Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism

Dieuwke Luijten; Cindy M. M. de Jong; Maarten K. Ninaber; Martijn A. Spruit; Menno V. Huisman; Frederikus A. Klok

doi:10.1055/s-0042-1749659

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2023; 49(08): 848-860
DOI: 10.1055/s-0042-1749659

Review Article

Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism

Dieuwke Luijten

¹Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Cindy M. M. de Jong

¹Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Maarten K. Ninaber

²Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands

,

Martijn A. Spruit

³Department of Research & Development, Ciro, Horn, The Netherlands

⁴Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands

,

Menno V. Huisman

¹Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Frederikus A. Klok

¹Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

› Author Affiliations

Abstract

Survivors of acute pulmonary embolism (PE) are at risk of developing persistent, sometimes disabling symptoms of dyspnea and/or functional limitations despite adequate anticoagulant treatment, fulfilling the criteria of the post-PE syndrome (PPES). PPES includes chronic thromboembolic pulmonary hypertension (CTEPH), chronic thromboembolic pulmonary disease, post-PE cardiac impairment (characterized as persistent right ventricle impairment after PE), and post-PE functional impairment. To improve the overall health outcomes of patients with acute PE, adequate measures to diagnose PPES and strategies to prevent and treat PPES are essential. Patient-reported outcome measures are very helpful to identify patients with persistent symptoms and functional impairment. The primary concern is to identify and adequately treat patients with CTEPH as early as possible. After CTEPH is ruled out, additional diagnostic tests including cardiopulmonary exercise tests, echocardiography, and imaging of the pulmonary vasculature may be helpful to rule out non-PE–related comorbidities and confirm the ultimate diagnosis. Most PPES patients will show signs of physical deconditioning as main explanation for their clinical presentation. Therefore, cardiopulmonary rehabilitation provides a good potential treatment option for this patient category, which warrants testing in adequately designed and executed randomized trials. In this review, we describe the definition and characteristics of PPES and its diagnosis and management.

Keywords

pulmonary embolism - cardiopulmonary rehabilitation - pulmonary hypertension - patient-reported outcome measures - echocardiography

Full Text

References

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