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CME Evaluation

Oral Communication Session

Venous Thromboembolism

Session: Pulmonary Embolism

OC 70.3 - Exercise capacity in dyspneic persons with a recent acute pulmonary embolism

Wednesday, June 26, 2024
10:45 – 11:00 ICT
Room: Ballroom B1

    Presenting Author(s)

  • Dieuwke Luijten, MD, PhD cadidate

    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

    • Co-Author(s)

  • AV

    Anton Vonk Noordegraaf

    MD, PhD, prof
    Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • JA

    Jannie J Abbink

    MD, PhD
    Basalt rehabilitation Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • Stefano Barco

    MD, PhD
    Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
    Zurich, Zurich, Switzerland

  • Jv

    J.M.W. van den Berg

    MD
    Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands
    the Hague, Zuid-Holland, Netherlands

  • Jv

    Josien van Es

    MD, PhD
    Department of Pulmonology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • Waleed Ghanima

    Head of Research and Consultant Hematologist
    Department of Medicine, Østfold Hospital Trust
    Kalnes, Ostfold, Norway

  • MH

    Menno V. Huisman

    Professor of Medicine
    Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, The Netherlands.
    Leiden, Zuid-Holland, Netherlands

  • Cv

    Coen van Kan

    MD, PhD
    Department of Pulmonology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • BL

    Bas Langeveld

    MD, PhD
    Department of Pulmonology, Deventer ziekenhuis, Deventer, The Netherlands
    Deventer, Overijssel, Netherlands

  • Iv

    Ivo van der Lee

    MD, PhD
    Department of Pulmonology, Spaarne gasthuis, Haarlem, The Netherlands
    Haarlem, Noord-Holland, Netherlands

  • Tv

    Thijs E. van Mens

    MD, PhD
    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

  • TM

    Timothy Morris

    MD, prof
    Division of Pulmonary and Critical Care Medicine, University of California at San Diego, La Jolla, CA, USA.
    La Jolla, California, United States

  • MO

    Marieke Overbeek

    MD, PhD
    Department of Pulmonology, Haaglanden Medisch Centrum, The Hague, The Netherlands
    the Hague, Zuid-Holland, Netherlands

  • Mv

    Mart van der Plas

    PhD
    Department of Pulmonology, Haaglanden Medisch Centrum, The Hague, The Netherlands
    the Hague, Zuid-Holland, Netherlands

  • MS

    Martijn Spruit

    PhD, prof
    Department of Research & Development, Ciro, Horn, the Netherlands
    Horn, Limburg, Netherlands

  • Erik Klok, MD, PhD, FESC

    Leiden University Medical Center

  • MN

    Maarten K. Ninaber

    MD, PhD
    Department of pulmonology, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

Background: Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in acute pulmonary embolism (PE) patients. However, the response to exercise shortly after diagnosis of acute PE is currently unknown.

Aims: We aimed to gain insight into the cardiopulmonary function of PE patients shortly after diagnosis.

Methods: Acute PE patients without major comorbidities who reported dyspnea (Medical Research Council ≥2) and associated functional limitations (Post VTE Functional status scale grade ≥2) 1-2 weeks after PE-diagnosis were subjected to CPET within 1-2 weeks of enrollment. We evaluated the frequency of reduced exercise capacity (peak V’O2 < 80% of predicted), insufficient cardiocirculatory reserve (peak O2-pulse < 80% of predicted) and ventilatory inefficiency (V’E/V’CO2 ≥35 at anaerobic threshold), and their relationship with markers of PE severity at diagnosis. Adequate cardiopulmonary reserve was designated as absence of reduced exercise capacity, insufficient cardiocirculatory reserve and ventilatory inefficiency (as defined, Figure-1).

Results: There were no adverse events related to the procedure. Among 80 symptomatic PE patients, CPET disclosed adequate cardiopulmonary reserve in 48 patients (60%), reduced exercise capacity in 19 (24%), insufficient cardiocirculatory reserve in 20 (25%) and ventilatory inefficiency in 17 (21%). Patients with intermediate-high risk PE had an increased incidence of reduced exercise capacity, insufficient cardiocirculatory reserve and overall a higher risk of inadequate cardiopulmonary reserve compared to low-risk PE patients (OR 5.6, 5.7 and 5.2 respectively, table-1). Patients with a centrally localized PE had an increased incidence of insufficient cardiocirculatory reserve compared to those with lobar or (sub)segmental PE (OR 3.6 ).

Conclusion(s): Performing strenuous exercise shortly after diagnosis was safe. Despite remaining dyspneic, over half of the patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Centrally located PE predicted insufficient cardiocirculatory reserve and intermediate-high risk PE predicted reduced exercise capacity, insufficient cardiocirculatory reserve and overall inadequate cardiopulmonary reserve.