Persistent dyspnea complaints at long-term follow-up after an episode of
acute pulmonary embolism: Results of a questionnaire
F.A. Kloka,⁎, J.E. Tijmensena, M.L.A. Haecka, K.W. van Kralingenb, M.V. Huismana
aSection of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
bDepartment of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands
Received 3 September 2007; received in revised form 27 December 2007; accepted 17 February 2008
Available online 22 April 2008
Background: There is a lack of information on long term complications of patients with pulmonary embolism (PE), including chronic
complaints of dyspnea.
Methods: 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.
Results: 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 (pb0.001). 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.
Conclusion: 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,
© 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Keywords: Pulmonary embolism; Follow-up; Questionnaire; Dyspnia
There is extensive literature on pulmonary embolism (PE)
focusing on its incidence, prevention, diagnostic strategies
and treatment. Long term prospective studies on the clinical
course of PE are however lacking. Patients with a first epi-
, dependent on the underlying cause of thromboembolism.
After this, patients are usually no longer subject to clinical
supervision. In spite of frequent clinical impression of per-
sisting dyspnea, no study has systematically evaluated this
phenomenon. Most follow-up studies have dealt with differ-
ent diagnostic strategies, recurrent thrombotic events, major
bleeding from anticoagulant therapy and mortality [2–6].
Little studies have follow-up for more than 2 years and des-
cribe the natural course of dyspnea complaints [7–9]. Rele-
vance of persisting dyspnea complaints is underscored by
Pengo et al , describing an incidence of 4% chronic
thromboembolic pulmonary hypertension (CTEPH) in pa-
tients after a first episode of PE. Chronic thromboembolic
pulmonary hypertension is a late complication of PE .
an average interval of 17.6 months . A total of 65 patients
European Journal of Internal Medicine 19 (2008) 625–629
Abbreviations: PE, Pulmonary embolism; PH, Pulmonary hypertension;
CTEPH, Chronic thrombo-embolic pulmonary hypertension; NYHA, New
York Heart Association; CT, Computed tomography; OR, Odds Ratio;
APPT, Activated partial thromboplastin time; ANOVA, Analysis of
variance; CI, Confidential interval.
⁎Corresponding author. LUMC (C4-70), Albinusdreef 2, Postbus 9600,
2300 RC Leiden, The Netherlands. Tel.: +3171 5262085; fax: +3171
E-mail address: F.A.Klok@LUMC.nl (F.A. Klok).
0953-6205/$ - see front matter © 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.