Incomplete echocardiographic recovery at 6 months predicts long-term sequelae after intermediate-risk pulmonary embolism. A post-hoc analysis of the Pulmonary Embolism Thrombolysis (PEITHO) trial

Abstract

Introduction Symptoms and functional limitation are frequently reported by survivors of acute pulmonary embolism (PE). However, current guidelines provide no specific recommendations on which patients should be followed after acute PE, when follow-up should be performed, and which tests it should include. Definition and classification of late PE sequelae are evolving, and their predictors remain to be determined. Methods In a post hoc analysis of the Pulmonary Embolism Thrombolysis (PEITHO) trial, we focused on 219 survivors of acute intermediate-risk PE with clinical and echocardiographic follow-up 6 months after randomisation as well as over the long term (median, 3 years after acute PE). The primary outcome was a composite of (1) confirmed chronic thromboembolic pulmonary hypertension (CTEPH) or (2) ‘post-PE impairment’ (PPEI), defined by echocardiographic findings indicating an intermediate or high probability of pulmonary hypertension along with New York Heart Association functional class II–IV. Results Confirmed CTEPH or PPEI occurred in 29 (13.2%) patients, (6 with CTEPH and 23 with PPEI). A history of chronic heart failure at baseline and incomplete or absent recovery of echocardiographic parameters at 6 months predicted CTEPH or PPEI at long-term follow-up. Conclusions CTEPH or PPEI occurs in almost one out of seven patients after acute intermediate-risk PE. Six-month echocardiographic follow-up may be useful for timely detection of late sequelae.

One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism

“…Sustained echocardiographic improvement seems to be important for preventing the post-PE syndrome by enabling more complete functional recovery. 32 Kahn et al 8 examined 100 patients at 1 and 12 months after PE. Nearly half had exercise limitation and echocardiographic abnormalities at 1 year.…”

Risk Stratification of Acute Pulmonary Embolism and Determining the Effect on Chronic Cardiopulmonary Complications: The REACH Study

“…26 Additionally, a further post hoc analysis of the PEITHO trial suggested that 13% of those with intermediate risk PE had either post-PE syndrome or CTEPH when combining both echocardiographic findings and NYHA functional classification. 27 However, direct comparison of the functional and radiological measures in these trials should be performed with caution due to differences in the definitions of outcome measures. Our study demonstrates that initial risk stratification is useful in predicting which patients with acute PE may be at risk of developing RV dysfunction.…”

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

“…Further diagnostic evaluation e may be considered in asymptomatic patients with risk factors for CTEPH f [447][448][449]478]. C IIb CPET: cardiopulmonary exercise testing; CT: computed tomography; CTEPH: chronic thromboembolic pulmonary hypertension; PE: pulmonary embolism; PH: pulmonary hypertension; V/Q: ventilation/perfusion (lung scintigraphy).…”