Pulmonary and cardiac variables associated with persistent dyspnea after pulmonary embolism

Øyvind Jervan; Jostein Gleditsch; Mazdak Tavoly; Frederikus A Klok; Diyar Rashid; René Holst; Kjetil Steine; Knut Stavem; Waleed Ghanima

doi:10.1016/j.thromres.2021.02.014

Pulmonary and cardiac variables associated with persistent dyspnea after pulmonary embolism

Thromb Res. 2021 May:201:90-99. doi: 10.1016/j.thromres.2021.02.014. Epub 2021 Feb 19.

Authors

Øyvind Jervan¹, Jostein Gleditsch², Mazdak Tavoly³, Frederikus A Klok⁴, Diyar Rashid⁵, René Holst⁶, Kjetil Steine⁷, Knut Stavem⁸, Waleed Ghanima⁹

Affiliations

¹ Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: Oyvind.Jervan@so-hf.no.
² Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Radiology, Østfold Hospital, Kalnes, Norway.
³ Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
⁵ Department of Radiology, Østfold Hospital, Kalnes, Norway.
⁶ Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
⁷ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
⁹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Medicine, Østfold Hospital, Kalnes, Norway; Dept of hematology, Oslo University hospital, Oslo, Norway.

PMID: 33662800
DOI: 10.1016/j.thromres.2021.02.014

Abstract

Introduction: Persistent dyspnea is common in follow-up after pulmonary embolism (PE), but the underlying mechanisms are poorly understood.

Material and methods: This cross-sectional study included subjects aged 18-75 years with confirmed PE by computed tomography pulmonary angiography (CTPA) 6-72 months earlier. A total of 180 participants underwent clinical examination, incremental shuttle walk test, laboratory tests, transthoracic echocardiography, pulmonary function tests and ventilation/perfusion scintigraphy. In further analysis, we divided participants into two groups; "dyspnea" or "no dyspnea", based on interview and questionnaires at inclusion. The association of cardiac and pulmonary variables with persistent dyspnea was assessed using multiple logistic regression analysis.

Results: In total, 44% (95% CI: 39%-51%) of the participants reported persistent dyspnea after PE. Age (adjusted odds ratio (aOR) 0.93 per year, 95% CI: 0.90-0.97, P = 0.001), body mass index (BMI) (aOR 1.14 per kg/m², 95% CI: 1.04-1.25, P = 0.004), recurrent venous thromboembolism (VTE) (aOR 3.69, 95% CI: 1.45-9.38, P = 0.006) and diffusion capacity of the lung for carbon monoxide (DLCO) (aOR 0.95 per increase of 1%, 95% CI: 0.92-0.98, P = 0.001) were independently associated with persistent dyspnea.

Conclusions: Persistent dyspnea was prevalent after PE. Age, BMI and recurrent VTE were independently associated with dyspnea. Apart from reduced DLCO, no other cardiac or pulmonary variables were associated with persistent dyspnea.

Keywords: Dyspnea; Echocardiography; Pulmonary embolism; Radionuclide imaging; Respiratory function tests.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Dyspnea / etiology
Humans
Lung
Pulmonary Embolism* / complications
Venous Thromboembolism*