{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:34Z","timestamp":1787016934087,"version":"build-2736575974"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Metro South Health SERTA, Queensland.","award":["Project Grant"],"award-info":[{"award-number":["Project Grant"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2023,6,30]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Data on right ventricular (RV) exercise adaptation following acute intermediate and high-risk pulmonary embolism (PE) remain limited. This study aimed to evaluate the symptom burden, RV functional recovery during exercise and cardiopulmonary exercise parameters in survivors of intermediate and high-risk acute PE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively recruited patients following acute intermediate and high-risk PE at four sites in Australia and UK. Study assessments included stress echocardiography, cardiopulmonary exercise testing (CPET) and ventilation\u2013perfusion (VQ) scan at 3\u2009months follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty patients were recruited and 24 (median age: 55 years, IQR: 22) completed follow-up. Reduced peak oxygen consumption (VO\n                      <jats:sub>2<\/jats:sub>\n                      ) and workload was seen in 75.0% (n=18), with a persistent high symptom burden (mean PEmb-QoL Questionnaire 48.4\u00b121.5\u2009and emPHasis-10 score 22.4\u00b18.8) reported at follow-up. All had improvement in RV-focused resting echocardiographic parameters. RV systolic dysfunction and RV to pulmonary artery (PA) uncoupling assessed by stress echocardiography was seen in 29.2% (n=7) patients and associated with increased ventilatory inefficiency (V\u0307E\/V\u0307CO\n                      <jats:sub>2<\/jats:sub>\n                      slope 47.6 vs 32.4, p=0.03), peak exercise oxygen desaturation (93.2% vs 98.4%, p=0.01) and reduced peak oxygen pulse (p=0.036) compared with controls. Five out of seven patients with RV\u2013PA uncoupling demonstrated persistent bilateral perfusion defects on VQ scintigraphy consistent with chronic thromboembolic pulmonary vascular disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our cohort, impaired RV adaptation on exercise was seen in almost one-third of patients. Combined stress echocardiography and CPET may enable more accurate phenotyping of patients with persistent symptoms following acute PE to allow timely detection of long-term complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2023-001637","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T13:03:53Z","timestamp":1690290233000},"page":"e001637","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Right ventricular functional recovery assessment with stress echocardiography and cardiopulmonary exercise testing after pulmonary embolism: a pilot prospective multicentre study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3996-4205","authenticated-orcid":false,"given":"Chinthaka Bhagya","family":"Samaranayake","sequence":"first","affiliation":[{"name":"National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0017-3433","authenticated-orcid":false,"given":"John","family":"Upham","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"Princess Alexandra Hospital, Woolloongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khoa","family":"Tran","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"Department of Respiratory Medicine, Logan Hospital, Loganholme, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke S","family":"Howard","sequence":"additional","affiliation":[{"name":"National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK"},{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital, Woolloongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myo","family":"Lwin","sequence":"additional","affiliation":[{"name":"National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Anderson","sequence":"additional","affiliation":[{"name":"Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhir","family":"Wahi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"Princess Alexandra Hospital, Woolloongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5250-660X","authenticated-orcid":false,"given":"Laura C","family":"Price","sequence":"additional","affiliation":[{"name":"National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK"},{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Wort","sequence":"additional","affiliation":[{"name":"National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK"},{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Li","sequence":"additional","affiliation":[{"name":"National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK"},{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colm","family":"McCabe","sequence":"additional","affiliation":[{"name":"National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK"},{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J","family":"Keir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"Princess Alexandra Hospital, Woolloongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"2025083110315308000_10.1.e001637.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.11.030"},{"key":"2025083110315308000_10.1.e001637.2","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.thromres.2018.09.048","article-title":"The impact of post-pulmonary embolism syndrome and its possible determinants","volume":"171","author":"Tavoly","year":"2018","journal-title":"Thromb Res"},{"key":"2025083110315308000_10.1.e001637.3","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1007\/s00392-018-1405-1","article-title":"Incomplete echocardiographic recovery at 6 months predicts long-term sequelae after intermediate-risk pulmonary embolism. A post-hoc analysis of the pulmonary embolism thrombolysis (PEITHO) trial","volume":"108","author":"Barco","year":"2019","journal-title":"Clin Res Cardiol"},{"key":"2025083110315308000_10.1.e001637.4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/1358863X16670250","article-title":"Persistent right ventricular dysfunction, functional capacity limitation, exercise intolerance, and quality of life impairment following pulmonary embolism: systematic review with meta-analysis","volume":"22","author":"Sista","year":"2017","journal-title":"Vasc Med"},{"key":"2025083110315308000_10.1.e001637.5","doi-asserted-by":"crossref","DOI":"10.5339\/gcsp.2015.58","article-title":"Pulmonary arterial compliance: how and why should we measure it?","volume":"2015","author":"Ghio","year":"2015","journal-title":"Glob Cardiol Sci Pract"},{"key":"2025083110315308000_10.1.e001637.6","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-216324"},{"key":"2025083110315308000_10.1.e001637.7","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01915-2018","article-title":"Chronic thromboembolic pulmonary hypertension","volume":"53","author":"Kim","year":"2019","journal-title":"Eur Respir J"},{"key":"2025083110315308000_10.1.e001637.8","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01787-2018","article-title":"Limitations of resting Haemodynamics in chronic thromboembolic disease without pulmonary hypertension","volume":"53","author":"Swietlik","year":"2019","journal-title":"Eur Respir J"},{"key":"2025083110315308000_10.1.e001637.9","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01934-2019","article-title":"Chronic thromboembolic disease following pulmonary embolism: time for a fresh look at old clot","volume":"55","author":"McCabe","year":"2020","journal-title":"Eur Respir J"},{"key":"2025083110315308000_10.1.e001637.10","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hft044"},{"key":"2025083110315308000_10.1.e001637.11","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00153613"},{"key":"2025083110315308000_10.1.e001637.12","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01123.2013"},{"key":"2025083110315308000_10.1.e001637.13","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.119.010059","article-title":"Validation of the tricuspid Annular plane systolic excursion\/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension","volume":"12","author":"Tello","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025083110315308000_10.1.e001637.14","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00157.2013"},{"key":"2025083110315308000_10.1.e001637.15","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00879-2022"},{"key":"2025083110315308000_10.1.e001637.16","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00450-2022","article-title":"Right ventricular-pulmonary arterial coupling and its relationship to exercise Haemodynamics in a continuum of patients with pulmonary vascular disease due to chronic thromboembolism","volume":"60","author":"Douschan","year":"2022","journal-title":"Eur Respir J"},{"key":"2025083110315308000_10.1.e001637.17","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/ehjci\/jeaa243","article-title":"The echocardiographic ratio tricuspid annular plane systolic excursion\/pulmonary arterial systolic pressure predicts short-term adverse outcomes in acute pulmonary embolism","volume":"22","author":"Lyhne","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025083110315308000_10.1.e001637.18","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.006841","article-title":"Cardiopulmonary exercise testing in patients following massive and submassive pulmonary embolism","volume":"7","author":"Albaghdadi","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025083110315308000_10.1.e001637.19","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1093\/eurheartj\/ehab816","article-title":"Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology working group on pulmonary circulation and right ventricular function, in collaboration with the European Society of Cardiology working group on Atherosclerosis and vascular biology, endorsed by the European respiratory society","volume":"43","author":"Klok","year":"2022","journal-title":"Eur Heart J"},{"key":"2025083110315308000_10.1.e001637.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2009.03726.x"},{"key":"2025083110315308000_10.1.e001637.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2009.03726.x"},{"key":"2025083110315308000_10.1.e001637.22","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00127113"},{"key":"2025083110315308000_10.1.e001637.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.05.010"},{"key":"2025083110315308000_10.1.e001637.24","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s11239-016-1415-7","article-title":"Late outcomes after acute pulmonary embolism: rationale and design of FOCUS, a prospective observational multicenter cohort study","volume":"42","author":"Konstantinides","year":"2016","journal-title":"J Thromb Thrombolysis"},{"key":"2025083110315308000_10.1.e001637.25","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.ijcard.2016.08.275","article-title":"Physiologic correlates of tricuspid annular plane systolic excursion in 1168 healthy subjects","volume":"223","author":"Ferrara","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025083110315308000_10.1.e001637.26","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/echo.13396","article-title":"Echocardiographic assessment of right ventricular contractile reserve in healthy subjects","volume":"34","author":"D\u2019Alto","year":"2017","journal-title":"Echocardiography"},{"key":"2025083110315308000_10.1.e001637.27","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1093\/ehjci\/jeaa085","article-title":"Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents","volume":"22","author":"Forton","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025083110315308000_10.1.e001637.28","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.hrtlng.2011.06.009","article-title":"Cardiopulmonary exercise test in patients with subacute pulmonary emboli","volume":"41","author":"Topilsky","year":"2012","journal-title":"Heart Lung"},{"key":"2025083110315308000_10.1.e001637.29","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00076009"},{"key":"2025083110315308000_10.1.e001637.30","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201211-2090CI"},{"key":"2025083110315308000_10.1.e001637.31","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1113\/JP279759","article-title":"New insights into resting and exertional right ventricular performance in the healthy heart through real-time pressure-volume analysis","volume":"598","author":"Cornwell","year":"2020","journal-title":"J Physiol"},{"key":"2025083110315308000_10.1.e001637.32","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.116.005711","article-title":"Accuracy of echocardiography to estimate pulmonary artery pressures with exercise: a simultaneous invasive-noninvasive comparison","volume":"10","author":"van Riel","year":"2017","journal-title":"Circ Cardiovasc Imaging"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2023-001637","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:32:07Z","timestamp":1756661527000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2023-001637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,7,25]]},"published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1136\/bmjresp-2023-001637"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2023-001637","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}