• Mavromanoli, Anna
• Keller, K.
• Farmakis, I.
• Valerio, L.
• Barco, S.
• Alsheimer, E.
• Held, M.
• Ewert, R.
• Giannakoulas, G.
• Rosenkranz, S.
• Konstantinides, S.
• Hobohm, L.
• Dumitrescu, D.
• Morris, T. A.

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Echocardiography and cardiopulmonary exercise testing (CPET) can both provide prognostically relevant information during the follow-up after pulmonary embolism (PE).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To investigate the association of cardiopulmonary exercise limitation, as assessed by CPET, with the tricuspid regurgitation velocity (TRV) and probability of pulmonary hypertension (PH) as estimated by echocardiography after PE.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In a prospective cohort study, consecutive unselected survivors of acute PE underwent 3-month and 12-month follow-up, including echocardiography and CPET. We defined cardiopulmonary exercise limitation from CPET as at least one of VE/VCO2-slope ≥ 30 (≥ 36 for severe), or VE/VCO2-nadir ≥ 30 (≥ 36 for severe), peak O2 pulse &amp;lt; 80% of the predicted value (&amp;lt; 70% for severe). Echocardiographic probability of PH was defined according to the 2022 ESC/ERS PH Guidelines.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 395 patients were included in the analysis. On CPET performed at 3 months, cardiopulmonary exercise limitation was found in 180/360 patients (50.0%; 34.7% mild/moderate; 15.3% severe), and at 12 months in 119/267 patients (44.5%; 28.8% mild/moderate; 15.7% severe). On echocardiography at 3 months, high probability was found in 13/360 patients (3.6%) and intermediate in 60/360 patients (16.7%); at 12 months, it was 10/267 (3.8%) and 36/267 (13.5%), respectively. TRV &amp;gt;2.8 m/s (Figure 1A) and high echocardiographic probability of PH (Figure 1B) were both significantly more prevalent among patients with severe cardiopulmonary limitation (both p &amp;lt;0.001 ). For patients who had measurable and quantified TRV values (n = 246 patients), TRV was significantly weakly/moderately associated with VE/VCO2 slope and VE/VCO2 nadir, but not associated with O2 pulse (Figure 2).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Abnormal exercise capacity of cardiopulmonary origin is frequent after PE and was associated with high echocardiographic probability of PH. Still, 67% of patients with severe cardiopulmonary limitation after PE exhibit low echocardiographic probability PH, thus supporting the argument to upgrade the role of CPET in the follow-up of patients after acute PE.Figure 1Figure 2</jats:p></jats:sec>

Topics

• impedance spectroscopy
• size-exclusion chromatography