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Chronic Thromboembolism Phenotypes after Acute Pulmonary Embolism: Identification with the SEARCH Algorithm.
Timothy A Morris1, Khadizhat Dakaeva2, Mona Alotaibi2
1Division of Pulmonary and Critical Care Medicine, University of California San Diego t1morris@health.ucsd.edu.
The European Respiratory Journal
|April 9, 2026
Summary
Chronic thromboembolism (CTE) phenotypes are common after acute pulmonary embolism (PE), often causing dyspnea without pulmonary hypertension. The reliable SEARCH algorithm effectively diagnoses these conditions, improving patient outcomes.
Area of Science:
- Pulmonology
- Cardiology
- Medical Diagnostics
Background:
- Chronic dyspnea and exercise limitation are frequent sequelae of acute pulmonary embolism (PE).
- These post-PE conditions are often poorly characterized, necessitating improved diagnostic approaches.
Purpose of the Study:
- To validate a diagnostic algorithm (SEARCH) for identifying discrete post-pulmonary embolism outcomes.
- To specifically characterize chronic thromboembolism phenotypes in patients following acute PE.
Main Methods:
- A prospective observational study involving 150 patients evaluated 3+ months post-PE.
- Utilized the stepwise SEARCH algorithm: symptom screen, cardiopulmonary exercise testing, perfusion scans, echocardiography, confirmatory imaging, and right heart catheterization.
- Independent review by six pulmonologists ensured diagnostic reliability (Krippendorff's alpha = 0.984).
Main Results:
- Symptomatic recovery was observed in 66.2% of patients.
- Chronic thromboembolism (CTE) phenotypes were diagnosed in 12.0% of patients.
- Dyspnea from CTE, often without pulmonary hypertension, was common; CTE with exercise-induced pulmonary hypertension occurred in 5.6%.
Conclusions:
- Dyspnea due to chronic thromboembolism is prevalent after acute PE, frequently without associated pulmonary hypertension.
- The SEARCH protocol demonstrates high reliability in diagnosing chronic thromboembolism phenotypes post-PE.
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