PT  - JOURNAL ARTICLE
AU  - Cimini, Ludovica Anna
AU  - Luijten, Dieuwke
AU  - Barco, Stefano
AU  - Ghanima, Waleed
AU  - Jervan, Øyvind
AU  - Kahn, Susan R.
AU  - Konstantinides, Stavros
AU  - Lachant, Daniel
AU  - Nakano, Yoshihisa
AU  - Ninaber, Maarten
AU  - van Es, Josien
AU  - van Mens, Thijs
AU  - Vonk Noordegraaf, Anton
AU  - Becattini, Cecilia
AU  - Klok, Frederikus A.
TI  - Pulmonary perfusion defects or residual vascular obstruction and persistent symptoms after pulmonary embolism: a systematic review and meta-analysis
AID  - 10.1183/23120541.01010-2023
DP  - 2024 Jul 01
TA  - ERJ Open Research
PG  - 01010-2023
VI  - 10
IP  - 4
4099  - https://publications.ersnet.org//content/10/4/01010-2023.short
4100  - https://publications.ersnet.org//content/10/4/01010-2023.full
SO  - erjor2024 Jul 01; 10
AB  - Introduction: 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.Methods: We performed a systematic review and meta-analysis including studies assessing both the presence of perfusion defects or residual vascular obstruction and functional recovery (i.e. 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.Results: 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%, I2=82%) remained symptomatic during follow-up, compared to 34% (95% CI 20–51%, I2=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; I2=0%, τ=0). Notably, there was no association between these defects and quality of life or cardiopulmonary exercise test parameters.Conclusion: 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.Perfusion defects or residual vascular obstruction are associated with persistent symptoms after acute pulmonary embolism with a pooled odds ratio of 2.15, although direct causality could not be proven https://bit.ly/4cvHc5h