Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism

Abstract

Survivors of acute pulmonary embolism (PE) are at risk of developing persistent, sometimes disabling symptoms of dyspnea and/or functional limitations despite adequate anticoagulant treatment, fulfilling the criteria of the post-PE syndrome (PPES). PPES includes chronic thromboembolic pulmonary hypertension (CTEPH), chronic thromboembolic pulmonary disease, post-PE cardiac impairment (characterized as persistent right ventricle impairment after PE), and post-PE functional impairment. To improve the overall health outcomes of patients with acute PE, adequate measures to diagnose PPES and strategies to prevent and treat PPES are essential. Patient-reported outcome measures are very helpful to identify patients with persistent symptoms and functional impairment. The primary concern is to identify and adequately treat patients with CTEPH as early as possible. After CTEPH is ruled out, additional diagnostic tests including cardiopulmonary exercise tests, echocardiography, and imaging of the pulmonary vasculature may be helpful to rule out non-PE–related comorbidities and confirm the ultimate diagnosis. Most PPES patients will show signs of physical deconditioning as main explanation for their clinical presentation. Therefore, cardiopulmonary rehabilitation provides a good potential treatment option for this patient category, which warrants testing in adequately designed and executed randomized trials. In this review, we describe the definition and characteristics of PPES and its diagnosis and management.

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“…Consequently, the most popular papers from each category are identified separately. Tables 3 and 4 respectively list the top 25 downloaded articles from STH in 2023 (from 2022 and 2023 inclusive), as eligible for either the “free access” ( Table 3 ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 or “general category” ( Table 4 ) 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 awards.…”

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“…Lastly, to enable tailored treatment after the first VTE, we should also consider other relevant outcomes, such as post -thrombotic syndrome and post -PE syndrome, which have a considerable impact on the quality of life of the patients. 94, 95 These long -term sequels of VTE have shared risk factors with recurrent VTE, 16,94-96 and in addition they occur more often after recurrent VTE. 97,98 Therefore, the efforts to improve treatment after the first VTE should not only focus on anticoagulant treatment duration, VTE recurrence, and bleeding, but also on other treatment modalities and outcomes.…”

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“…In Analogie zum PICS besteht in der Pneumologie bereits Erfahrung mit einer chronischen Erkrankung nach einem initial (lebensbedrohlichen) Akutereignis: das Post-Lungenarterienembolie-Syndrom. Durch persistierende Embolien entstehen fibrotische Obstruktionen mit erhöhtem pulmonalen Gefäßwiderstand und rückleitend erhöhter Rechtsherzbelastung [10]. Diese chronisch-thromboembolische Lungenerkrankung (CTEPD) kann mit pulmonaler Hypertonie einhergehen (CTEPH) und äußert sich in einer Leistungseinschränkung, chronischer Dyspnoe und letztlich auch mit Einschränkungen im Alltag.…”