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: 2.3). 01/2009; 19(8):625-9. DOI: 10.1016/j.ejim.2008.02.006
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Background The functional capacity of long-term survivors of submassive pulmonary embolism (PE) is unreported. A six-minute walk distance (6MWD) <350m and reduced heart rate recovery (HRR) indicate adverse prognosis in various chronic diseases. Methods Long-term survivors of acute PE (January 2000-June 2005) were invited to undergo prospectively planned six-minute walk test (6MWT), transthoracic echocardiogram (TTE), clinical and biochemical evaluation with cardiac biomarkers. HRR was calculated as the difference between heart rate at 6-minutes during and at 1-minute post 6MWT. Results 120 patients (52 males; mean age [±standard deviation]-65±14years) were identified 7.7±1.4years after PE. 6MWD was significantly lower than that predicted after adjustment for age, sex, and height (448±114m vs 475±89m, p=0.005), and 16% (17/104) had 6MWD <350m. Among patients with no baseline comorbidities at follow-up (Charlson comorbidity index=0), 8% (4/52) had 6MWD <350m. Resting TTE identified 29% of patients had raised right ventricular (RV) pulmonary pressure (pulmonary arterial systolic pressure [PASP]>36mmHg) and 13% had impaired RV function. Patients with 6MWD<85% predicted had significantly greater impairment of RV longitudinal function (p<0.001), higher PASP (p<0.001) and pulmonary vascular resistance (p<0.001), elevated NT-proBNP (p=0.03) and high-sensitivity troponin-T (HsTropT, p=0.03), but similar left ventricular systolic and diastolic function, to those with normal 6MWT. Conclusions Apparently well, long-term survivors of PE demonstrate impaired exercise capacity, heart rate recovery, mild pulmonary hypertension, raised PVR and right ventricular dysfunction associated with elevated NT-proBNP and HsTropT.
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