Dieuwke Luijten MD , Josien van Es MD, PhD , Jannie J. Abbink MD, PhD , Stefano Barco MD, PhD , Johanna M.W. van den Berg MD , Waleed Ghanima MD, PhD , Menno V. Huisman MD, PhD , Coen van Kan MD, PhD , Bas Langeveld MD, PhD , Ivo van der Lee MD, PhD , Rosa Mali MD , Thijs E. van Mens MD, PhD , Timothy A. Morris MD , Maria Overbeek MD, PhD , Mart van der Plas PhD , Martijn A. Spruit PhD , Frederikus A. Klok MD, PhD , Anton Vonk Noordegraaf MD, PhD , Maarten K. Ninaber MD, PhD
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However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown.</div></div><div><h3>Research Question</h3><div>What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE?</div></div><div><h3>Study Design and Methods</h3><div>A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale ≥ 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade ≥ 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulse<sub>AT</sub>/oxygen pulse<sub>rest</sub> < 2.6, and a ventilatory equivalent for carbon dioxide ≥ 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis.</div></div><div><h3>Results</h3><div>There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulse<sub>AT</sub>/oxygen pulse<sub>rest</sub> < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥ 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities.</div></div><div><h3>Interpretation</h3><div>There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes.</div></div><div><h3>Clinical Trial Registration</h3><div>Dutch Trial Register; No.: NTR NL9615; URL: <span><span>https://onderzoekmetmensen.nl/en/trial/54292</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100164"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism\",\"authors\":\"Dieuwke Luijten MD , Josien van Es MD, PhD , Jannie J. Abbink MD, PhD , Stefano Barco MD, PhD , Johanna M.W. van den Berg MD , Waleed Ghanima MD, PhD , Menno V. Huisman MD, PhD , Coen van Kan MD, PhD , Bas Langeveld MD, PhD , Ivo van der Lee MD, PhD , Rosa Mali MD , Thijs E. van Mens MD, PhD , Timothy A. Morris MD , Maria Overbeek MD, PhD , Mart van der Plas PhD , Martijn A. Spruit PhD , Frederikus A. Klok MD, PhD , Anton Vonk Noordegraaf MD, PhD , Maarten K. Ninaber MD, PhD\",\"doi\":\"10.1016/j.chpulm.2025.100164\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown.</div></div><div><h3>Research Question</h3><div>What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE?</div></div><div><h3>Study Design and Methods</h3><div>A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale ≥ 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade ≥ 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. 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Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities.</div></div><div><h3>Interpretation</h3><div>There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. 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Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism
Background
Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown.
Research Question
What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE?
Study Design and Methods
A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale ≥ 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade ≥ 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6, and a ventilatory equivalent for carbon dioxide ≥ 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis.
Results
There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥ 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities.
Interpretation
There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes.
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