Hemodynamic determinants of functional capacity following percutaneous reperfusion for acute PE
M Caetano Coelho, J U L I E N Lopes, D Pinheiro, B Lacerda Teixeira, A N D R E Grazina, J O ÃO Reis, P E D R O Costa, A N A Galrinho, M Ferreira, P E D R O Coelho, R U I Cruz Ferreira, L U I S Almeida MoraisAbstract
Background
Acute pulmonary embolism (PE) remains a clinically significant condition with a growing incidence worldwide. Nearly half of patients (46.5%) exhibit exercise intolerance, defined by a peak oxygen consumption (VO₂max) below 80% of the predicted value, and approximately 3.8% progress to chronic thromboembolic pulmonary hypertension (CTEPH). Beyond CTEPH, the spectrum of post-PE sequelae is increasingly recognized. This growing awareness underscores the importance of evaluating functional recovery after the acute event. In particular, understanding whether improvements in pulmonary vascular load and right-heart hemodynamics following reperfusion therapy translate into measurable gains in functional capacity is essential for optimizing long-term management and rehabilitation strategies in this population.
Aim
To assess whether improvements in pulmonary vascular and right-heart hemodynamic parameters following percutaneous treatment of acute PE are associated with enhanced functional capacity, as measured by peak oxygen consumption (VO₂).
Methods
We conducted an observational study including 45 patients (46% female; median age 61 ± 17.5 years) treated with advanced percutaneous reperfusion techniques for acute PE. Therapeutic strategies included in situ fibrinolysis (71%), aspiration thrombectomy (13%), or a combined approach (16%). Pulmonary artery systolic pressure (PASP) and cardiac output (CO) were recorded at baseline and at 6-month follow-up. The primary variables of interest were the changes in PASP (ΔPASP) and CO (ΔCO). Functional capacity was evaluated by cardiopulmonary exercise testing with measurement of peak VO₂.
Results
Mean peak VO₂ was 84.7% ± 22.4 of predicted, with no significant difference between women (81.4% ± 5.2) and men (90% ± 4.7; p = 0.229). Overall, 44% of patients exhibited exercise intolerance (VO₂max < 80%), a lower proportion than typically reported in post-PE populations. Mean VO₂ did not differ between patients with and without CTEPH (85% ± 10 vs. 86% ± 3.7; p = 0.944). Hemodynamic recovery was significantly associated with functional capacity at 6 months: greater reductions in PASP correlated with higher peak VO₂ (r = 0.376, p = 0.011), as did increases in cardiac output (r = 0.381, p = 0.010), indicating superior functional recovery in patients with greater hemodynamic improvement.
Conclusion
Improvements in PASP and CO following percutaneous reperfusion therapy for acute PE are significantly associated with enhanced functional capacity at 6-month follow-up and may serve as useful indicators of post-PE rehabilitation and prognosis.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.