Abstract
Background Cardiopulmonary exercise testing (CPET) may provide prognostically valuable information during follow-up after pulmonary embolism (PE).
Objective To investigate the association of patterns and degree of exercise limitation, as assessed by CPET, with clinical, echocardiographic, laboratory abnormalities and quality of life (QoL) after PE.
Methods In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3-month and 12-month follow-up, including CPET. We defined cardiopulmonary limitation as ventilatory inefficiency or insufficient cardiocirculatory reserve. Deconditioning was defined as peak VO2<80% with no other abnormality.
Results Overall, 396 patients were included. At 3 months, prevalence of cardiopulmonary limitation and deconditioning was 50.1% (34.7% mild/moderate; 15.4% severe) and 12.1%, respectively; at 12 months, it was 44.8% (29.1% mild/moderate 15.7% severe) and 14.9%. Cardiopulmonary limitation and its severity were associated with age (OR per decade 2.05; 95% CI 1.65–2.55), history of chronic lung disease (OR 2.72; 95% CI 1.06–6.97), smoking (OR 5.87; 2.44–14.15), and intermediate- or high-risk acute PE (OR 4.36; 95% CI 1.92–9.94). Severe cardiopulmonary limitation at 3 months was associated with the prospectively defined, combined clinical-haemodynamic endpoint of “post-PE impairment” (OR 6.40, 95% CI 2.35–18.45) and with poor disease-specific and generic health-related QoL.
Conclusion Abnormal exercise capacity of cardiopulmonary origin is frequent after PE, being associated with clinical and hemodynamic impairment as well as long-term QoL reduction. CPET can be considered for selected patients with persisting symptoms after acute PE to identify candidates for closer follow-up and possible therapeutic interventions.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflicts of interest: ITF reports no conflicts of interest.
Conflicts of interest: LV reports no conflicts of interest.
Conflicts of interest: SB reports grants or contracts from Bayer, INARI, Boston Scientific, Medtronic, Bard, SANOFI, and Concept Medical; consulting fees from INARI; payment or honoraria from INARI, Boston Scientific, and Concept Medical; and support for attending meetings and/or travel from Bayer and Daiichi Sankyo.
Conflicts of interest: EA reports no conflicts of interest.
Conflicts of interest: RE reports lecture fees from Boehringer Ingelheim, OMT, Novartis, Janssen-Cilag, United Therapeutics, AstraZeneca, Berlin Chemie, research funding from Boehringer Ingelheim, OMT, Janssen-Cilag, and consulting fees from BetaPharm, OMT, Lungpacer Medical.
Conflicts of interest: GG reports personal lecture/advisory fees from Bayer HealthCare, Pfizer and LeoPharma.
Conflicts of interest: LH reports consulting fees and lecture honoraria from MSD and Janssen.
Conflicts of interest: KK reports no conflicts of interest.
Conflicts of interest: ACM reports no conflicts of interest.
Conflicts of interest: SR reports grants or contracts from Actelion, AstraZeneca, Bayer, Janssen, and Novartis; consulting fees from Abbott, Acceleron, Actelion, Bayer, Janssen, MSD, Novartis, Pfizer, United Therapeutics, and Vifor; payment or honoraria from Actelion, Bayer, BMS, Ferrer, GSK, Janssen, MSD, Novartis, Pfizer, United Therapeutics, and Vifor.
Conflicts of interest: TAM reports research funding from Inari.
Conflicts of interest: SVK reports grants or contracts from Bayer AG; consulting fees from Bayer AG, Daiichi Sankyo, and Boston Scientific; and payment or honoraria from Bayer AG, INARI Medical, MSD, Pfizer, and Bristol-Myers Squibb.
Conflicts of interest: MH reports honoraria for lectures and advisory board activities from Astra Zeneca, Bayer HealthCare, Berlin Chemie, Boehringer Ingelheim, Bristol Myes Squibb, Daichi Sankyo, Janssen, MSD, OMT, Pfizer, Santis.
Conflicts of interest: DD reports honoraria for lectures or consulting fees from Actelion, Bayer, Boehringer Ingelheim Pharma, GlaxoSmithKline, Janssen, MSD, Novartis, OMT, Pfizer, Servier and Vifor.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org