Key result
Right ventricular to pulmonary artery uncoupling during exercise was associated with increased ventilatory inefficiency (V̇E/V̇CO2 slope 47.6 vs 32.4, p=0.03) compared with controls.
Why the study?
Data on right ventricular exercise adaptation following acute intermediate and high-risk pulmonary embolism remain limited.
Does combined stress echocardiography and cardiopulmonary exercise testing identify impaired right ventricular functional recovery in survivors of intermediate and high-risk acute pulmonary embolism?
Observational (n=30)
Yes
Does combined stress echocardiography and cardiopulmonary exercise testing identify impaired right ventricular functional recovery in survivors of intermediate and high-risk acute pulmonary embolism?
Absolute Event Rate: 47.6% vs 32.4%
p-value: p=0.03
Combined stress echocardiography and CPET at 3 months post-pulmonary embolism identifies impaired right ventricular adaptation in nearly one-third of patients, potentially aiding in the early detection of chronic thromboembolic pulmonary vascular disease.
RV recovery data post-intermediate/high-risk PE remain sparse; leaves open optimal exercise assessment and rehabilitation strategies.
Background Data on right ventricular (RV) exercise adaptation following acute intermediate and high-risk pulmonary embolism (PE) remain limited. This study aimed to evaluate the symptom burden, RV functional recovery during exercise and cardiopulmonary exercise parameters in survivors of intermediate and high-risk acute PE. Methods We prospectively recruited patients following acute intermediate and high-risk PE at four sites in Australia and UK. Study assessments included stress echocardiography, cardiopulmonary exercise testing (CPET) and ventilation–perfusion (VQ) scan at 3 months follow-up. Results Thirty patients were recruited and 24 (median age: 55 years, IQR: 22) completed follow-up. Reduced peak oxygen consumption (VO 2 ) and workload was seen in 75.0% (n=18), with a persistent high symptom burden (mean PEmb-QoL Questionnaire 48.4±21.5 and emPHasis-10 score 22.4±8.8) reported at follow-up. All had improvement in RV-focused resting echocardiographic parameters. RV systolic dysfunction and RV to pulmonary artery (PA) uncoupling assessed by stress echocardiography was seen in 29.2% (n=7) patients and associated with increased ventilatory inefficiency (V̇E/V̇CO 2 slope 47.6 vs 32.4, p=0.03), peak exercise oxygen desaturation (93.2% vs 98.4%, p=0.01) and reduced peak oxygen pulse (p=0.036) compared with controls. Five out of seven patients with RV–PA uncoupling demonstrated persistent bilateral perfusion defects on VQ scintigraphy consistent with chronic thromboembolic pulmonary vascular disease. Conclusion In our cohort, impaired RV adaptation on exercise was seen in almost one-third of patients. Combined stress echocardiography and CPET may enable more accurate phenotyping of patients with persistent symptoms following acute PE to allow timely detection of long-term complications.
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Samaranayake et al. (2023) conducted an observational in Acute intermediate and high-risk pulmonary embolism (n=30). Right ventricular systolic dysfunction and RV to pulmonary artery uncoupling vs. Controls (patients without RV-PA uncoupling) was evaluated on Ventilatory inefficiency (V̇E/V̇CO2 slope) (p=0.03). Right ventricular to pulmonary artery uncoupling during exercise was associated with increased ventilatory inefficiency (V̇E/V̇CO2 slope 47.6 vs 32.4, p=0.03) compared with controls.
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