RT Journal Article
SR Electronic
T1 Pulmonary perfusion defects or residual vascular obstruction and persistent symptoms after pulmonary embolism: a systematic review and meta-analysis
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 01010-2023
DO 10.1183/23120541.01010-2023
VO 10
IS 4
A1 Cimini, Ludovica Anna
A1 Luijten, Dieuwke
A1 Barco, Stefano
A1 Ghanima, Waleed
A1 Jervan, Øyvind
A1 Kahn, Susan R.
A1 Konstantinides, Stavros
A1 Lachant, Daniel
A1 Nakano, Yoshihisa
A1 Ninaber, Maarten
A1 van Es, Josien
A1 van Mens, Thijs
A1 Vonk Noordegraaf, Anton
A1 Becattini, Cecilia
A1 Klok, Frederikus A.
YR 2024
UL https://publications.ersnet.org//content/10/4/01010-2023.abstract
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