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There is a growing body of evidence revealing that many patients with a history of venous thromboembolism (VTE) suffer from long-lasting sequelae such as post-thrombotic syndrome and post-pulmonary embolism syndrome. These two syndromes are detrimental to patients as they affect their quality of life (QOL). From this perspective, monitoring QOL may play a crucial role to improve quality care in VTE patients. Many studies have explored possible temporal relations between VTE episodes and decreased functional status and/or QOL. However, studies exploring the implementation of QOL and functional status questionnaires in clinical practice are scarce. In this context, we discuss possible perspectives synthetized from available literature regarding in whom, when, and how QOL could be measured in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The value of the proximal extension of the clot in risk stratification of pulmonary embolism (PE) has not been established. The mean bilateral proximal extension of the clot (MBPEC) is a computed tomography (CT) radiological score, where initial evaluation showed promising results considering its ability in predicting the severity of PE. Purpose: To explore the possible associations between MBPEC and PE-severity parameters, short- and long-term outcomes of PE, and inter-observer agreement. Material and Methods: Patients diagnosed with PE at Østfold Hospital, Norway during 2003–2011 were identified. MBPEC was calculated by calculating the mean of a score in the range of 1–4 assigned for the most proximal extension of the clot in each lung: sub-segmental; segmental; lobar; and main pulmonary arteries. Medical records were reviewed to capture clinical, biochemical, and management-associated data (thrombolysis, admission to ICU). Results: The mean age of 245 included patients was 55 ± 16 years; 42% were women. Patients with higher MBPEC scores had a significantly higher pulse rate and lower oxygen saturation. MBPEC score <4 predicted a negative troponin value with a negative predictive value of 90% (95% confidence interval [CI] 81–95). Patients with MBPEC 4 were 5.3 times more likely to have elevated troponin (odds ratio [OR] 5.3, 95% CI 2.0–14.3). MBPEC score of 4 was independently associated with admission to ICU (OR 3.8, 95% CI 1.8–7.9). The inter-observer agreement was excellent; weighted kappa 0.82. Conclusion: MBPEC is associated with PE-severity parameters and can predict short-term adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Persistent dyspnea is a common symptom after pulmonary embolism (PE). However, the pathophysiology of persistent dyspnea is not fully clarified. This study aimed to explore possible associations between diffuse myocardial fibrosis, as assessed by cardiac magnetic resonance (CMR) T1 mapping, and persistent dyspnea in patients with a history of PE., Methods: CMR with T1 mapping and extracellular volume fraction (ECV) calculations were performed after PE in 51 patients with persistent dyspnea and in 50 non-dyspneic patients. Patients with known pulmonary disease, heart disease and CTEPH were excluded., Results: Native T1 was higher in the interventricular septum in dyspneic patients compared to non-dyspneic patients; difference 13 ms (95% CI: 2-23 ms). ECV was also significantly higher in patients with dyspnea; difference 0.9 percent points (95% CI: 0.04-1.8 pp). There was no difference in native T1 or ECV in the left ventricular lateral wall. Native T1 in the interventricular septum had an adjusted Odds Ratio of 1.18 per 10 ms increase (95% CI: 0.99-1.42) in predicting dyspnea, and an adjusted Odds Ratio of 1.47 per 10 ms increase (95% CI: 1.10-1.96) in predicting Incremental Shuttle Walk Test (ISWT) score < 1020 m., Conclusion: Septal native T1 and ECV values were higher in patients with dyspnea after PE compared with those who were fully recovered suggesting a possible pathological role of myocardial fibrosis in the development of dyspnea after PE. Further studies are needed to validate our findings and to explore their pathophysiological role and clinical significance., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [W. Ghanima reports personal fees for lectures and participation in advisory board from Novartis, Amgen, Grifols, SOBI, UCB, ARGENX, Sanofi, Principia biophrma, Pfizer, BMS and Bayer and grants from Bayer and, PfizerBMS, all outside the submitted work. Dr. FA Klok reports research support from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, MSD, Daiichi-Sankyo, Actelion, the Dutch thrombosis association, The Netherlands Organization for Health Research and Development and the Dutch Heart foundation. J. Gleditsch, Ø. Jervan, M. Tavoly, O. Geier, R. Holst and E. Hopp report no relationships that could be construed as a conflict of interest. The project received an unrestricted grant from the Norwegian patient organizations “Fredrikstad Tuberkuloseforenings Stiftelse” and “Landsforeningen for hjerte- og lungesyke”.]., (© 2021 The Author(s).)