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. 2025 Feb 5;15(1):e70045.
doi: 10.1002/pul2.70045. eCollection 2025 Jan.

Cardiopulmonary Exercise Testing With Simultaneous Echocardiography After Pulmonary Embolism

Karys Khilzi  1 , Lucilla Piccari  1   2 , Gerard Franco  3 , Anna Rodó-Pin  1   3 , Anna Herranz  1 , Isabel Blanco  4   5 , Giuseppe Paciocco  6 , Lorenzo Volpiano  6 , Jose Gonzalez Garcia  1 , Ana Diez-Llaneza  1 , Lluis Molina  2   3   7 , Diego A Rodríguez Chiaradía  1   2   3   5
Affiliations

Cardiopulmonary Exercise Testing With Simultaneous Echocardiography After Pulmonary Embolism

Karys Khilzi et al. Pulm Circ. .

Abstract

Although current guidelines recommend standard cardiopulmonary exercise testing (CPET) to evaluate symptomatic patients after pulmonary embolism (PE), CPET with simultaneous echocardiography could provide relevant information to evaluate right ventricular-pulmonary arterial coupling. The aim of this study was to investigate exercise-induced changes in echocardiographic variables of RV function or RV- arterial coupling in patients with residual thrombotic defects at 3 months after PE. This retrospective study investigated patients with residual thromboembolic disease on V/Q scintigraphy with persistent symptoms despite adequate anticoagulation after 3 months of acute PE, and resting echocardiography with a low probability of PH. At rest and during exercise, CPET and doppler echocardiography were performed following a standard protocol. Forty-five patients were included, completing a follow-up period of at least 24 months. The mean (standard deviation) age was 63 (15) years, and 24 (53%) patients were male. Four patients developed CTEPH after 2 years follow up. Correlation analyses showed that the peak TAPSE was significantly associated with peak workload (r = 0.454, p = 0.003), peak VO2 (r = 0.558, p < 0.001), VE/VECO2 (AT) (r = -0.531, p < 0.001), and oxygen pulse (r = 0.375, p = 0.02). TAPSE/PASP was only slightly associated with peak workload (r = 0.300, p = 0.045). By contrast, the change on TAPSE (from rest to peak) was significantly correlate with peak oxygen uptake (r = 0.491, p = 0.01). Also, reduced VO2 at AT and TAPSE/PASP was seen in patients with CTEPH. CPET with synchronic echocardiography could be a useful tool in early assessment of symptomatic patients with perfusion defects on imaging after 3 months of correctly treated PE.

Keywords: exercise capacity; post‐PE syndrome; right ventricular function.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Scatter plot representation of correlations between echocardiography parameters at rest and peak exercise. (A) Pulmonary arterial systolic pressure (PASP); (B) Tricuspid Annular Plane Systolic Excursion (TAPSE); (C) TAPSE/PASP.
Figure 2
Figure 2
Scatter plot representation of correlations between Tricuspid Annular Plane Systolic Excursion (TAPSE) and several parameters on cardiopulmonary exercise testing (A) peak workload, (B) peak oxygen uptake, (C) VE/VCO2 and (D) peak oxygen pulse.
Figure 3
Figure 3
ΔTAPSE (peak‐rest) (A) and ΔTAPSE/PAPs (peak‐rest) (B) as a function of peak oxygen uptake.
See this image and copyright information in PMC

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