Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism

Background Little data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary emb...

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Bibliographic Details
Published in:Journal of the American Heart Association Vol. 7; no. 5
Main Authors: Albaghdadi, Mazen S., Dudzinski, David M., Giordano, Nicholas, Kabrhel, Christopher, Ghoshhajra, Brian, Jaff, Michael R., Weinberg, Ido, Baggish, Aaron
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 06.03.2018
Wiley
Subjects:
Adult
Aged
echocardiography
Echocardiography, Doppler
exercise physiology
Exercise Test
Exercise Tolerance
Female
Health Status
Humans
Hypertrophy, Right Ventricular - diagnostic imaging
Hypertrophy, Right Ventricular - physiopathology
Longitudinal Studies
Male
Middle Aged
Original Research
Oxygen Consumption
Predictive Value of Tests
Prospective Studies
pulmonary embolism
Pulmonary Embolism - diagnosis
Pulmonary Embolism - physiopathology
Pulmonary Embolism - therapy
Quality of Life
Recovery of Function
Time Factors
Ventricular Dysfunction, Right - diagnostic imaging
Ventricular Dysfunction, Right - physiopathology
Ventricular Function, Right
pulmonary embolism
quality of life
exercise physiology
echocardiography
ISSN:2047-9980, 2047-9980
Online Access:Get full text
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Summary:Background Little data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary embolism. Methods and Results Survivors of submassive or massive pulmonary embolism (n=20, age 57±13.3 years, 8/20 female) underwent clinical evaluation, transthoracic echocardiography, and cardiopulmonary exercise testing at 1 and 6 months following hospital discharge. At 1 month, 9/20 (45%) patients had New York Heart Association II or greater symptoms, 13/20 (65%) demonstrated either persistent RV dilation or systolic dysfunction, and 14/20 (70%) had objective exercise impairment as defined by a peak oxygen consumption (V˙O2) of <80% of age‐sex predicted maximal values (16.25 [13.4–20.98] mL/kg per minute). At 6 months, no appreciable improvements in symptom severity, RV structure or function, and peak V˙O2 (17.45 [14.08–22.48] mL/kg per minute, P=NS) were observed. No patients demonstrated an exercise limitation attributable to either RV/pulmonary vascular coupling, as defined by a VE/VCO2 slope >33, or a pulmonary mechanical limit to exercise at either time point. Similarly, persistent RV dilation or dysfunction was not significantly related to symptom burden or peak V˙O2 at either time point. Conclusions Persistent symptoms, abnormalities of RV structure and function, and objective exercise limitation are common among survivors of massive and submassive pulmonary embolism. Functional impairment appears to be attributable to general deconditioning rather than intrinsic cardiopulmonary limitation, suggesting an important role for prescribed exercise rehabilitation as a means toward improved patient outcomes and quality of life.
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Dr Albaghdadi and Dr Dudzinski are co‐first authors.
Dr Weinberg and Dr Baggish are co‐senior authors.
Conflict of interest: Equity Investment, Embolitech.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.117.006841