Persistent dyspnea complaints at long-term follow-up after an episode of acute pulmonary embolism: Results of a questionnaire

Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
European Journal of Internal Medicine (Impact Factor: 2.89). 01/2009; 19(8):625-9. DOI: 10.1016/j.ejim.2008.02.006
Source: PubMed


There is a lack of information on long term complications of patients with pulmonary embolism (PE), including chronic complaints of dyspnea.
Consecutive patients with a prior diagnosis of acute PE and an age and gender matched control group with no medical history of PE were presented with a questionnaire, designed to establish the presence, severity and possible causes of dyspnea in the clinical course of PE.
The questionnaire was taken in 48 PE-survivors 40+/-7.4 months after PE; 27 patients (56%) had complaints of dyspnea. Sixteen (35%) were categorized as NYHA class II, 6 (13%) as class III and 5 (10%) as class IV. Overall, 19 patients (70%) had new or worsened complaints after PE. The study included 61 controls. Corrected for gender, age and medical history, the control group was significantly less dyspnoeic compared to the PE survivors (p<0.001). Corrected for gender and age, patients were 4 times more often in NYHA class II (OR 3.6 95%CI 1.4-9.7) and 7-fold more often in NYHA class III or IV (OR 6.5 95%CI 1.7-24), both compared to control subjects.
A large percentage of patients with prior PE have persistent complaints of dyspnea at long term follow-up. The majority of them developed new or worsened dyspnea after the thrombo-embolic event. In comparison to a control population without a medical history of VTE, PE patients were overall significantly more dyspnoeic. An explanation for this phenomenon needs to be studied in further functional work-up of these patients.

11 Reads
  • Source
    • "As a result, patients with PTS report significant disability and impaired quality of life [5]. Although a previous diagnosis of acute pulmonary embolism (PE) has been found to frequently have a negative impact on both physical performance and quality of life [6] [7], and chronic thromboembolic pulmonary hypertension (CTEPH) is a well-known long-lasting complication of acute PE associated with poor thrombus resolution and altered pulmonary artery hemodynamics [8] [9], a comprehensive definition of a " post-PE syndrome " has not been proposed yet, let alone a pathophysiological explanation for such a syndrome. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Long-term follow-up studies have consistently demonstrated that after an episode of acute pulmonary embolism (PE), half of patients report functional limitations and/or decreased quality of life up to many years after the acute event. Incomplete thrombus resolution occurs in one-fourth to one-third of patients. Further, pulmonary artery pressure and right ventricular function remain abnormal despite adequate anticoagulant treatment in 10-30% of patients, and 0.5-4% is diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) which represents the most severe long term complication of acute PE. From these numbers, it seems that CTEPH itself is the extreme manifestation of a much more common phenomenon of permanent changes in pulmonary artery flow, pulmonary gas exchange and/or cardiac function caused by the acute PE and associated with dyspnea and decreased exercise capacity, which in analogy to post-thrombotic syndrome after deep vein thrombosis could be referred to as the post-pulmonary embolism syndrome. The acknowledgement of this syndrome would both be relevant for daily clinical practice and also provide a concept that aids in further understanding of the pathophysiology of CTEPH. In this clinically oriented review, we discuss the established associations and hypotheses between the process of thrombus resolution or persistence, lasting hemodynamic changes following acute PE as well as the consequences of a PE diagnosis on long-term physical performance and quality of life.
    Blood Reviews 11/2014; 28(6). DOI:10.1016/j.blre.2014.07.003 · 5.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Even though quality of life (QoL) has become a key component of medical care, there is no instrument available that specifically measures QoL after pulmonary embolism (PE). Recently, the Pulmonary Embolism Quality of Life (PEmb-QoL) Questionnaire has been developed to address this gap. To evaluate the validity of the PEmb-QoL questionnaire. We distributed the PEmb-QoL questionnaire and the Short Form-36 (SF-36) questionnaire twice among consecutive subjects with a history of objectively confirmed acute PE. Internal consistency reliability, test-retest reliability, convergent validity and criterion validity, and correlations between the PEmb-QoL and clinical patient characteristics were assessed using standard-scale construction techniques. Ninety participants completed the questionnaires twice. Internal consistency was adequate (Cronbach's alpha 0.62-0.94), as well as test-retest reliability (intra-class correlation coefficients: 0.78-0.94). Furthermore, correlation between the PEmb-QoL questionnaire and the SF-36 questionnaire supported convergent validity. Age, obesity, cardiopulmonary comorbidity, centrally located PE and a family history of venous thromboembolism were shown to be independent determinants of disease-specific QoL. The PEmb-QoL questionnaire is a reliable instrument to specifically assess QoL following PE, which is helpful in the identification of patients with decreased QoL following acute PE.
    Journal of Thrombosis and Haemostasis 12/2009; 8(3):523-32. DOI:10.1111/j.1538-7836.2009.03726.x · 5.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This thesis describes the diagnostic management, short term prognosis and long term complications of pulmonary embolism. We have validated a newly derived clinical decision rule, the revised Geneva score, for predicting the pre-test probability of having acute pulmonary embolism. This rule can be used in clinical practice to managge patients with suspected pulmonary embolism. We further found that NT-pro-BNp levels are the best predictors of benign clinical course, when compared to troponin and D-dimer levels, and CT derived maesurements of the right ventricular volume and function. Finally, we demonstrate that although the incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism is very low, the long term clinical course after pulmonary embolism is complicated frequently by mortalitity, recurrent venous thombosis, newly diagnosed maligancies and arterial cardiovascular events.
Show more


11 Reads
Available from