Post-pulmonary embolism syndrome: a practical narrative review

Post-pulmonary embolism syndrome (PPES) describes the spectrum of long-term sequelae following acute pulmonary embolism (PE), including persistent dyspnea, exercise intolerance, and psychological impairment, often in the absence of pulmonary hypertension (PH) or right ventricular (RV) abnormalities. Persistent RV dysfunction occurs in up to 18% of patients beyond three months and is associated with recurrent venous thromboembolism (VTE) and PE-related mortality. The FOCUS study introduced the concept of post-PE impairment (PPI), defined by a combination of echocardiographic RV dysfunction and clinical or functional deterioration, which predicted higher mortality, rehospitalization rates, and impaired quality of life. Chronic thromboembolic pulmonary disease (CTEPD) refers to symptomatic patients with residual perfusion defects but without PH. In contrast, chronic thromboembolic pulmonary hypertension (CTEPH) is defined by pre-capillary PH in the presence of residual obstruction, with a cumulative incidence of 0.5-4% within two years. Prognosis in CTEPH is driven primarily by RV dysfunction, but advances in multimodal therapies-surgical, interventional, and pharmacological-have improved survival, underscoring the importance of early recognition and systematic follow-up.