Quality of Life, Dyspnea, and Functional Exercise Capacity Following a First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study

Kahn, Susan R.; Akaberi, Arash; Granton, John; Anderson, David R.; Wells, Philip S.; Rodger, Marc; Solymoss, Susan; Kovacs, Michael J.; Rudski, Lawrence; Shimony, Avi; Dennie, Carole; Rush, Christopher; Hernández, Paul; Aaron, Shawn D.; Hirsch, Andrew

doi:10.1016/j.amjmed.2017.03.033

Cited by 136 publications

(180 citation statements)

References 25 publications

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“…Although the number of patients included in the present study was comparable to previous studies investigating quality of life after acute PE, the small sample size constitutes a potential limitation of our study.…”

Section: Discussionmentioning

confidence: 72%

“…Overall, in the present study, 25.3% of patients were diagnosed with PPEI at 6‐month follow‐up. In comparison, in the Evaluation of Long‐Term Outcomes after PE (ELOPE) study, following 100 patients 1, 3, 6, and 12 months after acute PE at five Canadian hospitals between 2010 and 2013, 46.5% of patients had functional limitations (defined as peak oxygen consumption <80% on cardiopulmonary exercise testing) 1 year after the PE event . The authors concluded that deconditioning might have contributed to this notably high prevalence.…”

Section: Discussionmentioning

confidence: 99%

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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: 72%

Section: Discussionmentioning

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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“…In a randomized study of thrombolysis versus placebo in 1006 patients with submassive PE (PEITHO [Pulmonary Embolism Thrombolysis] trial), ≈33% of patients reported dyspnea or a subjective impairment in functional capacity at a median of >3 years of follow‐up . Mechanisms underlying these findings remain speculative . We are aware of only 1 prior prospective study of patients with PE that utilized CPET and echocardiography in which Kahn et al examined 100 patients at 1 and 12 months following acute PE .…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, this has been illustrated in a large study of patients recovering from acute myocardial infarction, recent coronary artery bypass grafting, or new ischemic heart disease . Comparatively, few studies have comprehensively examined the cardiopulmonary physiology of recovery following acute PE . Among acute PE survivors, cross‐sectional data derived from patient questionnaires, New York Heart Association (NYHA) functional class scoring, 6‐minute walk testing, and objective exercise testing suggest that functional limitations are common and of variable severity, but there are sparse longitudinal data examining functional capacity following acute PE.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism

Albaghdadi

Dudzinski

Giordano

et al. 2018

JAHA

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BackgroundLittle data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary embolism.Methods and ResultsSurvivors of submassive or massive pulmonary embolism (n=20, age 57±13.3 years, 8/20 female) underwent clinical evaluation, transthoracic echocardiography, and cardiopulmonary exercise testing at 1 and 6 months following hospital discharge. At 1 month, 9/20 (45%) patients had New York Heart Association II or greater symptoms, 13/20 (65%) demonstrated either persistent RV dilation or systolic dysfunction, and 14/20 (70%) had objective exercise impairment as defined by a peak oxygen consumption (trueV˙O2) of <80% of age‐sex predicted maximal values (16.25 [13.4–20.98] mL/kg per minute). At 6 months, no appreciable improvements in symptom severity, RV structure or function, and peak trueV˙O2 (17.45 [14.08–22.48] mL/kg per minute, P=NS) were observed. No patients demonstrated an exercise limitation attributable to either RV/pulmonary vascular coupling, as defined by a VE/VCO 2 slope >33, or a pulmonary mechanical limit to exercise at either time point. Similarly, persistent RV dilation or dysfunction was not significantly related to symptom burden or peak trueV˙O2 at either time point.ConclusionsPersistent symptoms, abnormalities of RV structure and function, and objective exercise limitation are common among survivors of massive and submassive pulmonary embolism. Functional impairment appears to be attributable to general deconditioning rather than intrinsic cardiopulmonary limitation, suggesting an important role for prescribed exercise rehabilitation as a means toward improved patient outcomes and quality of life.

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“…[6][7][8][9] In a prospective cohort study of 100 patients with acute PE and a low rate of baseline comorbidities, 46.5% had an abnormally low maximum rate of oxygen consumption 1 year after the PE. 10 On average, these subjects had poorer healthrelated quality of life, a shorter 6-minute walk distance, and higher dyspnea scores. In some studies, incomplete recovery of lung perfusion has been associated with chronic respiratory symptoms, 11 hypoxemia, 12-14 gas exchange deficits, 13,15,16 exercise intolerance, [11][12][13][14][15][16][17][18] and increased pulmonary artery pressure.…”

Section: Introductionmentioning

confidence: 99%

How I use catheter-directed interventional therapy to treat patients with venous thromboembolism

Vedantham

Sista

2018

Blood

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Patients who present with severe manifestations of acute venous thromboembolism (VTE) are at higher risk for premature death and long-term disability. In recent years, catheter-based interventional procedures have shown strong potential to improve clinical outcomes in selected VTE patients. However, physicians continue to be routinely faced with challenging decisions that pertain to the utilization of these risky and costly treatment strategies, and there is a relative paucity of published clinical trials with sufficient rigor and directness to inform clinical practice. In this article, using 3 distinct clinical scenario presentations, we draw from the available published literature describing the natural history, pathophysiology, treatments, and outcomes of VTE to illustrate the key factors that should influence clinical decision making for patients with severe manifestations of deep vein thrombosis and pulmonary embolism. The results of a recently completed pivotal multicenter randomized trial are also discussed. (Blood. 2018;131(7):733-740) IntroductionHematologists play a crucial role in managing patients with severe manifestations of acute venous thromboembolism (VTE). Although they are often asked to advise physicians on when to use catheter-based therapies, many hematologists may feel less familiar with their nuances and pathophysiological underpinnings. Moreover, many important clinical questions are not yet directly addressed by high-quality clinical trials or evidence-based practice guidelines. In this article, we delineate key considerations relating to the natural history, pathophysiology, and outcomes of VTE, and the potential impact of interventional VTE therapies. Our goal is to strengthen the clinician's ability to individualize care for patients with severe manifestations of deep vein thrombosis (DVT) and pulmonary embolism (PE).In addition to the biology of VTE, the anatomy and physiology also matter Most recognized VTE risk factors are clinical factors that affect the physiological balance between clotting and bleeding, including both inherited conditions (eg, genetic mutations of clotting factors) and acquired conditions (eg, cancer, postoperative state, trauma, hormonal exposure). Although Virchow's Triad also includes stasis and endothelial injury, the search for therapeutic targets has been primarily focused on the biology of coagulation, and major advances in care have been largely limited to new anticoagulant drugs that prevent recurrent VTE at least as effectively and safely as do predecessor drugs.1 Anticoagulant therapy is unquestionably tremendously effective in reducing fatal PE and recurrent VTE, both important outcomes in patients with DVT and PE. However, it is also true that anticoagulant therapy is often insufficient to prevent the full range of VTE consequences that are important to patients' ability to function normally.In patients with symptomatic PE and signs of right heart strain ("submassive PE"), anticoagulant therapy is unable to prevent short-term deterioration, death,...

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Quality of Life, Dyspnea, and Functional Exercise Capacity Following a First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study

Cited by 136 publications

References 25 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

Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism

How I use catheter-directed interventional therapy to treat patients with venous thromboembolism

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