Persistent dyspnea after acute pulmonary embolism is related to perfusion defects and lower long-term quality of life

Background: The rate or persistent perfusion defects after acute pulmonary embolism (PE) varies from 30 % to 50 % after 6 months of treatment. Moreover, PE patients may suffer from persistent dyspnea and decreased quality of life (QoL). However, it is unknown whether persistent dyspnea results from perfusion defects and if either may affect QoL on the very long term. This study assessed the rate of persistent dyspnea and perfusion defects after PE and their association with long-term QoL. Methods: This observational study included consecutive patients with acute PE. At 6 months, a perfusion scan (Q-scan) was performed, patient-reported dyspnea was assessed, and of both the cumulative incidence rates with 95 % confidence intervals (CI) were calculated. After five years, disease-specific QoL was assessed with the PEmb-QoL questionnaire. Differences in PEmb-QoL between patients with and without dyspnea and between patients with and without persisting perfusion defects were calculated with the Mann-Whitney U test. Results: In 179 PE patients, the rate of persistent dyspnea was 24 % (95 % CI:17–30 %). Of these patients, 57 % (95 % CI:40–72 %) had persistent perfusion defects at 6 months which was significantly related to the persistent dyspnea (OR: 2.3 (95 % CI:1.1–4.9); p = 0.027). Perfusion defects did not result a difference in PEmb-QoL at five years. However, patients with persistent dyspnea had significantly worse PEmb-QoL after 5 years (38 % [18–55 %] versus 11 % [4.2–25 %]; p < 0.001). Conclusion: Persistent dyspnea after acute PE was associated with a lower QoL on the long term, however no relation was found between persistent perfusion defects and a lower QoL.