Risk Stratification of Acute Pulmonary Embolism and Determining the Effect on Chronic Cardiopulmonary Complications: The REACH Study.

Hannah Stevens,Huyen Tran,James Mcfadyen,Jason Bloom,Warren Clements,Wendy Fang

doi:10.1055/s-0040-1708558

Abstract

Introduction Patients with acute pulmonary embolism (PE) are at risk of developing chronic complications including the post-PE syndrome with reduced cardiopulmonary function and chronic thromboembolism pulmonary hypertension (CTEPH). Risk stratification at PE diagnosis is an important tool in predicting early mortality; however, its use in predicting chronic complications has not been evaluated. Objective This study investigates the effect of initial risk stratification of intermediate risk and standard risk PE on the rate of development of chronic complications including right ventricular (RV) dysfunction, residual perfusion defects, and CTEPH. Methods Cases of acute PE ( n = 1,524) were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification discharge diagnosis coding for PE. Evidence of RV dysfunction and systolic blood pressure < 90 mm Hg were used to risk stratify into high, intermediate and standard risk PE. Results There were 508 patients included in the analysis. Intermediate risk PE was associated with higher rates of persistent RV dysfunction as well as residual perfusion defects on repeat imaging. The overall rate of CTEPH was low (0.6%) and there was no difference between the intermediate risk and standard risk PE groups. Conclusion These findings demonstrate that acute intermediate risk PE is associated with higher rates of RV dysfunction on follow-up imaging than standard risk PE. However, the rate of CTEPH was similar between the two groups and overall the CTEPH rate was low among all patients with intermediate and standard risk PE.

Highlights

Patients with acute pulmonary embolism (PE) are at risk of developing chronic complications including the post-PE syndrome with reduced cardiopulmonary function and chronic thromboembolism pulmonary hypertension (CTEPH)
This study investigates the effect of initial risk stratification of intermediate risk and standard risk PE on the rate of development of chronic complications including right ventricular (RV) dysfunction, residual perfusion defects, and CTEPH
These findings demonstrate that acute intermediate risk PE is associated with higher rates of RV dysfunction on follow-up imaging than standard risk PE

Summary

Introduction

Patients with acute pulmonary embolism (PE) are at risk of developing chronic complications including the post-PE syndrome with reduced cardiopulmonary function and chronic thromboembolism pulmonary hypertension (CTEPH). No formal definition yet exists, this syndrome may include components such as suboptimal cardiac function, pulmonary artery flow dynamics or pulmonary gas exchange in combination with persistent dyspnoea, reduced exercise tolerance and diminished quality of life, without an alternative explanation.[6] Prospective research has demonstrated that 44% of patients suffering from an acute PE are described having a New York Heart Association (NYHA) heart failure score of II or higher at least 6 months after PE diagnosis.[7] nearly half of all patients have exercise limitation at 1-year post-PE diagnosis as measured by peak oxygen uptake on cardiopulmonary exercise testing. These functional limitations significantly impact those affected with a reduction in health-related quality of life.[8]

Methods

Results

Conclusion