title: Detection of Residual Pulmonary Vascular Obstruction by Ventilation-Perfusion Lung Scan Late After a First Pulmonary Embolism.
abstract: The long-term impact of persistent pulmonary vascular obstruction after pulmonary embolism (PE) remains unknown. Based on ventilation-perfusion lung scan performed at discharge and 3 months after a first PE, we aimed to investigate the prognostic value on 5-year adverse events of (1) residual pulmonary vascular obstruction (RPVO) at discharge (DIS-RPVO), (2) RPVO at 3 months (3M-RPVO), and (3) relative change in RPVO between the 2 scans (RC-RPVO). We performed a prospective, multicenter cohort study from January 2007 to December 2009 including patients who survived at least 3 months after a PE. RC-RPVO was defined as (DIS-RPVO - 3M-RPVO)/DIS-RPVO. The primary end point was a combined end point at 5 years, composed of all-cause death, recurrent venous thromboembolism, chronic thromboembolic pulmonary hypertension, heart failure, and rehospitalization for cardiac causes. Receiver-operating characteristic curves were computed to define thresholds of DIS-RPVO, 3M-RPVO, and RC-RPVO predictive of the primary combined end point at 5 years. Overall, 241 patients were included (high-risk PE: 11.2%, intermediate-risk PE: 51.8%, low-risk PE: 37%). Mean DIS-RPVO was 27.9 ± 15.1%, mean 3M-RPVO was 10.3 ± 10.8%, and mean RC-RPVO was 61.7 ± 33.4%. At 5 years, 112 patients (46.5%) experienced the combined end point. Both 3M-RPVO ≥15% and RC-RPVO ≤37.5% were independently related to the occurrence of the combined end point at 5 years (p = 0.01 and p = 0.02, respectively). DIS-RPVO did not predict long-term adverse events. In conclusion, RC-RPVO ≤37.5% and 3M-RPVO ≥15% were independently related to the occurrence of adverse events 5 years after a first PE.
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France. Electronic address: rchopard@chu-besancon.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Genet
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Fiona
authors.initials: F
authors.lastname: Ecarnot
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Chatot
authors.affiliation: Department of Cardiology, General Hospital of Dole, Dole, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Napporn
authors.affiliation: Department of Cardiology, General Hospital of Pontarlier, Pontarlier, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Hyvert
authors.affiliation: Department of Cardiology, General Hospital of Vesoul, Vesoul, France.
authors.forename: Katy
authors.initials: K
authors.lastname: Didier-Petit
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000072226:Computed Tomography Angiography; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D013997:Time Factors