Pulmonary perfusion defects or residual vascular obstruction and persistent symptoms after pulmonary embolism: a systematic review and meta-analysis
ERJ Open Research, vol. 10, pp. 01010–2023
Abstract
Introduction: Up to 50% of pulmonary embolism (PE) patients have perfusion defects or residual vascular obstruction during follow-up despite adequate anticoagulant treatment, and a similar percentage experience chronic functional limitations and/or dyspnoea post-PE. We aimed to evaluate the association between pulmonary perfusion defects or residual vascular obstruction and functional recovery after PE. Methods: We performed a systematic review and meta-analysis including studies assessing both the presence of perfusion defects or residual vascular obstruction and functional recovery (i.e.persistent symptoms, quality of life, exercise endurance). An odds ratio was pooled for perfusion defects or residual vascular obstruction and persistent symptoms using a random-effect model. Results: 12 studies were included totalling 1888 PE patients; at a median of 6 months after PE (range 2–72 months), 34% had perfusion defects or residual vascular obstruction and 37% reported persistent symptoms. Among patients with perfusion defects or residual vascular obstruction, 48% (95% CI 37–60%, I2=82%) remained symptomatic during follow-up, compared to 34% (95% CI 20–51%, I2=96%) of patients without such defects. Presence of perfusion defects or residual vascular obstruction was associated with persistent symptoms (OR 2.15, 95% CI 1.66–2.78; I2=0%, τ=0). Notably, there was no association between these defects and quality of life or cardiopulmonary exercise test parameters. Conclusion: While the odds of having persistent symptoms was higher in patients with perfusion defects or residual vascular obstruction after acute PE, a significant proportion of these patients reported no limitations. A possible causality between perfusion defects or residual vascular obstruction and residual functional limitation therefore remains to be proven.
Authors 15
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Affiliation as printed
L.A. Cimini and D. Luijten contributed equally and share first authorship
Vascular and Emergency Medicine, University of Perugia, Perugia, Italy
LAC and DL contributed equally and have shared first authorship
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
L.A. Cimini and D. Luijten contributed equally and share first authorship
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
LAC and DL contributed equally and have shared first authorship
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Affiliation as printed
Department of Angiology, University Hospital Zurich, Zurich, Switzerland
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Oslo University Hospital · University of Oslo · Østfold Hospital Trust
Affiliation as printed
Department of Haematology, Oslo University Hospital, Oslo, Norway
Department of Internal Medicine, Østfold Hospital Trust, Grålum, Norway
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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University of Oslo · Østfold Hospital Trust
Affiliation as printed
Department of Internal Medicine, Østfold Hospital Trust, Grålum, Norway
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Jewish General Hospital · Lady Davis Institute for Medical Research · McGill University
Affiliation as printed
Department of Medicine, McGill University, Montreal, QC, Canada
Division of Internal Medicine and Division of Clinical Epidemiology, Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
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University Medical Center of the Johannes Gutenberg University Mainz
Affiliation as printed
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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University of Rochester Medicine · University of Rochester
Affiliation as printed
Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Nagoya University Hospital · Nagoya University
Affiliation as printed
Department of Cardiology, Nagoya University Hospital, Nagoya, Japan
Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Leiden University Medical Center
Affiliation as printed
Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
Department of Pulmonology, Leiden University Medical Center (LUMC), Leiden, Netherlands
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OLVG · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Pulmonology, Amsterdam UMC, Cardiovascular sciences, VU University Amsterdam, Amsterdam, The Netherlands
Department of Pulmonology, OLVG, Amsterdam, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Pulmonology, Amsterdam UMC, Cardiovascular sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Vascular and Emergency Medicine, University of Perugia, Perugia, Italy
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
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