Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Vasc Endovascular Surg. 2023 Oct;57(7):665-672. doi: 10.1177/15385744231165152. Epub 2023 Mar 22.
Little evidence is available on post-pulmonary embolism impairment (PPEI), a recently defined complication of pulmonary embolism (PE) encompassing dysfunctional clinical and imaging parameters. In the present study, we sought to evaluate its frequency with a focus on the main components.
In this prospective registry, we included patients with a confirmed diagnosis of acute PE and focused on those with initial right ventricular (RV) dysfunction. Their baseline, pre-discharge, and 6 month follow-up clinical and imaging characteristics were recorded. The main study outcomes were incomplete RV functional recovery, exercise capacity limitations (based on the 6 minute walk test), and their combination, which defines PPEI, within six months of acute PE.
Of 170 consecutive patients with a confirmed diagnosis of acute PE, 123 accepted to participate in the follow-up study, of whom 87 had initial RV dysfunction. The 6 month rates of incomplete RV functional recovery, signs of an intermediate-to-high echocardiographic probability of PH, and exercise limitations were observed in 58.6, 32.1, and 45.9%, respectively. A total of 22 (25.2%; 95% CI 15.5-34.4%) patients had PPEI. The RV/LV ratio and the fractional area change on discharge after acute PE were more often impaired among patients with incomplete RV recovery, exercise limitations, and a high probability of PH at 6 months. In contrast, an initial impaired RV diastolic function indices appeared to characterize patients with a limited exercise capacity at 6 months.
PPEI affects one fourth of patients surviving acute PE with half of them presenting with RV dysfunction or exercise limitations.
肺栓塞后损伤（PPEI）是一种新近定义的肺栓塞（PE）并发症，包括功能障碍的临床和影像学参数。本研究旨在评估其发生率，并重点关注主要组成部分。
本前瞻性登记研究纳入了确诊为急性 PE 的患者，并重点关注了那些初始存在右心室（RV）功能障碍的患者。记录了他们的基线、出院前和 6 个月随访时的临床和影像学特征。主要研究结局为急性 PE 后 6 个月内 RV 功能不完全恢复、运动能力受限（基于 6 分钟步行试验）及其组合，定义为 PPEI。
在 170 例确诊为急性 PE 的连续患者中，有 123 例接受了随访研究，其中 87 例初始 RV 功能障碍。6 个月时，RV 功能不完全恢复、超声心动图提示中重度肺动脉高压（PH）概率高和运动受限的发生率分别为 58.6%、32.1%和 45.9%。共有 22 例（25.2%；95%置信区间 15.5-34.4%）患者出现 PPEI。在 RV 功能不完全恢复、运动受限和 6 个月时 PH 概率高的患者中，急性 PE 出院时 RV/LV 比值和射血分数分数变化较大。相比之下，初始 RV 舒张功能指标受损似乎可作为 6 个月时运动能力受限患者的特征。
PPEI 影响四分之一的急性 PE 存活患者，其中一半患者表现为 RV 功能障碍或运动受限。
