CHEST Guidelines-Chronic-Thromboembolism-Phenotypes-Aside-From-Pulm

Chronic-Thromboembolism-Phenotypes-Aside-From-Pulm

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The editorial by Dr. Timothy A. Morris discusses the evolving understanding of chronic thromboembolism phenotypes aside from pulmonary hypertension, particularly focusing on the aftermath of acute pulmonary embolism (PE). Historically, attention has been given to chronic thromboembolic pulmonary hypertension (CTEPH), but other chronic thromboembolism (CTE) phenotypes are receiving increased scrutiny due to their association with persistent dyspnea and exercise intolerance. These symptoms affect a significant portion of PE patients, complicating recovery.<br /><br />The editorial highlights research on different physiological phenotypes that remain present post-PE. A study by Insel and colleagues, as discussed in the editorial, utilizes combined cardiopulmonary exercise testing (CPET) and right heart catheterization to unveil varying degrees of exercise intolerance and clinical defects among those patients. Three main clusters of patients were identified based on the severity and pattern of their exercise physiologic disturbances and CTE symptoms. The first cluster experienced severe ventilatory inefficiency and limited stroke volume augmentation, often linked to CTEPH. The second showed moderated defects but maintained diminished exercise capacity, possibly due to other cardiopulmonary conditions. The last cluster, while having minor ventilatory issues, demonstrated inadequate stroke volume augmentation, raising questions about underlying cardiomyopathy.<br /><br />The editorial stresses the significant diagnostic value of CPET in assessing post-PE physiologic impairments. This technique provides key insights into the underlying problems like regional perfusion defects and stroke volume limitations during physical exertion, which predict poorer clinical outcomes. The editorial concludes by calling for greater incorporation of CPET in clinical settings to better assess and manage chronic thromboembolism in PE survivors, acknowledging its potential for improving diagnosis and treatment strategies amid ongoing debates about CTE phenotype characterization.

Keywords

chronic thromboembolism

pulmonary embolism

CTEPH

dyspnea

exercise intolerance

cardiopulmonary exercise testing

right heart catheterization

ventilatory inefficiency

stroke volume

cardiomyopathy