Mazdak Tavoly1, Hilde S Wik2, Per-Anton Sirnes3, Lars-Petter Jelsness-Jørgensen4, Josef P Ghanima5, Frederikus A Klok6, Per-Morten Sandset7, Waleed Ghanima8. 1. Department of Medicine, Østfold Hospital Trust, Sarpsborg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: mazdak.tavoly@vgregion.se. 2. Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 3. Cardiology Practice, Østlandske Hjertesenter, Moss, Norway. 4. Department of Medicine, Østfold Hospital Trust, Sarpsborg, Norway; Department of Health Science, Østfold University College, Fredrikstad, Norway. 5. Department of Medicine, Østfold Hospital Trust, Sarpsborg, Norway. 6. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 7. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 8. Department of Medicine, Østfold Hospital Trust, Sarpsborg, Norway; Department of Haematology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
INTRODUCTION: Recent studies suggest that up to 50% of patients surviving pulmonary embolism (PE) may suffer from post-PE syndrome, which is defined by persistent dyspnea, impaired exercise capacity and/or decreased health-related quality of life (HRQoL). The possible determinants of post-PE syndrome are however not fully established. AIMS: To describe the differences between dyspneic and non-dyspneic PE-patients and to explore determinants of dyspnea, 6-min walking test (6MWT) and HRQoL. MATERIAL AND METHODS: In this cross-sectional study, consecutive patients diagnosed with PE between 2002 and 2011 at Østfold Hospital, Norway were identified from hospital registries. Patients were scheduled for clinical examination and a 6MWT. Dyspnea was assessed by the New York Heart Association (NYHA) classification. HRQoL was assessed with PEmb-QoL questionnaire. PE severity was assessed with PESI score, mean bilateral proximal extent of the clot and right-/left ventricle-ratio (RV/LV-ratio). RESULTS: 203 patients participated in this study, of which 96 patients reported dyspnea (47%). Median time from diagnosis was 3.6 years (IQR 1.9-6.5). Patients without dyspnea performed better on 6MWT (488 m vs 413 m, p < 0.005) and had better HRQoL results (p < 0.005). None of the variables we examined, including Charlson comorbidity index, was independently associated with dyspnea. However, higher RV/LV ratio at diagnosis was significantly associated with reduced 6MWT at follow-up. Further, ongoing anticoagulation and unemployment were independently associated with impaired HRQoL. CONCLUSIONS: PE-survivors complaining of dyspnea suffer from impaired HRQoL and reduced exercise capacity. Although PE-severity factors were associated with reduced exercise capacity, none of the examined factors were found to be independent determinants of dyspnea.
INTRODUCTION: Recent studies suggest that up to 50% of patients surviving pulmonary embolism (PE) may suffer from post-PE syndrome, which is defined by persistent dyspnea, impaired exercise capacity and/or decreased health-related quality of life (HRQoL). The possible determinants of post-PE syndrome are however not fully established. AIMS: To describe the differences between dyspneic and non-dyspneic PE-patients and to explore determinants of dyspnea, 6-min walking test (6MWT) and HRQoL. MATERIAL AND METHODS: In this cross-sectional study, consecutive patients diagnosed with PE between 2002 and 2011 at Østfold Hospital, Norway were identified from hospital registries. Patients were scheduled for clinical examination and a 6MWT. Dyspnea was assessed by the New York Heart Association (NYHA) classification. HRQoL was assessed with PEmb-QoL questionnaire. PE severity was assessed with PESI score, mean bilateral proximal extent of the clot and right-/left ventricle-ratio (RV/LV-ratio). RESULTS: 203 patients participated in this study, of which 96 patients reported dyspnea (47%). Median time from diagnosis was 3.6 years (IQR 1.9-6.5). Patients without dyspnea performed better on 6MWT (488 m vs 413 m, p < 0.005) and had better HRQoL results (p < 0.005). None of the variables we examined, including Charlson comorbidity index, was independently associated with dyspnea. However, higher RV/LV ratio at diagnosis was significantly associated with reduced 6MWT at follow-up. Further, ongoing anticoagulation and unemployment were independently associated with impaired HRQoL. CONCLUSIONS: PE-survivors complaining of dyspnea suffer from impaired HRQoL and reduced exercise capacity. Although PE-severity factors were associated with reduced exercise capacity, none of the examined factors were found to be independent determinants of dyspnea.
Authors: Rafael S Cires-Drouet; Minerva Mayorga-Carlin; Shahab Toursavadkohi; Rachel White; Emily Redding; Frederick Durham; Kathleen Dondero; Steven J Prior; John D Sorkin; Brajesh K Lal Journal: Phlebology Date: 2020-07-27 Impact factor: 1.740
Authors: J Gleditsch; Ø Jervan; S Haukeland-Parker; M Tavoly; O Geier; R Holst; F A Klok; H H Johannessen; W Ghanima; E Hopp Journal: Int J Cardiol Heart Vasc Date: 2022-03-23
Authors: Gregory Piazza; Keith M Sterling; Victor F Tapson; Kenneth Ouriel; Andrew S P Sharp; Ping-Yu Liu; Samuel Z Goldhaber Journal: Circ Cardiovasc Interv Date: 2020-08-06 Impact factor: 6.546
Authors: Roisin Bavalia; Ingrid M Bistervels; Wim G Boersma; Isabelle Quere; Dominique Brisot; Nicolas Falvo; Dominique Stephan; Francis Couturaud; Sebastian Schellong; Jan Beyer-Westendorf; Karine Montaclair; Waleed Ghanima; Marije Ten Wolde; Michiel Coppens; Emile Ferrari; Olivier Sanchez; Patrick Carroll; Pierre-Marie Roy; Susan R Kahn; Karina Meijer; Simone Birocchi; Michael J Kovacs; Amanda Hugman; Hugo Ten Cate; Hilde Wik; Gilles Pernod; Marie-Antoinette Sevestre-Pietri; Michael A Grosso; Minggao Shi; Yong Lin; Barbara A Hutten; Peter Verhamme; Saskia Middeldorp Journal: Res Pract Thromb Haemost Date: 2021-07-14