Abstract
IntroductionSymptoms and functional limitation are frequently reported by survivors of acute pulmonary embolism (PE). However, current guidelines provide no specific recommendations on which patients should be followed after acute PE, when follow-up should be performed, and which tests it should include. Definition and classification of late PE sequelae are evolving, and their predictors remain to be determined.MethodsIn a post hoc analysis of the Pulmonary Embolism Thrombolysis (PEITHO) trial, we focused on 219 survivors of acute intermediate-risk PE with clinical and echocardiographic follow-up 6 months after randomisation as well as over the long term (median, 3 years after acute PE). The primary outcome was a composite of (1) confirmed chronic thromboembolic pulmonary hypertension (CTEPH) or (2) ‘post-PE impairment’ (PPEI), defined by echocardiographic findings indicating an intermediate or high probability of pulmonary hypertension along with New York Heart Association functional class II–IV.ResultsConfirmed CTEPH or PPEI occurred in 29 (13.2%) patients, (6 with CTEPH and 23 with PPEI). A history of chronic heart failure at baseline and incomplete or absent recovery of echocardiographic parameters at 6 months predicted CTEPH or PPEI at long-term follow-up.ConclusionsCTEPH or PPEI occurs in almost one out of seven patients after acute intermediate-risk PE. Six-month echocardiographic follow-up may be useful for timely detection of late sequelae.
Highlights
Symptoms and functional limitation are frequently reported by survivors of acute pulmonary embolism (PE)
Of 709 intermediate-risk patients randomised at the Pulmonary Embolism Thrombolysis (PEITHO) sites which participated in the extension of the followup period, 136 patients died and 13 were lost during follow-up [13]
We investigated the long-term clinical and haemodynamic course of 219 survivors of acute intermediate-risk PE presenting with right ventricular (RV) dysfunction and positive cardiac biomarkers, who had been enrolled in the PEITHO trial [12]
Summary
Symptoms and functional limitation are frequently reported by survivors of acute pulmonary embolism (PE). Methods In a post hoc analysis of the Pulmonary Embolism Thrombolysis (PEITHO) trial, we focused on 219 survivors of acute intermediate-risk PE with clinical and echocardiographic follow-up 6 months after randomisation as well as over the long term (median, 3 years after acute PE). Persisting symptoms and abnormalities of cardiorespiratory function or of echocardiographic parameters are frequently reported or detected after acute pulmonary embolism (PE). The frequent clinical need for caring for these patients is not met by current guidelines, which provide no specific advice on whom, when, and how to follow after acute PE [8]. The definition of PPEI continues to evolve, and it is hoped that the results of ongoing studies will help to further optimise the detection, prediction, and classification of late PE sequelae [10]
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