Right ventricular functional recovery assessment with stress echocardiography and cardiopulmonary exercise testing after pulmonary embolism: a pilot prospective multicentre study.

Autor:	Samaranayake CB; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK c.samaranayake@uq.net.au.; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia., Upham J; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia., Tran K; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Department of Respiratory Medicine, Logan Hospital, Loganholme, Queensland, Australia., Howard LS; National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Nguyen S; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia., Lwin M; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK., Anderson J; Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia., Wahi S; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia., Price LC; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Wort S; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Li W; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., McCabe C; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Keir GJ; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open respiratory research [BMJ Open Respir Res] 2023 Jul; Vol. 10 (1).
DOI:	10.1136/bmjresp-2023-001637
Abstrakt:	Background: Data on right ventricular (RV) exercise adaptation following acute intermediate and high-risk pulmonary embolism (PE) remain limited. This study aimed to evaluate the symptom burden, RV functional recovery during exercise and cardiopulmonary exercise parameters in survivors of intermediate and high-risk acute PE. Methods: We prospectively recruited patients following acute intermediate and high-risk PE at four sites in Australia and UK. Study assessments included stress echocardiography, cardiopulmonary exercise testing (CPET) and ventilation-perfusion (VQ) scan at 3 months follow-up. Results: Thirty patients were recruited and 24 (median age: 55 years, IQR: 22) completed follow-up. Reduced peak oxygen consumption (VO 2 ) and workload was seen in 75.0% (n=18), with a persistent high symptom burden (mean PEmb-QoL Questionnaire 48.4±21.5 and emPHasis-10 score 22.4±8.8) reported at follow-up. All had improvement in RV-focused resting echocardiographic parameters. RV systolic dysfunction and RV to pulmonary artery (PA) uncoupling assessed by stress echocardiography was seen in 29.2% (n=7) patients and associated with increased ventilatory inefficiency (V̇E/V̇CO 2 slope 47.6 vs 32.4, p=0.03), peak exercise oxygen desaturation (93.2% vs 98.4%, p=0.01) and reduced peak oxygen pulse (p=0.036) compared with controls. Five out of seven patients with RV-PA uncoupling demonstrated persistent bilateral perfusion defects on VQ scintigraphy consistent with chronic thromboembolic pulmonary vascular disease. Conclusion: In our cohort, impaired RV adaptation on exercise was seen in almost one-third of patients. Combined stress echocardiography and CPET may enable more accurate phenotyping of patients with persistent symptoms following acute PE to allow timely detection of long-term complications. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu