Long-term outcomes of pulmonary embolism in children and adolescents

• Published in: Blood 2024-02, Vol.143 (7), p.631-640
• Main Authors: Bastas, Denise, Brandão, Leonardo R., Vincelli, Jennifer, Wilson, David, Perrem, Lucy, Guerra, Vitor, Wong, Gina, Bentley, Robert F., Tole, Soumitra, Schneiderman, Jane E., Amiri, Nour, Williams, Suzan, Avila, M. Laura
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Cohort Studies; Dyspnea; Exercise Test - adverse effects; Humans; Infant; Infant, Newborn; Lung; Pulmonary Embolism - complications; Pulmonary Embolism - therapy
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood.2023021953

•This cohort study describes the long-term outcomes of PE in 150 children and adolescents followed-up at a single-center institution.•Patients were screened for abnormal functional outcomes using a local protocol (symptoms, lung and cardiac function, and exercise testing). [Display omitted] Knowledge regarding the long-term consequences of pulmonary embolism (PE) in children is limited. This cohort study describes the long-term outcomes of PE in children who were followed-up at a single-center institution using a local protocol that included clinical evaluation, chest imaging, echocardiography, pulmonary function tests, and cardiopulmonary exercise tests at follow-up, starting 3 to 6 months after acute PE. Children objectively diagnosed with PE at age 0 to 18 years, who had ≥6 months of follow-up were included. Study outcomes consisted of PE resolution, PE recurrence, death, and functional outcomes (dyspnea, impaired pulmonary or cardiac function, impaired aerobic capacity, and post-PE syndrome). The frequency of outcomes was compared between patients with/without underlying conditions. In total, 150 patients were included; median age at PE was 16 years (25th-75th percentile, 14-17 years); 61% had underlying conditions. PE did not resolve in 29%, recurrence happened in 9%, and death in 5%. One-third of patients had at least 1 documented abnormal functional finding at follow-up (ventilatory impairments, 31%; impaired aerobic capacity, 31%; dyspnea, 26%; and abnormal diffusing capacity of the lungs to carbon monoxide, 22%). Most abnormalities were transient. When alternative explanations for the impairments were considered, the frequency of post-PE syndrome was lower, ranging between 0.7% and 8.5%. Patients with underlying conditions had significantly higher recurrence, more pulmonary function and ventilatory impairments, and poorer exercise capacity. Exercise intolerance was, in turn, most frequently because of deconditioning than to respiratory or cardiac limitation, highlighting the importance of physical activity promotion in children with PE. In this month’s CME article, Bastas et al examined long-term outcomes following pulmonary embolism (PE) in 150 children and adolescents in a single-center longitudinal cohort using clinical evaluation, imaging, echocardiography, pulmonary function tests, and exercise testing starting 3-6 months after PE. Outcomes were excellent in patients without underlying conditions, with post-PE syndrome between 0.7-8.5%. Patie