Short Attention Span Summary
PE - Not Just an Acute Illness
Fibrinolysis is indicated for massive PE, and recent studies suggest it may also be helpful in reducing the incidence of chronic pulmonary hypertension in those with submassive PE (which makes one unable to exert without dyspnea...no more jogging or tennis). See this for an excellent review of pertinent studies. This study sheds more light on how common residual dyspnea is post-PE. At one year follow up, almost half the patients with PE had decreased VO2 and dyspnea, although echo findings had normalized in the dyspneic patients. Deconditioning could explain this, at least in part. There is not an action you should take based on this study. It is meant to create awareness that PE is not only an acute disease; it can lead to chronic dyspnea (not to mention the post-phlebitic leg pain that is common after large DVT).
PE may cause chronic dyspnea in almost half of affected patients. As we learn more, we may be able to better target which people with submassive PE benefit from fibrinolysis.
Chest. 2016 Dec 5. pii: S0012-3692(16)62555-2. doi: 10.1016/j.chest.2016.11.030. [Epub ahead of print]
1Department of Medicine, Jewish General Hospital, Montreal, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada. Electronic address: email@example.com.
2Department of Medicine, Jewish General Hospital, Montreal, Canada.
3Center for Clinical Epidemiology, Lady Davis Institute, Montreal, Canada.
4Department of Medicine, Dalhousie University, Halifax, Canada.
5Department of Medicine, The University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Canada.
6Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Canada.
7Department of Medicine, McGill University, Montreal, Canada.
8Department of Medicine, Division of Hematology, Western University, London, Canada.
9Department of Cardiology, Ben Gurion University, Beer Sheva, Israel.
10Department of Diagnostic Imaging, University of Ottawa, Ottawa, Canada.
11Department of Nuclear Medicine, Jewish General Hospital, Montreal, Canada.
12Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
13Division of Respirology, Department of Medicine, University of Toronto, Toronto, Canada.
We aimed to determine the frequency and predictors of exercise limitation after pulmonary embolism (PE), and to assess its association with health-related quality of life (HRQOL) and dyspnea.
100 patients with acute PE were recruited at five Canadian hospitals from 2010-2013. Cardiopulmonary exercise testing (CPET) was performed at 1 and 12 months. Quality of life, dyspnea, six-minute walk distance (6MWD), residual clot burden (perfusion (Q) scan; CT pulmonary angiography (CTPA)), cardiac function (echocardiogram) and pulmonary function tests (PFT) were measured during follow-up. The prespecified primary outcome was percent-predicted peak oxygen uptake (VO2 peak) <80% on 1-year CPET.
At 1-year, 40/86 (46.5%) of patients had percent-predicted VO2 peak <80% on CPET, which was associated with significantly worse generic HRQOL, PE-specific HRQOL and dyspnea scores, and significantly reduced 6MWD at 1-year. Predictors of the primary outcome included male sex (relative risk (RR)= 3.2 [95% CI 1.3-8.1]), age (RR 0.98 [0.96-0.99] per 1-year age increase), body mass index (BMI) (RR 1.1 [1.01-1.2] per 1 kg/m2 BMI increase), and smoking history (RR 1.8 [1.1-2.9]), as well as percent-predicted VO2 peak <80% on 1-month CPET (RR 3.8 [1.9-7.2]) and 6MWD at 1-month (RR 0.82 [0.7-0.9] per 30m increased walking distance). Baseline or residual clot burden were not associated with the primary outcome. Mean PFT and echocardiogram (pulmonary artery pressure, right and left ventricular systolic function) results at 1 year were similarly within normal limits in exercise limited and non-exercise limited patients.
Almost half of PE patients have exercise limitation at 1 year which adversely influences HRQOL, dyspnea and walking distance. CPET or 6MWD testing at 1-month may help to identify patients with a higher risk of exercise limitation at 1-year after PE. Based on our results, we believe that deconditioning that occurs after acute PE could underlie this exercise limitation, but cannot exclude that this may have been present pre-PE.
Copyright © 2016. Published by Elsevier Inc.
PMID: 27932051 [PubMed - as supplied by publisher]