, Lawrence; Shimony, Avi; Dennie, Carole; Rush, Christopher; Geerts, William; Aaron, Shawn D.; Granton, John

doi:10.1016/j.chest.2016.11.030

Cited by 198 publications

(135 citation statements)

References 33 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…As was previously reported,4 the intra‐class correlation coefficient for inter‐rater concordance on the CTPA obstruction index was 0.96 (95% CI 0.90, 0.98) and for % PVO on Q scan was 0.96 (95% CI 0.89, 0.98), indicating excellent agreement.…”

Section: Resultssupporting

confidence: 81%

“…A detailed chart of patient flow was previously published 4. Mean (SD) age was 50 (15) years, 57% were male, and 80% were outpatients.…”

Section: Resultsmentioning

confidence: 99%

“…Patients attended study visits at baseline, 1, 3, 6, and 12 months. At the 1‐ and 12‐month visits, CPET was performed in the pulmonary function laboratory of the respective hospital (details of CPET protocol were previously described4). …”

Section: Methodsmentioning

confidence: 99%

“…Mortality after untreated acute PE has been estimated to be as high as 30%,1 but with current treatment standards, has decreased to as low as 1.8% 2. Despite current success in acute PE treatment, up to 4.8% of PE patients continue to develop long‐term sequelae such as chronic thromboembolic pulmonary hypertension, or more commonly, exercise limitation 3, 4. To date, there is a paucity of research aimed at identifying patients at risk to experience persistent long‐term functional limitation after PE.…”

Section: Introductionmentioning

confidence: 99%

“…As a planned sub‐study of the prospective, multicenter ELOPE (Evaluation of Longterm Outcomes after PE) Study,4 we aimed to describe the results of serial imaging by CTPA and perfusion scan during 1 year after a first episode of acute PE, and to assess the association between imaging parameters and exercise limitation at 1 year.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Serial imaging after pulmonary embolism and correlation with functional limitation at 12 months: Results of the ELOPE Study

Kahn

Akaberi

et al. 2018

Research and Practice in Thrombosis and Haemostasis

Self Cite

View full text Add to dashboard Cite

Essentials Exercise Limitation 1 year after an acute pulmonary embolism is common.Serial imaging after acute pulmonary embolism is not well described and how it affects exercise limitation remains unknown.1 year after an acute pulmonary embolism chronic changes are common, more so on perfusion lung scanning than CT pulmonary angiography, but imaging findings did not predict exercise limitation. IntroductionRisk factors for exercise limitation after acute pulmonary embolism (PE) are unknown. As a planned sub‐study of the prospective, multicenter ELOPE (Evaluation of Long‐term Outcomes after PE) Study, we aimed to describe the results of serial imaging by computed tomography pulmonary angiography (CTPA) and perfusion scan during 1 year after a first episode of acute pulmonary embolism, and to assess the association between imaging parameters and exercise limitation at 1 year.MethodsIn a prospective cohort study, 100 patients were recruited between June 2010 and February 2013 at five Canadian university–affiliated hospitals. CT pulmonary angiography was performed at baseline and 12 months, perfusion scan at 6 and 12 months, and cardio‐pulmonary exercise testing at 1 and 12 months. Imaging parameters included: on CT pulmonary angiography, CT obstruction index (CTO) (% clot burden in the pulmonary vasculature), and on perfusion scan, pulmonary vascular obstruction (PVO) (% perfusion defect). Abnormal cardio‐pulmonary exercise test (primary outcome) was defined as percent of predicted peak oxygen uptake (VO2) <80%.ResultsMean (median; SD) CT obstruction index was 28.1% (27.5%; 18.3%) at baseline, 1.2% (0%; 4.3%) at 12 months. Mean (median; SD) pulmonary vascular obstruction was 6.0% (0%; 9.6%) at 6 months, 5.6% (0%; 9.8%) at 12 months. Eighty‐six patients had exercise testing at 12 months, and 46.5% had VO2 < 80% predicted. Mean (median; SD) CT obstruction index at 1 year was similar in patients with percent‐predicted VO2 peak <80% vs >80% on 1‐year cardio‐pulmonary exercise testing (1.4% [0%; 5.7%] vs 1.0% [0%; 2.4%]; P = .70). Mean (SD) pulmonary vascular obstruction at 6 and at 12 months was similar in patients with percent‐predicted VO2 peak <80% vs >80% (6 months: 5.9% [0%; 10.4%] vs 6.2% [4.5%; 9.0%]; P = .91; 12 months: 5.1% [0%; 10.2%] vs 6.0% [0%; 9.7%]; P = .71).ConclusionsImaging findings after pulmonary embolism did not predict exercise limitation. Residual thrombus does not appear to explain long‐term functional limitation after pulmonary embolism.

show abstract

Section: Resultssupporting

confidence: 81%

“…A detailed chart of patient flow was previously published 4. Mean (SD) age was 50 (15) years, 57% were male, and 80% were outpatients.…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Serial imaging after pulmonary embolism and correlation with functional limitation at 12 months: Results of the ELOPE Study

Kahn

Akaberi

et al. 2018

Research and Practice in Thrombosis and Haemostasis

Self Cite

View full text Add to dashboard Cite

show abstract

Acute Pulmonary Embolism

Freund

Cohen‐Aubart

Bloom

2022

JAMA

View full text Add to dashboard Cite

ImportancePulmonary embolism (PE) is characterized by occlusion of blood flow in a pulmonary artery, typically due to a thrombus that travels from a vein in a lower limb. The incidence of PE is approximately 60 to 120 per 100 000 people per year. Approximately 60 000 to 100 000 patients die from PE each year in the US.ObservationsPE should be considered in patients presenting with acute chest pain, shortness of breath, or syncope. The diagnosis is determined by chest imaging. In patients with a systolic blood pressure of at least 90 mm Hg, the following 3 steps can be used to evaluate a patient with possible PE: assessment of the clinical probability of PE, D-dimer testing if indicated, and chest imaging if indicated. The clinical probability of PE can be assessed using a structured score or using clinical gestalt. In patients with a probability of PE that is less than 15%, the presence of 8 clinical characteristics (age &lt;50 years, heart rate &lt;100/min, an oxygen saturation level of &gt; 94%, no recent surgery or trauma, no prior venous thromboembolism event, no hemoptysis, no unilateral leg swelling, and no estrogen use) identifies patients at very low risk of PE in whom no further testing is needed. In patients with low or intermediate clinical probability, a D-dimer level of less than 500 ng/mL is associated with a posttest probability of PE less than 1.85%. In these patients, PE can be excluded without chest imaging. A further refinement of D-dimer threshold is possible in patients aged 50 years and older, and in patients with a low likelihood of PE. Patients with a high probability of PE (ie, &gt;40% probability) should undergo chest imaging, and D-dimer testing is not necessary. In patients with PE and a systolic blood pressure of 90 mm Hg or higher, compared with heparin combined with a vitamin K antagonist such as warfarin followed by warfarin alone, direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, are noninferior for treating PE and have a 0.6% lower rate of bleeding. In patients with PE and systolic blood pressure lower than 90 mm Hg, systemic thrombolysis is recommended and is associated with an 1.6% absolute reduction of mortality (from 3.9% to 2.3%).Conclusions and RelevanceIn the US, PE affects approximately 370 000 patients per year and may cause approximately 60 000 to 100 000 deaths per year. First-line therapy consists of direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, with thrombolysis reserved for patients with systolic blood pressure lower than 90 mm Hg.

show abstract

Effect of a Physiotherapist-Guided Home-Based Exercise Intervention on Physical Capacity and Patient-Reported Outcomes Among Patients With Acute Pulmonary Embolism

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Survivors of acute pulmonary embolism (PE) experience long-term negative physical and mental consequences, but the effects of rehabilitation on outcomes among these patients have not been investigated.OBJECTIVE To investigate the effect of a rehabilitation intervention, comprising an 8-week homebased exercise program and nurse consultations, on physical capacity and patient-reported outcomes among patients with acute PE. DESIGN, SETTING, AND PARTICIPANTSThis multicenter randomized clinical superiority trial was conducted at 4 regional hospitals and 1 university hospital in Denmark. The 140 consecutively included participants had been diagnosed with an acute PE between April 2016 and February 2018 and had 6 months of follow-up. An intention-to-treat analysis was conducted.INTERVENTION Patients in the control group received a brief nurse consultation, while patients in the exercise group participated in an 8-week home-based exercise program in addition to receiving nurse consultations. MAIN OUTCOMES AND MEASURESThe primary outcome was the Incremental Shuttle Walk Test, and secondary outcomes were the Pulmonary Embolism Quality of Life and the EuroQol-5Dimensions-3 Levels questionnaires, self-reported number of sick-leave days, and self-reported use of psychotropic drugs. RESULTSA total of 140 patients (90 [64.3%] men) were included, with a mean (SD) age of 61 (11) years. Of 70 participants (50.0%) randomized to each group, 69 participants (49.3%) received the intervention and 68 (48.6%) received the control intervention. Both groups achieved improvements in all outcomes (eg, mean [SD] improvement on Incremental Shuttle Walk Test: control group, 78 (127) m; intervention group, 104 [106] m; median [interquartile range] improvement on Pulmonary Embolism Quality of Life: control group, −17 [−22 to −11] points; intervention group, −20 [−24 to −15]points). Between-group differences were nonsignificant. The mean differences between the intervention group and the control group were 25 m (95% CI, −20 to 70 m; P = .27) on the Incremental Shuttle Walk Test, 3.0 points (95% CI, −3.7 to 9.9 points; P = .39) on the Pulmonary Embolism Quality of Life questionnaire, and 0.017 point (95% CI, −0.032 to 0.065 point; P = .50) on the EuroQol-5 Dimensions-3 Levels questionnaire. Of the 27 patients in the intervention group on sick leave at baseline, 24 (88.9%) reported fit-for-duty at the 6-month follow-up, and of 18 patients (continued) Key Points Question Can a rehabilitation intervention consisting of physiotherapist-guided home-based exercise intervention and nurse consultations improve physical capacity and quality of life among patients with acute pulmonary embolism more than nurse consultations alone? Findings In this randomized clinical trial of 140 participants, improvements in physical capacity and quality of life were achieved with no differences between the intervention and control groups. No adverse events were reported.Meaning Adding an exercise intervention to nurse consultations did not increase physical capac...

show abstract

Functional and Exercise Limitations After a First Episode of Pulmonary Embolism

Cited by 198 publications

References 33 publications

Serial imaging after pulmonary embolism and correlation with functional limitation at 12 months: Results of the ELOPE Study

Serial imaging after pulmonary embolism and correlation with functional limitation at 12 months: Results of the ELOPE Study

Acute Pulmonary Embolism

Effect of a Physiotherapist-Guided Home-Based Exercise Intervention on Physical Capacity and Patient-Reported Outcomes Among Patients With Acute Pulmonary Embolism

Contact Info

Product

Resources

About