{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T14:34:57Z","timestamp":1789223697082,"version":"build-2803163510"},"reference-count":31,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>For the majority of patients who experience persistent dyspnea 3 months after an acute pulmonary embolism (PE), the cause of exercise limitation is unknown. We hypothesized that data collected from invasive cardiopulmonary exercise (iCPET) would inform whether pre-load failure (PLF) may be an under-recognized cause of post-PE dyspnea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Between 2015 and 2023, we retrospectively identified patients with prior PE and unexplained dyspnea who underwent iCPET testing. Those with chronic thromboembolic pulmonary hypertension (CTEPH) were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Thirty-four patients with PE history and unexplained dyspnea were identified. The mean peak VO2 for the cohort was reduced at 71.0 \u00b1 20.5%. This cardiovascular limit was explained by PLF with a reduced right atrial pressure (RAP) at peak exercise (4.5 [5.0] mmHg). There was no evidence of ventilatory inefficiency (VE\/VCO2 slope: 30.8 [10.9]). However, dead space ventilation at peak exercise was increased (0.24 \u00b1 0.10). Owing prior work establishing an association between PLF and small fiber neuropathy (SFN), we evaluated the results of post-PE patients referred for skin biopsies at the providers\u2019 discretion (32.4%, n = 11). Of these, 9 patients (82%) had confirmed SFN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This is the first case series to utilize iCPET data to investigate novel causes of post-PE dyspnea. We describe PLF, characterized by a central cardiac limit to exercise and low RAP at peak, in post-PE patients with otherwise unexplained symptoms. We additionally describe an association between PLF and SFN and hypothesize a mechanistic link between an inflammatory PE insult, peripheral neuronal injury, and resultant dyspnea.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x261429983","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T12:17:51Z","timestamp":1781093871000},"page":"323-328","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Preload failure and small fiber neuropathy are associated with persistent dyspnea following acute pulmonary embolism: Insights from invasive cardiopulmonary exercise testing"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6297-6389","authenticated-orcid":false,"given":"Shelsey W","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna W","family":"Squires","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvind K","family":"Pandy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Systrom","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron B","family":"Waxman","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201901-061PS"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X16670250"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00879-2022"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00449-2023"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.11.030"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00059-2023"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202302-108RL"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.10.047"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/685054"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.104463"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202005-581CME"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.03.049"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.08.010"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.2917"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.01.082"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317709605"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01307-2015"},{"key":"e_1_3_2_19_2","volume-title":"Principles of exercise testing and interpretation: Including pathophysiology and clinical applications","author":"Wasserman K","year":"1999","unstructured":"Wasserman K, Hansen JE, Sue DY, Stringer WW. 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