The impact of post-pulmonary embolism syndrome and its possible determinants. Issue 171 (November 2018)

• Record Type: Journal Article
• Authors: Tavoly, Mazdak; Wik, Hilde S.; Sirnes, Per-Anton; Jelsness-Jørgensen, Lars-Petter; Ghanima, Josef P.; Klok, Frederikus A.; Sandset, Per-Morten; Ghanima, Waleed
• Is Part Of: Thrombosis research. Issue 171(2018)
• Page Start: 84
• Page End: 91
• Publication Date: 2018-11
• Subjects: PE pulmonary embolism -- HRQoL health-related quality of life -- 6MWT 6-min walking test -- CTEPH chronic thromboembolic pulmonary hypertension -- CTPA computed tomography pulmonary angiogram -- V/Q-scan ventilation/perfusion scintigraphy -- BMI body mass index -- PESI pulmonary embolism severity index score -- RV/LV-ratio right ventricle to left ventricle ratio -- BNP brain natriuretic peptide -- CCI Charlson comorbidity index -- PEmb-QoL Pulmonary embolism quality of life questionnaire -- NYHA New York heart association -- Sp02 peripheral oxygen saturation -- ADL activities of daily living -- TTE transthoracic echocardiography -- TAPSE tricuspid annular plane systolic excursion -- estPASP estimated pulmonary artery systolic pressure -- pTRV peak tricuspid regurgitation velocity -- RVGLS the global longitudinal strain of the RV free wall -- LVEF left ventricle ejection fraction -- LVGLS left ventricular global longitudinal strain -- LAVI left atrial volume index -- MBPEC mean bilateral proximal extension of the clot -- SD standard deviation -- IQR interquartile range -- VIF variance inflation factor -- SPSS statistical package for social science -- CI confidence interval; Dyspnea -- Exercise capacity -- Post-PE syndrome -- Pulmonary embolism -- Quality of life; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2018.09.048
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Recent studies suggest that up to 50% of patients surviving pulmonary embolism (PE) may suffer from post-PE syndrome, which is defined by persistent dyspnea, impaired exercise capacity and/or decreased health-related quality of life (HRQoL). The possible determinants of post-PE syndrome are however not fully established. Aims: To describe the differences between dyspneic and non-dyspneic PE-patients and to explore determinants of dyspnea, 6-min walking test (6MWT) and HRQoL. Material and methods: In this cross-sectional study, consecutive patients diagnosed with PE between 2002 and 2011 at Østfold Hospital, Norway were identified from hospital registries. Patients were scheduled for clinical examination and a 6MWT. Dyspnea was assessed by the New York Heart Association (NYHA) classification. HRQoL was assessed with PEmb-QoL questionnaire. PE severity was assessed with PESI score, mean bilateral proximal extent of the clot and right-/left ventricle-ratio (RV/LV-ratio). Results: 203 patients participated in this study, of which 96 patients reported dyspnea (47%). Median time from diagnosis was 3.6 years (IQR 1.9–6.5). Patients without dyspnea performed better on 6MWT (488 m vs 413 m, p < 0.005) and had better HRQoL results (p < 0.005). None of the variables we examined, including Charlson comorbidity index, was independently associated with dyspnea. However, higher RV/LV ratio at diagnosis was significantly associated with reduced 6MWT at follow-up. Further, ongoing anticoagulation and unemployment were independently associated with impaired HRQoL. Conclusions: PE-survivors complaining of dyspnea suffer from impaired HRQoL and reduced exercise capacity. Although PE-severity factors were associated with reduced exercise capacity, none of the examined factors were found to be independent determinants of dyspnea. Highlights: Persistent dyspnea, reduced 6MWT and impaired HRQoL are independently associated. Impaired post-PE recovery cannot simply be explained by patient comorbidities. Higher RV/LV-ratio at diagnosis predicted reduced 6MWT results. Unemployment and ongoing anticoagulation predicted impaired HRQoL.