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. 2024 Oct 10;14(4):e12451.
doi: 10.1002/pul2.12451. eCollection 2024 Oct.

Cardiopulmonary exercise testing following acute pulmonary embolism: Systematic review and pooled analysis of global studies

Gabriella VanAken  1 , Daniel Wieczorek  2 , Drew Rubick  3 , Ahmad Jabri  4 , Domingo Franco-Palacios  5 , Gillian Grafton  4 , Bryan Kelly  5   6 , Olusegun Osinbowale  4 , Syed T Ahsan  4 , Rana Awdish  5 , Herbert D Aronow  6   7 , Supriya Shore  8 , Vikas Aggarwal  4
Affiliations

Cardiopulmonary exercise testing following acute pulmonary embolism: Systematic review and pooled analysis of global studies

Gabriella VanAken et al. Pulm Circ. .

Abstract

Recent reports have revealed a substantial morbidity burden associated with "post-PE syndrome" (PPES). Cardiopulmonary exercise testing (CPET) has shown promise in better characterizing these patients. In this systematic review and pooled analysis, we aim to use CPET data from PE survivors to understand PPES better. A literature search was conducted in PubMed, EMBASE, and Cochrane for studies reporting CPET results in post-PE patients without known pulmonary hypertension published before August 1, 2023. Studies were independently reviewed by two authors. CPET findings were subcategorized into (1) exercise capacity (percent predicted pVO2 and pVO2) and (2) ventilatory efficiency (VE/VCO2 slope and VD/VT). We identified 14 studies (n = 804), 9 prospective observational studies, 4 prospective case-control studies, and 1 randomized trial. Pooled analysis demonstrated a weighted mean percent predicted pVO2 of 76.09 ± 20.21% (n = 184), with no difference between patients tested <6 months (n = 76, 81.69±26.06%) compared to ≥6 months post-acute PE (n = 88, 82.55 ± 21.47%; p = 0.817). No difference was seen in pVO2 in those tested <6 months (n = 76, 1.67 ± 0.51 L/min) compared to ≥6 months post-acute PE occurrence (n = 144, 1.75 ± 0.57 L/min; p = 0.306). The weighted mean VE/VCO2 slope was 32.72 ± 6.02 (n = 244), with a significant difference noted between those tested <6 months (n = 91, 36.52 ± 6.64) compared to ≥6 months post-acute PE (n = 191, 31.99 ± 5.7; p < 0.001). In conclusion, this study, which was limited by small sample sizes and few multicenter studies, found no significant difference in exercise capacity between individuals tested <6 months versus ≥6 months after acute PE. However, ventilatory efficiency was significantly improved in patients undergoing CPET ≥ 6 months compared to those <6 months from the index PE.

Keywords: CPET; post‐PE syndrome; pulmonary embolism.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart for inclusion of studies in the review. Of the full‐text articles reviewed (n = 77), 63 were excluded for only having abstracts without full‐text publications,, , , , , , , , , , , , , , , , , , , , , , , , duplicate patient data,, , , , , , , , patient populations with chronic thromboembolic pulmonary disease,, , , , review articles,, , , , , protocol publications for ongoing trials,, , patients with known PH,, , studies without English translations available,, pediatric populations, retrospective studies,, and studies without included CPET parameters., , , , , , CPET, cardiopulmonary exercise testing.
FIGURE 2
FIGURE 2
Central illustration.
See this image and copyright information in PMC

References

    1. Aggarwal V, Hyder SN, Kamdar N, Zghouzi M, Visovatti SH, Yin Z, Barnes G, Froehlich J, Moles VM, Cascino T, Agarwal P, Haft J, Rosenfield K, Qiang A, McLaughlin VV, Nallamothu BK. Symptoms suggestive of postpulmonary embolism syndrome and utilization of diagnostic testing. J Soc Cardiovasc Angiogr Interv. 2023;2(6):101063. https://www.jscai.org/article/S2772-9303(23)00554-9/fulltext - PMC - PubMed
    1. Klok FA, Ageno W, Ay C, Bäck M, Barco S, Bertoletti L, Becattini C, Carlsen J, Delcroix M, van Es N, Huisman MV, Jara‐Palomares L, Konstantinides S, Lang I, Meyer G, Ní Áinle F, Rosenkranz S, Pruszczyk P. Optimal follow‐up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society. Eur Heart J. 2022;43(3):183–189. - PMC - PubMed
    1. Valerio L, Mavromanoli AC, Barco S, Abele C, Becker D, Bruch L, Ewert R, Faehling M, Fistera D, Gerhardt F, Ghofrani HA, Grgic A, Grünig E, Halank M, Held M, Hobohm L, Hoeper MM, Klok FA, Lankeit M, Leuchte HH, Martin N, Mayer E, Meyer FJ, Neurohr C, Opitz C, Schmidt KH, Seyfarth HJ, Wachter R, Wilkens H, Wild PS, Konstantinides SV, Rosenkranz S. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study. Eur Heart J. 2022;43(36):3387–3398. - PMC - PubMed
    1. Malhotra R, Bakken K, D'Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC: Heart Failure. 2016;4(8):607–616. - PubMed
    1. Zhu H, Sun X, Cao Y, Pudasaini B, Yang W, Liu J, Guo J. Cardiopulmonary exercise testing and pulmonary function testing for predicting the severity of CTEPH. BMC Pulm Med. 2021;21(1):324. - PMC - PubMed

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