Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism

Pesavento, Raffaele; Filippi, Lucia; Palla, Antonio; Visonà, Adriana; Bova, Carlo; Marzolo, Marco; Porro, Fernando; Villalta, Sabina; Ciammaichella, Maurizio; Bucherini, Eugenio; Nante, Giovanni; Battistelli, S; Muiesan, María Lorenza; Beltramello, Giampietro; Prisco, Domenico; Casazza, Franco; Ageno, Walter; Palareti, Gualtiero; Quintavalla, Roberto; Monti, Simonetta; Mumoli, Nicola; Zanatta, Nello; Cappelli, Roberto; Cattaneo, Marco; Moretti, Valentino; Corà, Francesco; Bazzan, M.; Ghirarduzzi, Angelo; Frigo, Anna Chiara; Miniati, Massimo; Prandoni, Paolo

doi:10.1183/13993003.01980-2016

Cited by 96 publications

(89 citation statements)

References 35 publications

(39 reference statements)

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“…The long-term course of PE is complicated by several adverse events including recurrent venous thromboembolism (VTE), development of chronic thromboembolic pulmonary hypertension (CTEPH), and major bleeding due to anticoagulant therapy. [1][2][3] Furthermore, methodically heterogeneous studies demonstrated that residual perfusion defects can be detected in up to 50% of the patients after 6 months using ventilation-perfusion lung scan [4][5][6] and that approximately 50% of patients suffer from persisting symptoms and cardiopulmonary functional limitations up to 1 year after the initial PE. 3,[7][8][9] While the long-term hemodynamic and functional consequences of an acute PE have received increasing attention during the past years, the burden of an acute PE on patients' psychological-emotional well-being and QoL has remained insufficiently studied thus far.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…6,8,9 ). Only 3 published studies have examined the effect of persistent perfusion disorders in relation to clinical endpoints 5,9,10 . Of these, only Pesavento reported that the persistence of perfusion defects after 3 years of initial TED correlates with combined endpoint of CTEPH development + TED recurrence 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Only 3 published studies have examined the effect of persistent perfusion disorders in relation to clinical endpoints 5,9,10 . Of these, only Pesavento reported that the persistence of perfusion defects after 3 years of initial TED correlates with combined endpoint of CTEPH development + TED recurrence 5 . No remaining studies have shown any statistically significant correlation of persistent defects with higher incidence of recurrence of pulmonary embolism 9 or unfavourable patient outlook 10 .…”

Section: Discussionmentioning

confidence: 99%

“…8 ), greater age 5,7 , higher degree of PE severity 7,12 , spontaneous PE (OR 1.4) (ref. 5 ), or higher TFPI or factor VIII levels 8 . Studies are however not in mutual agreement on the individual parameters constituting the risk factors of reperfusion disorders.…”

Section: Discussionmentioning

confidence: 99%

“…The only known long-term complication of PE is chronic thromboembolic pulmonary hypertension (CTEPH), which occurs in 2-3% of patients within two years of PE (ref. [2][3][4][5][6] ). The outlook in remaining PE patients is good, providing they receive appropriate treatment, and most of them (over 75%) survive in the long-term without any impact on their condition or quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Reperfusion after pulmonary embolism - long-term follow-up, risk factors, clinical impact

Mrózek¹,

Petrova²,

Vaclavkova³

et al. 2018

BIOMED PAP

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Background and Aim. Thromboembolic disease is the third most common cardiovascular disorder and deep vein thrombosis carries the risk of pulmonary embolism (PE). Questions related to reperfusion after PE remain, especially risk factors. Incomplete reperfusion after PE is closely related to the development of chronic thromboembolic pulmonary hypertension. The aim of this study was to determine the relation between reperfusion after PE in the long term over a period of 24 months, laboratory results and clinical risk factors found during the initial PE event.Patients and Methods. 85 consecutive patients with a first episode of acute PE, diagnosed at 4 cardiology clinics, were followed up using clinical evaluation, scintigraphy and echocardiography (6, 12 and 24 months after the PE. 35 patients were in the low risk category (41%), 42 (49%) in the intermediate risk group and 8 (9%) in the high risk category. Results. Perfusion defects persisted in 20 patients (26%) after 6 months, in 19 patients (25%) after 12 months and in 14 patients (19%) after 24 months. The incidence was more frequent in older patients, with more serious (higher risk) PE, increased right ventricular internal diameter during the initial episode, and more significant tricuspid insufficiency in the initial echocardiography. Notably, higher hemoglobin levels were also shown as a significant risk factor. The presence of perfusion defects after 24 months correlated with a concurrent higher pulmonary pressure but not with either patient function or adverse events (recurrence of PE, re-hospitalization or bleeding). In 3 cases (4% of patients), long-term echocardiographic evidence of pulmonary hypertension was detected. Conclusion. Even after 24 months from acute PE with adequate anticoagulation treatment, incomplete reperfusion was found in 19% of patients with a corresponding risk of chronic thromboembolic pulmonary disease and hypertension.

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Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism

Harvey

Huang

Uberoi

2022

Cochrane Database of Systematic Reviews

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Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism

Cited by 96 publications

References 35 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

Reperfusion after pulmonary embolism - long-term follow-up, risk factors, clinical impact

Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism

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