title: Functional and Exercise Limitations After a First Episode of Pulmonary Embolism: Results of the ELOPE Prospective Cohort Study.
abstract: 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.
  
  
  
  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 (Vo2peak) < 80% at 1-year CPET.
  
  
  
  At 1 year, 40 of 86 patients (46.5%) had percent predicted Vo2peak < 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/m2BMI increase), and smoking history (RR, 1.8; 95% CI, 1.1-2.9), as well as percent predicted Vo2peak < 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.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov; No.: NCT01174628; URL: www.clinicaltrials.gov.
authors.affiliation: Department of Medicine, Jewish General Hospital, Montreal, QC; Center for Clinical Epidemiology, Lady Davis Institute, Montreal, QC; Department of Medicine, McGill University, Montreal, QC. Electronic address: susan.kahn@mcgill.ca.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Kahn
authors.affiliation: Department of Medicine, Jewish General Hospital, Montreal, QC.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Hirsch
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Montreal, QC.
authors.forename: Arash
authors.initials: A
authors.lastname: Akaberi
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS.
authors.forename: Paul
authors.initials: P
authors.lastname: Hernandez
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS.
authors.forename: David R
authors.initials: DR
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Rodger
authors.affiliation: Department of Medicine, McGill University, Montreal, QC.
authors.forename: Susan
authors.initials: S
authors.lastname: Solymoss
authors.affiliation: Department of Medicine, Division of Hematology, Western University, London, ON.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kovacs
authors.affiliation: Department of Medicine, Jewish General Hospital, Montreal, QC.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rudski
authors.affiliation: Department of Cardiology, Ben Gurion University, Beer Sheva, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Shimony
authors.affiliation: Department of Diagnostic Imaging, University of Ottawa, Ottawa, ON.
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
authors.affiliation: Department of Nuclear Medicine, Jewish General Hospital, Montreal, QC.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rush
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: William H
authors.initials: WH
authors.lastname: Geerts
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
authors.affiliation: Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002170:Canada; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology*; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D055420:Perfusion Imaging; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011788:Quality of Life; D000070857:Walk Test
keywords: 6-min walk test; exercise testing; pulmonary embolism; quality of life