Post-pulmonary embolism syndrome: a practical narrative review

Area of Science:

• Cardiology
• Pulmonology
• Vascular Medicine

Background:

• Post-pulmonary embolism syndrome (PPES) encompasses long-term sequelae after acute pulmonary embolism (PE), often without overt pulmonary hypertension (PH) or right ventricular (RV) dysfunction.
• Persistent RV dysfunction affects up to 18% of patients post-PE, correlating with increased risk of recurrent venous thromboembolism (VTE) and mortality.
• The FOCUS study defined post-PE impairment (PPI) using RV dysfunction and clinical decline, identifying it as a predictor of adverse outcomes.

Purpose of the Study:

• To elucidate the spectrum of long-term sequelae following acute pulmonary embolism (PE).
• To define and characterize post-PE impairment (PPI) and its prognostic implications.
• To differentiate between chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH) and highlight management considerations.

Main Methods:

• Review of literature and clinical studies defining PPES, PPI, CTED, and CTEPH.
• Analysis of echocardiographic and clinical parameters to assess RV function and patient status.
• Examination of prognostic factors and treatment outcomes in patients with chronic thromboembolic disease.

Main Results:

• PPES includes persistent dyspnea, exercise intolerance, and psychological issues, with or without PH/RV abnormalities.
• Post-PE impairment (PPI), defined by RV dysfunction and clinical deterioration, predicts higher mortality, rehospitalization, and reduced quality of life.
• Chronic thromboembolic pulmonary hypertension (CTEPH) has a cumulative incidence of 0.5-4% within two years and is primarily driven by RV dysfunction.

Conclusions:

• Early identification and systematic follow-up of patients with PPES are essential.
• Advances in multimodal therapies for CTEPH have improved survival, emphasizing the need for timely diagnosis and intervention.
• Understanding the nuances between CTED and CTEPH is critical for appropriate patient management and prognosis.