Follow-up algorithm for detecting chronic sequelae of pulmonary embolism: diagnostic performance and possible...

Area of Science:

• Cardiology
• Pulmonology
• Medical Diagnostics

Background:

• Pulmonary embolism (PE) survivors can experience significant long-term health issues.
• Early identification of these complications is crucial for effective patient management.
• Standardized follow-up protocols aim to detect post-PE sequelae.

Purpose of the Study:

• To evaluate the diagnostic performance of the European Society of Cardiology (ESC) guidelines for follow-up after acute PE.
• To assess the effectiveness of the recommended algorithm in identifying patients with long-term complications.
• To determine if current methods adequately capture the spectrum of post-PE impairment.

Main Methods:

• Prospective cohort study of acute PE survivors.
• Comprehensive 3-month follow-up including clinical assessment, lab tests, echocardiography, and cardiopulmonary exercise testing (CPET).
• Two-year follow-up for chronic thromboembolic pulmonary hypertension (CTEPH) and prospective definition of post-PE impairment (PPEI).

Main Results:

• 82.5% of patients were eligible for echocardiography per guidelines.
• 101 patients (23.1%) met criteria for V/Q scan, including 9 confirmed CTEPH cases.
• 54% of patients with PPEI and 3 CTEPH cases were in the 'low-probability' echocardiography group, indicating potential underdiagnosis.

Conclusions:

• Current ESC guideline algorithms primarily identify severe post-PE complications.
• Cardiopulmonary exercise testing (CPET) is essential for timely recognition of patients with milder long-term impairment.
• The current follow-up strategy may not fully capture the range of post-PE sequelae.