Pulmonary and cardiac variables associated with persistent dyspnea after pulmonary embolism. Issue 201 (May 2021)

• Record Type: Journal Article
• Authors: Jervan, Øyvind; Gleditsch, Jostein; Tavoly, Mazdak; Klok, Frederikus A.; Rashid, Diyar; Holst, René; Steine, Kjetil; Stavem, Knut; Ghanima, Waleed
• Is Part Of: Thrombosis research. Issue 201(2021)
• Page Start: 90
• Page End: 99
• Publication Date: 2021-05
• Subjects: A transmitral late diastolic filling peak velocity -- BMI body mass index -- CTEPH chronic thromboembolic pulmonary hypertension -- CTPA computed tomography pulmonary angiography -- DLCO diffusion capacity of the lung for carbon monoxide -- E transmitral early diastolic filling peak velocity -- E' early diastolic annular mitral velocity -- EF ejection fraction -- ESC European Society of Cardiology -- FVC forced vital capacity -- GLS global longitudinal strain -- ISWT Incremental Shuttle Walk Test -- LV left ventricular -- mMRC modified Medical Research Council -- PE pulmonary embolism -- RV right ventricular -- TAPSE tricuspid annular plane systolic excursion -- V/Q ventilation/perfusion -- VTE venous thromboembolism; Dyspnea -- Echocardiography -- Pulmonary embolism -- Radionuclide imaging -- Respiratory function tests; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.02.014
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Persistent dyspnea is common in follow-up after pulmonary embolism (PE), but the underlying mechanisms are poorly understood. Material and methods: This cross-sectional study included subjects aged 18–75 years with confirmed PE by computed tomography pulmonary angiography (CTPA) 6–72 months earlier. A total of 180 participants underwent clinical examination, incremental shuttle walk test, laboratory tests, transthoracic echocardiography, pulmonary function tests and ventilation/perfusion scintigraphy. In further analysis, we divided participants into two groups; "dyspnea" or "no dyspnea", based on interview and questionnaires at inclusion. The association of cardiac and pulmonary variables with persistent dyspnea was assessed using multiple logistic regression analysis. Results: In total, 44% (95% CI: 39%–51%) of the participants reported persistent dyspnea after PE. Age (adjusted odds ratio (aOR) 0.93 per year, 95% CI: 0.90–0.97, P = 0.001), body mass index (BMI) (aOR 1.14 per kg/m 2, 95% CI: 1.04–1.25, P = 0.004), recurrent venous thromboembolism (VTE) (aOR 3.69, 95% CI: 1.45–9.38, P = 0.006) and diffusion capacity of the lung for carbon monoxide (DLCO) (aOR 0.95 per increase of 1%, 95% CI: 0.92–0.98, P = 0.001) were independently associated with persistent dyspnea. Conclusions: Persistent dyspnea was prevalent after PE. Age, BMI and recurrent VTE were independently associated with dyspnea. Apart from reduced DLCO, no other cardiac or pulmonary variables were associated with persistent dyspnea. Highlights: Persistent dyspnea is common after pulmonary embolism (PE). The underlying mechanisms are poorly understood. We studied PE survivors without major cardiopulmonary comorbidities. 44% reported persistent dyspnea at median 19 months after the PE event. Carbon monoxide diffusion capacity was independently associated with dyspnea.