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. 2023 Jul 5;2(6Part A):101063.
doi: 10.1016/j.jscai.2023.101063. eCollection 2023 Nov-Dec.

Symptoms Suggestive of Postpulmonary Embolism Syndrome and Utilization of Diagnostic Testing

Vikas Aggarwal  1   2 , S Nabeel Hyder  1 , Neil Kamdar  3   4   5 , Mohamed Zghouzi  1 , Scott H Visovatti  6 , Zhe Yin  3   4   5 , Geoffrey Barnes  1 , James Froehlich  1 , Victor M Moles  1 , Thomas Cascino  1 , Prachi Agarwal  7 , Jonathan Haft  8 , Kenneth Rosenfield  9 , Amy Qiang  10 , Vallerie V McLaughlin  1 , Brahmajee K Nallamothu  1   2   3
Affiliations

Symptoms Suggestive of Postpulmonary Embolism Syndrome and Utilization of Diagnostic Testing

Vikas Aggarwal et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Persistent symptoms of chest pain, dyspnea, fatigue, lightheadedness, and/or syncope more than 3 months after an acute pulmonary embolism (PE) are collectively classified as postpulmonary embolism syndrome (PPES). Although PPES is increasingly recognized as an important long-term sequel of acute PE, its contemporary incidence is unclear. Furthermore, the utilization of diagnostic testing for further phenotypic characterization of these patients is unknown. This study aimed to define the incidence of PPES and evaluate the utilization of diagnostic tests among a national cohort of patients with PE.

Methods: Retrospective cohort study was performed using the national administrative database, Clinformatics DataMart Database (Optum Insight), and included adult patients (18 years or older) with no history of acute PE or pulmonary hypertension, diagnosed with acute PE between October 1, 2016, and December 31, 2018. With acute PE event as the exposure, the incidence of symptoms consistent with PPES and diagnostic test utilization among patients with PPES were evaluated.

Results: Of 21,297 incident patients with acute PE, 11,969 (56.2%) showed ≥1 symptom of PPES, which was new since their pre-PE baseline. New dyspnea was the most common and noted in 3268/15,203 (21.5%) patients, followed by new malaise or fatigue in 2894/15,643 (18.5%) patients. Among the 11,969 patients with PPES, 5128 (42.8%) received ≥1 diagnostic test, with 3242 (27%) receiving a computed tomography pulmonary angiogram, 2997 (25%) receiving an echocardiogram, and 325 (2.7%) received a ventilation-perfusion scan within 3-12 months after PE. Significantly lower use of diagnostic testing was noted in patients older than 65 years (adjusted odds ratio, 0.89; 95% CI, 0.81-0.98).

Conclusions: Symptoms consistent with PPES are common after acute PE, occurring in more than half of the patients. Diagnostic imaging for further phenotypic characterization is used in less than half of such patients with PPES.

Keywords: chronic thromboembolic disease; chronic thromboembolic pulmonary hypertension; post-PE syndrome; pulmonary embolism; pulmonary hypertension; residual pulmonary vascular obstruction.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Patient selection and study flow. ICD, International Classification of Diseases; PE, pulmonary embolism; PHTN, pulmonary hypertension.
Central Illustration
Central Illustration
Testing utilization in patients after PE with new symptoms suggestive of PPES. CT, computed tomography; PE, pulmonary embolism; PPES, postpulmonary embolism syndrome; V/Q, ventilation-perfusion.
Figure 2
Figure 2
Rates of computed tomography angiogram testing in patients with new symptoms after PE. CTPA, computed tomography pulmonary angiography; PE, pulmonary embolism.
Figure 3
Figure 3
Rates of echocardiogram testing in patients with new symptoms after PE. PE, pulmonary embolism.
Figure 4
Figure 4
Rates of V/Q scan testing in patients with new symptoms after PE. PE, pulmonary embolism; V/Q, ventilation-perfusion.
See this image and copyright information in PMC

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