Functional Characterization of Patients with Chronic Thromboembolic Disease

Held, Matthias; Kolb, Philipp; Grün, M; Jany, B; Hübner, Gudrun; Grgic, Aleksandar; Holl, R. van Lil; Schäefers, Hans-Joachim; Wilkens, Heinrike

doi:10.1159/000447247

Cited by 92 publications

(87 citation statements)

References 23 publications

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“…Assuming that persisting or progressive functional and/or hemodynamic impairment after acute PE is an early indicator of the subsequent development of CTEPH, PPEI has been defined as a coprimary outcome in the FOCUS study . Indeed, a recent cohort study demonstrated that patients fulfilling all diagnostic criteria of CTEPH despite elevation of mean pulmonary artery pressure (a condition called “chronic thromboembolic disease”) showed similar objective functional impairment using cardiopulmonary exercise testing compared to patients with CTEPH . These assumptions become of clinical importance if aiming to define who, when, and how patients should be followed after acute PE.…”

Section: Discussionmentioning

confidence: 53%

Quality of life and functional limitations after pulmonary embolism and its prognostic relevance

Keller

Tesche

Gerhold‐Ay

et al. 2019

Journal of Thrombosis and Haemostasis

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BackgroundWhile the importance of patients’ quality of life (QoL) in chronic cardiac or pulmonary disease is uncontroversial, the burden of an acute pulmonary embolism (PE) on QoL has received little attention thus far.ObjectivesWe aimed to validate the German PEmb‐QoL questionnaire, identify associations between QoL and clinical/functional parameters, and investigate the prognostic relevance of QoL for long‐term survival in survivors of an acute PE episode.Patients/MethodsPatients were invited for a clinical follow‐up visit including assessment of QoL using the German PEmb‐QoL questionnaire 6 months after an objectively confirmed PE at a single center. Internal consistency reliability, construct‐related validity, and regressions between PEmb‐QoL and clinical patient‐characteristics were assessed using standard scale construction techniques.ResultsOverall, 101 patients [median age, 69 ([interquartile range] IQR 57‐75) years; women, 48.5%] were examined 208 (IQR 185‐242) days after PE. Internal consistency reliability and construct‐related validity of the PEmb‐QoL questionnaire were acceptable. As many as 47.0% of patients reported dyspnea, 27.5% had right ventricular (RV) dysfunction on transthoracic echocardiography (TTE), and 25.3% were diagnosed with post‐PE impairment (PPEI) at 6‐month follow‐up. Furthermore, 15.9% of patients were diagnosed with depression 6 months after an acute PE. The QoL was affected by dyspnea, preexisting pulmonary disease, and PPEI, and a reduced QoL was associated with an increased risk for long‐term mortality after an observation period of 3.6 years.ConclusionsThe German PEmb‐QoL questionnaire is a reliable instrument for assessing QoL 6 months after PE. The QoL was affected by dyspnea, preexisting pulmonary disease, and PPEI and was associated with long‐term mortality.

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Section: Discussionmentioning

confidence: 53%

Quality of life and functional limitations after pulmonary embolism and its prognostic relevance

Keller

Tesche

Gerhold‐Ay

et al. 2019

Journal of Thrombosis and Haemostasis

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“…CTED patients show the same exercise limitations and symptoms as World Health Organization (WHO) Functional Class II or III CTEPH patients as described by DONAHOE et al [7]. These symptoms are in line with an inadequate response in pulmonary haemodynamics during exercise [8][9][10]. Successful PEA has been reported in a limited number of patients with CTED without mortality [9,10].…”

Section: Introductionmentioning

confidence: 78%

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

et al. 2018

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Symptomatic patients with chronic thromboembolic disease (CTED) without pulmonary hypertension often show an excessive increase in mean pulmonary arterial pressure (MPAP) during exercise.We report on the impact of pulmonary endarterectomy (PEA) on pulmonary haemodynamics in a prospective series of 32 consecutive CTED patients who underwent PEA. All patients had a comprehensive diagnostic work-up including right heart catheterisation at baseline and 12 months after PEA. Furthermore, in 12 patients exercise right heart catheterisation was performed before and after PEA.After PEA, MPAP was lower at rest (20±3 17±3 mmHg; p=0.008) and during maximal exercise (39±8 31±6 mmHg; p=0.016). The mean total pulmonary resistance (TPR) decreased from 3.6±0.8 Wood Units (WU) pre-operatively to 2.7±0.7 WU 1 year after PEA (p=0.004) and the mean slope of the MPAP/cardiac output (CO) relationship decreased from 3.6±1.0 to 2.3±0.8 WU (p=0.002). Peak oxygen uptake increased from 1.2±0.4 to 1.5±0.3 L·min (p=0.014) and ventilatory equivalents of carbon dioxide decreased from 39±2 to 30±2 (p=0.002). There was a significant improvement in quality of life assessed by the Cambridge Pulmonary Hypertension Outcome Review questionnaire.In CTED patients, PEA resulted in haemodynamic and clinical improvements. The means of TPR and MPAP/CO slopes decreased to <3.0 WU.

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“…To further complicate the issue, the term “chronic thromboembolic disease” is increasingly used in the medical literature in recent years. While most experts agree that chronic thromboembolic disease is defined as persistent pulmonary vascular occlusion in the absence of pulmonary hypertension, it remains controversial whether actual documented impaired physical performance should also be part of chronic thromboembolic disease 25, 26. It might be interesting to hypothesize that post‐PE syndrome includes a spectrum of post‐PE patients: from those with symptoms and exercise intolerance with no or mild residual imaging abnormalities (as described in this paper), to those with symptoms, residual vascular obstruction, but minimal hemodynamic abnormalities (chronic thromboembolic disease), to full‐blown chronic thromboembolic pulmonary hypertension with symptoms, residual vascular obstruction and pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

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

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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.

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Functional Characterization of Patients with Chronic Thromboembolic Disease

Cited by 92 publications

References 23 publications

Quality of life and functional limitations after pulmonary embolism and its prognostic relevance

Quality of life and functional limitations after pulmonary embolism and its prognostic relevance

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

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

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