@article{bbd03601a0b44f7682960110204d4b19,
title = "Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome",
abstract = "Background: The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. Objectives: To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients. Methods: 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite ≥3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures. Results: Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved ≥1 grade in 18 (67%) patients, and declined in one (3.7%). Conclusions: Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising.",
keywords = "Dyspnea, Pulmonary embolism, Pulmonary hypertension, Quality of life, Rehabilitation",
author = "Boon, {Gudula J.A.M.} and Janssen, {Steffi M.J.} and Stefano Barco and Bogaard, {Harm Jan} and Waleed Ghanima and Kroft, {Lucia J.M.} and Meijboom, {Lilian J.} and Ninaber, {Maarten K.} and Nossent, {Esther J.} and Spruit, {Martijn A.} and Petr Symersky and Vliegen, {Hubert W.} and Noordegraaf, {Anton Vonk} and Huisman, {Menno V.} and Bob Siegerink and Abbink, {Jannie J.} and Klok, {Frederikus A.}",
note = "Funding Information: MAS reports grants from Lung Foundation Netherlands, grants from Stichting Astma Bestrijding, grants from and speaker fees from AstraZeneca and grants and speakers fees from Boehringer Ingelheim, outside the submitted work. Funding Information: MVH reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo, grants from Leo Pharma, outside the submitted work. Funding Information: GJAMB was supported by the Dutch Heart Foundation (2017T064). Funding Information: FAK reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart foundation (2017T064) and the Dutch Thrombosis association, all outside the submitted work. Funding Information: AVN reports grants from Netherlands CardioVascular Research Initiative, grants from Netherlands Organization for Scientific Research, other from Johnson & Johnson and Ferrer in the past 3 years, non-financial support from member of scientific advisory board of Morphogen-XI, outside the submitted work. Funding Information: This work was supported by unrestricted grants from Bayer / Merck Sharp & Dohme (MSD) and Actelion Pharmaceuticals Ltd . Publisher Copyright: {\textcopyright} 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = oct,
doi = "10.1016/j.thromres.2021.08.012",
language = "English",
volume = "206",
pages = "66--75",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "Elsevier Limited",
}