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Functional capacity and dyspnea during follow-up after acute pulmonary embolism

Background - Dissecting the determinants of functional capacity during long-term follow-up after acute pulmonary embolism (PE) can help to better characterize a patient population with persisting limitation. - Methods - In a prospective cohort study, consecutive unselected survivors of acute PE unde...

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Main Authors: Farmakis, Ioannis T. (Author) , Valerio, Luca (Author) , Barco, Stefano (Author) , Christodoulou, Konstantinos C. (Author) , Ewert, Ralf (Author) , Giannakoulas, George (Author) , Held, Matthias (Author) , Hobohm, Lukas (Author) , Keller, Karsten (Author) , Wilkens, Heinrike (Author) , Rosenkranz, Stephan (Author) , Konstantinides, Stavros V. (Author)
Format: Article (Journal)
Language:English
Published: January 2024
In: Journal of thrombosis and haemostasis
Year: 2024, Volume: 22, Issue: 1, Pages: 163-171
ISSN:1538-7836
DOI:10.1016/j.jtha.2023.08.024
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jtha.2023.08.024
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1538783623006529
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Author Notes:Ioannis T. Farmakis, Luca Valerio, Stefano Barco, Konstantinos C. Christodoulou, Ralf Ewert, George Giannakoulas, Matthias Held, Lukas Hobohm, Karsten Keller, Heinrike Wilkens, Stephan Rosenkranz, Stavros V. Konstantinides
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Summary:Background - Dissecting the determinants of functional capacity during long-term follow-up after acute pulmonary embolism (PE) can help to better characterize a patient population with persisting limitation. - Methods - In a prospective cohort study, consecutive unselected survivors of acute PE underwent 3- and 12-month follow-up, including six-minute walking distance (6MWD) and dyspnea assessment with the modified Medical Research Council (mMRC) scale. We used reference equations adjusting for age, sex, and anthropometric measurements to define abnormal 6MWD. - Results - Overall, 323 of 363 (89.0%) patients had at least one recorded 6MWD value at one year. At 3 months, the prevalence of abnormal 6MWD was 21.9% and at 12 months it was 18.3%. At 3 and 12 months, 58.8% and 52.1% with abnormal 6MWD did not report dyspnea, respectively. On average and during follow-up, 6MWD significantly improved with time, while the mMRC dyspnea scale did not. Abnormal 6MWD was associated with younger age (odds ratio per decade, 0.91; 95% CI, 0.88-0.94), higher body mass index (1.10; 1.03-1.17), smoking (3.53; 1.34-9.31), intermediate- or high-risk PE (3.21; 1.21-8.56), and higher mMRC grading (2.28; 1.59-3.27). Abnormal 6MWD at 3 months was associated with the prospectively defined endpoint of post-PE impairment (3.72; 1.50-9.28) and with poor disease-specific and generic health-related quality of life. - Conclusion - Three months after PE, 37% of patients reported dyspnea and 22% had abnormal 6MWD. After a year, 20% still had abnormal 6MWD. Dyspnea correlated with abnormal 6MWD, but over 50% of patients with abnormal 6MWD did not report dyspnea. Abnormal 6MWD predicted subsequent post-pulmonary embolism impairment and worse long-term quality of life. - Clinical Trial Registration - German Clinical Trials Register Identifier DRKS00005939.
Item Description:Online verfügbar: 29. August 2023, Artikelversion: 1. Januar 2024
Gesehen am 24.06.2024
Physical Description:Online Resource
ISSN:1538-7836
DOI:10.1016/j.jtha.2023.08.024

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