Cardiopulmonary exercise testing in the follow-up after acute pulmonary embolism.

Farmakis IT; Valerio L; Barco S; Alsheimer E; Ewert R; Hobohm L; Keller K; Germany.; Mavromanoli AC;
Rosenkranz S; Morris TA; Held M; Dumitrescu D;

The European respiratory journal [Eur Respir J] 2023 Mar 23.
Date of Electronic Publication: 2023 Mar 23.

Background: Cardiopulmonary exercise testing (CPET) may provide prognostically valuable information during follow-up after pulmonary embolism (PE).
Objective: To investigate the association of patterns and degree of exercise limitation, as assessed by CPET, with clinical, echocardiographic, laboratory abnormalities and quality of life (QoL) after PE.
Methods: In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3-month and 12-month follow-up, including CPET. We defined cardiopulmonary limitation as ventilatory inefficiency or insufficient cardiocirculatory reserve. Deconditioning was defined as peak VO 2 <80% with no other abnormality.
Results: Overall, 396 patients were included. At 3 months, prevalence of cardiopulmonary limitation and deconditioning was 50.1% (34.7% mild/moderate; 15.4% severe) and 12.1%, respectively; at 12 months, it was 44.8% (29.1% mild/moderate 15.7% severe) and 14.9%. Cardiopulmonary limitation and its severity were associated with age (OR per decade 2.05; 95% CI 1.65-2.55), history of chronic lung disease (OR 2.72; 95% CI 1.06-6.97), smoking (OR 5.87; 2.44-14.15), and intermediate- or high-risk acute PE (OR 4.36; 95% CI 1.92-9.94). Severe cardiopulmonary limitation at 3 months was associated with the prospectively defined, combined clinical-haemodynamic endpoint of “post-PE impairment” (OR 6.40, 95% CI 2.35-18.45) and with poor disease-specific and generic health-related QoL.
Conclusion: Abnormal exercise capacity of cardiopulmonary origin is frequent after PE, being associated with clinical and hemodynamic impairment as well as long-term QoL reduction. CPET can be considered for selected patients with persisting symptoms after acute PE to identify candidates for closer follow-up and possible therapeutic interventions.