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Original Research: Pulmonary Vascular Disease |

Functional and Exercise Limitations After a First Episode of Pulmonary Embolism: Results of the ELOPE Prospective Cohort Study

Susan R. Kahn, MD; Andrew M. Hirsch, MD; Arash Akaberi, MSc; Paul Hernandez, MD; David R. Anderson, MD; Philip S. Wells, MD; Marc A. Rodger, MD; Susan Solymoss, MD; Michael J. Kovacs, MD; Lawrence Rudski, MD; Avi Shimony, MD; Carole Dennie, MD; Christopher Rush, MD; William H. Geerts, MD; Shawn D. Aaron, MD; John T. Granton, MD
Author and Funding Information

FUNDING/SUPPORT: The ELOPE Study was funded by the Canadian Institutes of Health Research (CIHR) (MOP-93627).

This work was presented as an oral presentation (“Postpulmonary embolism syndrome after a first episode of PE: results of the ELOPE study”) at the 57th Annual Meeting of American Society of Hematology, December 5-8, 2015, Orlando, FL and Kahn SR, Hirsch A, Beddaoui M, et al. Post-pulmonary embolism syndrome after a first episode of PE: results of the E.L.O.P.E. study. Blood. 2015;126(23):650.

aDepartment of Medicine, Jewish General Hospital, Montreal, QC

bDepartment of Nuclear Medicine, Jewish General Hospital, Montreal, QC

cCenter for Clinical Epidemiology, Lady Davis Institute, Montreal, QC

dDepartment of Medicine, McGill University, Montreal, QC

eDepartment of Medicine, Dalhousie University, Halifax, NS

fDepartment of Medicine, University of Ottawa, Ottawa, ON

gDepartment of Diagnostic Imaging, University of Ottawa, Ottawa, ON

hDepartment of Medicine, Division of Hematology, Western University, London, ON

iDepartment of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

jDivision of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada

kDepartment of Cardiology, Ben Gurion University, Beer Sheva, Israel

CORRESPONDENCE TO: Susan R. Kahn MD, Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote St, Catherine Rm H-420, Montreal, QC, Canada H3T 1E2


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1058-1068. doi:10.1016/j.chest.2016.11.030
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Background  We aimed to determine the frequency and predictors of exercise limitation after pulmonary embolism (PE) and to assess its association with health-related quality of life (HRQoL) and dyspnea.

Methods  One hundred patients with acute PE were recruited at five Canadian hospitals from 2010 to 2013. Cardiopulmonary exercise testing (CPET) was performed at 1 and 12 months. Quality of life (QoL), dyspnea, 6-min walk distance (6MWD), residual clot burden (perfusion scan, CT pulmonary angiography), cardiac function (echocardiography), and pulmonary function tests (PFTs) were measured during follow-up. The prespecified primary outcome was percent predicted peak oxygen uptake (Vo2 peak) < 80% at 1-year CPET.

Results  At 1 year, 40 of 86 patients (46.5%) had percent predicted Vo2 peak < 80% on CPET, which was associated with significantly worse generic health-related QoL (HRQoL), PE-specific HRQoL and dyspnea scores, and significantly reduced 6MWD at 1 year. Predictors of the primary outcome included male sex (relative risk [RR], 3.2; 95% CI, 1.3-8.1), age (RR, 0.98; 95% CI, 0.96-0.99 per 1-year age increase), BMI (RR 1.1; 95% CI, 1.01-1.2 per 1 kg/m2 BMI increase), and smoking history (RR, 1.8; 95% CI, 1.1-2.9), as well as percent predicted Vo2 peak < 80% on CPET at 1 month (RR, 3.8; 95% CI,1.9-7.2), and 6MWD at 1 month (RR, 0.82; 95% CI, 0.7-0.9 per 30-m increased walking distance). Baseline or residual clot burden was not associated with the primary outcome. Mean PFT and echocardiographic results (pulmonary artery pressure, right and left ventricular systolic function) at 1 year were similarly within normal limits in both patients with exercise limitations and those without such limitations.

Conclusions  Almost half of patients with PE have exercise limitation at 1 year that adversely influences HRQoL, dyspnea, and walking distance. CPET or 6MWD testing at 1 month may help to identify patients with a higher risk of exercise limitation at 1 year after PE. Based on our results, we believe that the deconditioning that occurs after acute PE could underlie this exercise limitation, but we cannot exclude the fact that this may have been present before PE.

Trial Registry  ClinicalTrials.gov; No.: NCT01174628; URL: www.clinicaltrials.gov.

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