title: Pathophysiology of dyspnoea in acute pulmonary embolism: A cross-sectional evaluation.
abstract: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors.
  
  
  
  We undertook a prospective study of 90 consecutive non-obese patients (mean ± SD age: 49 ± 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi-detector computed tomography (MDCT) scan, n = 87 and high-probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilation-perfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission.
  
  
  
  Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory-affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability.
  
  
  
  Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory-affective domain of dyspnoea also correlates with age, depression and breathing variability.
authors.affiliation: Department of Pulmonology, AP-HP, Georges Pompidou European Hospital, Paris, France.|Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
authors.affiliation: Epidemiology and Clinical Research Unit, AP-HP, Georges Pompidou European Hospital, Paris, France.|Epidemiological Centre of Investigation 4, INSERM, Paris, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Caumont-Prim
authors.affiliation: Department of Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Riant
authors.affiliation: Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.|Department of Physiology - Dyspnea Clinic, AP-HP, Georges Pompidou European Hospital, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Plantier
authors.affiliation: Department of Pulmonology, AP-HP, Georges Pompidou European Hospital, Paris, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Dres
authors.affiliation: INSERM, Créteil, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Louis
authors.affiliation: Nuclear Medicine Unit, AP-HP, Georges-Pompidou European Hospital, Paris, France.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Collignon
authors.affiliation: Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.|Department of Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Diebold
authors.affiliation: Department of Pulmonology, AP-HP, Georges Pompidou European Hospital, Paris, France.|Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Department of Physiology - Dyspnea Clinic, AP-HP, Georges Pompidou European Hospital, Paris, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Peiffer
authors.affiliation: Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.|Department of Physiology - Dyspnea Clinic, AP-HP, Georges Pompidou European Hospital, Paris, France.|Clinical Investigation Centre 9201, AP-HP/INSERM, Georges-Pompidou European Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Delclaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: alveolar dead space; dyspnoea; psychological status; pulmonary embolism