L. A. Cimini, Dieuwke Luijten, Stefano Barco, Waleed Ghanima, Ø. Jervan, Susan R. Kahn, Stavros Konstantinides, Daniel Lachante, Yoshihisa Nakano, Maarten Ninaber, Josien van Es, T. V. van Mens, Anton Vonk Noordegraaf, Cecilia Becattini, F.A. Klok
{"title":"Pulmonary perfusion defects or residual vascular obstruction and persistent symptoms after pulmonary embolism: a systematic review and meta-analysis","authors":"L. A. Cimini, Dieuwke Luijten, Stefano Barco, Waleed Ghanima, Ø. Jervan, Susan R. Kahn, Stavros Konstantinides, Daniel Lachante, Yoshihisa Nakano, Maarten Ninaber, Josien van Es, T. V. van Mens, Anton Vonk Noordegraaf, Cecilia Becattini, F.A. Klok","doi":"10.1183/23120541.01010-2023","DOIUrl":null,"url":null,"abstract":"Up to 50% of pulmonary embolism (PE) patients has perfusion defects or residual vascular obstruction during follow-up despite adequate anticoagulant treatment and a similar percentage experience chronic functional limitations and/or dyspnea post-PE. We aimed to evaluate the association between pulmonary perfusion defects or residual vascular obstruction and functional recovery after PE.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 (OR) was pooled for perfusion defects or residual vascular obstruction and persistent symptoms using a random-effect model.12 studies were included totaling 1888 PE patients; at a median of 6 months after PE (range 2–72), 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.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.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ERJ Open Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1183/23120541.01010-2023","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Up to 50% of pulmonary embolism (PE) patients has perfusion defects or residual vascular obstruction during follow-up despite adequate anticoagulant treatment and a similar percentage experience chronic functional limitations and/or dyspnea post-PE. We aimed to evaluate the association between pulmonary perfusion defects or residual vascular obstruction and functional recovery after PE.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 (OR) was pooled for perfusion defects or residual vascular obstruction and persistent symptoms using a random-effect model.12 studies were included totaling 1888 PE patients; at a median of 6 months after PE (range 2–72), 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.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.
期刊介绍:
ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.