Cimini Ludovica Anna, Luijten Dieuwke, Barco Stefano, Ghanima Waleed, Jervan Øyvind, Kahn Susan R, Konstantinides Stavros, Lachant Daniel, Nakano Yoshihisa, Ninaber Maarten, van Es Josien, van Mens Thijs, Vonk Noordegraaf Anton, Becattini Cecilia, Klok Frederikus A
Vascular and Emergency Medicine, University of Perugia, Perugia, Italy.
L.A. Cimini and D. Luijten contributed equally and share first authorship.
ERJ Open Res. 2024 Jul 29;10(4). doi: 10.1183/23120541.01010-2023. eCollection 2024 Jul.
Up to 50% of pulmonary embolism (PE) patients have perfusion defects or residual vascular obstruction during follow-up despite adequate anticoagulant treatment, and a similar percentage experience chronic functional limitations and/or dyspnoea post-PE. We aimed to evaluate the association between pulmonary perfusion defects or residual vascular obstruction and functional recovery after PE.
We performed a systematic review and meta-analysis including studies assessing both the presence of perfusion defects or residual vascular obstruction and functional recovery ( persistent symptoms, quality of life, exercise endurance). An odds ratio was pooled for perfusion defects or residual vascular obstruction and persistent symptoms using a random-effect model.
12 studies were included totalling 1888 PE patients; at a median of 6 months after PE (range 2-72 months), 34% had perfusion defects or residual vascular obstruction and 37% reported persistent symptoms. Among patients with perfusion defects or residual vascular obstruction, 48% (95% CI 37-60%, I=82%) remained symptomatic during follow-up, compared to 34% (95% CI 20-51%, I=96%) of patients without such defects. Presence of perfusion defects or residual vascular obstruction was associated with persistent symptoms (OR 2.15, 95% CI 1.66-2.78; I=0%, τ0). Notably, there was no association between these defects and quality of life or cardiopulmonary exercise test parameters.
While the odds of having persistent symptoms was higher in patients with perfusion defects or residual vascular obstruction after acute PE, a significant proportion of these patients reported no limitations. A possible causality between perfusion defects or residual vascular obstruction and residual functional limitation therefore remains to be proven.
尽管接受了充分的抗凝治疗，但高达50%的肺栓塞（PE）患者在随访期间仍存在灌注缺损或残余血管阻塞，且有相似比例的患者在PE后出现慢性功能受限和/或呼吸困难。我们旨在评估肺灌注缺损或残余血管阻塞与PE后功能恢复之间的关联。
我们进行了一项系统评价和荟萃分析，纳入评估灌注缺损或残余血管阻塞的存在以及功能恢复（持续症状、生活质量、运动耐力）的研究。使用随机效应模型汇总灌注缺损或残余血管阻塞与持续症状的比值比。
纳入12项研究，共1888例PE患者；在PE后中位6个月（范围2 - 72个月）时，34%有灌注缺损或残余血管阻塞，37%报告有持续症状。在有灌注缺损或残余血管阻塞的患者中，48%（95%可信区间37% - 60%，I² = 82%）在随访期间仍有症状，而无此类缺损的患者为34%（95%可信区间20% - 51%，I² = 96%）。灌注缺损或残余血管阻塞的存在与持续症状相关（比值比2.15，95%可信区间1.66 - 2.78；I² = 0%，τ² = 0）。值得注意的是，这些缺损与生活质量或心肺运动试验参数之间无关联。
虽然急性PE后有灌注缺损或残余血管阻塞的患者出现持续症状的几率较高，但这些患者中有很大一部分报告无功能受限。因此，灌注缺损或残余血管阻塞与残余功能受限之间的可能因果关系仍有待证实。
