Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome. Issue 206 (October 2021)

• Record Type: Journal Article
• Authors: Boon, Gudula J.A.M.; Janssen, Steffi M.J.; Barco, Stefano; Bogaard, Harm Jan; Ghanima, Waleed; Kroft, Lucia J.M.; Meijboom, Lilian J.; Ninaber, Maarten K.; Nossent, Esther J.; Spruit, Martijn A.; Symersky, Petr; Vliegen, Hubert W.; Noordegraaf, Anton Vonk; Huisman, Menno V.; Siegerink, Bob; Abbink, Jannie J.; Klok, Frederikus A.
• Is Part Of: Thrombosis research. Issue 206(2021)
• Page Start: 66
• Page End: 75
• Publication Date: 2021-10
• Subjects: Pulmonary embolism -- Pulmonary hypertension -- Dyspnea -- Rehabilitation -- Quality of life; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.08.012
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. Objectives: To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients. Methods: 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite ≥3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures. Results: Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved ≥1 grade in 18 (67%) patients, and declined in one (3.7%). Conclusions: Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising. Highlights: We studied physiological determinants in patients with Post-Pulmonary Embolism Syndrome (PPES). Insufficient cardiopulmonary responses to exercise were common in these patients. These findings were not limited to patients with persistent vascular occlusions. Offering a 12-week pulmonary rehabilitation program seems safe and promising. 'Post-VTE Functional Status' improved after completing rehabilitation training.