Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Abstract

SummaryBackground and hypothesis: Hemodynamic and functional consequences of acute pulmonary embolism (APE) are believed to be reversible with antithrombotic treatment. To verify this hypothesis, we reassessed our patients at least 1 year after an episode of APE.Methods: We compared echo Doppler indices and 6-min walking test parameters (6-MWT) of 36 patients (13 men, 23 women, age 66 ± 11 years), studied on average 3.1 ± 2.2 years after an acute episode of pharmacologically treated massive or submassive APE, with data of 30 age-matched subjects (12 men, 18 women, age 67 ± 12 years).Results: At least 1 year after APE, right ventricular (RV) diameter remained increased in patients compared with controls (27 ± 2 vs. 23 ± 2 mm, p < 0.001). Also, acceleration time of pulmonary ejection (AcT) was markedly shorter (97 ± 19 vs. 123 ± 19 ms, p < 0.001) and the diameter of the pulmonary trunk was significantly larger in patients than in controls (21 ± 2.6 vs. 18 ± 2.2, p < 0.001). Although the mean value of the tricuspid valve peak systolic gradient (TVPG) in the APE group at follow-up was similar to that in controls, TVPG > 30 mmHg was recorded in three patients with APE (8.3%). There was no difference in the distance of 6-MWT between both groups; however, the mean desaturation after 6-MWT was higher in the APE group than in controls (3.04 ± 2.08 vs. 1.45 ± 0.69%, p = 0.0005).

Right ventricle injury during acute pulmonary embolism leads to its remodeling

“…Previously, it was reported that survivors of APE do present larger diameters of RV when compared to age and sex matched controls [9]. However, myocardial injury was not evaluated in this study.…”

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

“…31 RV damage sustained at the time of the PE can reduce the heart's ability to adapt to exercise. [32][33][34][35] In one study of PE patients with high pulmonary pressures on admission, 57% treated with anticoagulation alone had residual pulmonary arterial hypertension after 28 months of follow up. 21 In a separate study of 144 anticoagulated submassive PE patients, 27% of patients were found to have higher pulmonary pressures at the 6-month follow up than at the initial presentation.…”

Echocardiographic evolution of pulmonary artery pressure after acute pulmonary embolism. Results from IPER registry

“…In spite of the low accuracy of echo-Doppler to correctly measure the degree of PH [4,5], echocardiography remains to date the most utilized and often the only method to investigate, both in the acute phase and over time, the course of pulmonary artery systolic pressure (PAsP). Several studies considered the echocardiographic follow-up at least 6 months after an episode of acute PE [6][7][8][9][10][11][12][13][14]. Some of them [13,14] correlated the value of echocardiographycally derived PAsP in the acute phase with the persistence of PH 12 or 16 months later.…”