Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism

Dieuwke Luijten; Josien van Es; Jannie J. Abbink; Stefano Barco; Johanna M.W. van den Berg; Waleed Ghanima; Menno V. Huisman; Coen van Kan; Bas Langeveld; Ivo van der Lee; Rosa Mali; Thijs E. van Mens; Timothy A. Morris; Maria Overbeek; Mart van der Plas; Martijn A. Spruit; Frederikus A. Klok; Anton Vonk Noordegraaf; Maarten K. Ninaber

doi:10.1016/j.chpulm.2025.100164

Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism

Dieuwke Luijten^*
, Josien van Es
, Jannie J. Abbink
, Stefano Barco
, Johanna M.W. van den Berg
, Waleed Ghanima
, Menno V. Huisman
, Coen van Kan
, Bas Langeveld
, Ivo van der Lee
, Rosa Mali
, Thijs E. van Mens
, Timothy A. Morris
, Maria Overbeek
, Mart van der Plas
, Martijn A. Spruit
, Frederikus A. Klok
, Anton Vonk Noordegraaf
, Maarten K. Ninaber

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown. Research Question: What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE? Study Design and Methods: A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale = 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade = 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulse<inf>AT</inf>/oxygen pulse<inf>rest</inf> < 2.6, and a ventilatory equivalent for carbon dioxide = 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis. Results: There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulse<inf>AT</inf>/oxygen pulse<inf>rest</inf> < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold = 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities. Interpretation: There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes. Clinical Trial Registration: Dutch Trial Register; No.: NTR NL9615; URL: https://onderzoekmetmensen.nl/en/trial/54292

Original language	English
Article number	100164
Number of pages	10
Journal	CHEST Pulmonary
Volume	3
Issue number	3
DOIs	https://doi.org/10.1016/j.chpulm.2025.100164
Publication status	Published - 1 Sept 2025

Keywords

exercise test
exercise tolerance
pulmonary embolism

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Luijten, D., van Es, J., Abbink, J. J., Barco, S., van den Berg, J. M. W., Ghanima, W., Huisman, M. V., van Kan, C., Langeveld, B., van der Lee, I., Mali, R., van Mens, T. E., Morris, T. A., Overbeek, M., van der Plas, M., Spruit, M. A., Klok, F. A., Vonk Noordegraaf, A., & Ninaber, M. K. (2025). Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism. CHEST Pulmonary, 3(3), Article 100164. https://doi.org/10.1016/j.chpulm.2025.100164

@article{9d04b57caac54ba4af33e8b534b51eb9,

title = "Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism",

abstract = "Background: Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown. Research Question: What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE? Study Design and Methods: A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale = 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade = 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80\% predicted, a peak oxygen pulse < 80\% predicted or oxygen pulseAT/oxygen pulserest < 2.6, and a ventilatory equivalent for carbon dioxide = 34 at anaerobic threshold or dead space to tidal volume ratio > 30\% at peak, and their association with markers of PE severity at diagnosis. Results: There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80\% predicted in 23\% of patients, oxygen pulse < 80\% predicted or oxygen pulseAT/oxygen pulserest < 2.6 in 75\%, and ventilatory equivalent for carbon dioxide at anaerobic threshold = 34 or peak dead space to tidal volume ratio > 30\% in 49\%. In 1 of 7 patients, none of the previously reported signs were present (14\%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities. Interpretation: There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes. Clinical Trial Registration: Dutch Trial Register; No.: NTR NL9615; URL: https://onderzoekmetmensen.nl/en/trial/54292",

keywords = "exercise test, exercise tolerance, pulmonary embolism",

author = "Dieuwke Luijten and \{van Es\}, Josien and Abbink, \{Jannie J.\} and Stefano Barco and \{van den Berg\}, \{Johanna M.W.\} and Waleed Ghanima and Huisman, \{Menno V.\} and \{van Kan\}, Coen and Bas Langeveld and \{van der Lee\}, Ivo and Rosa Mali and \{van Mens\}, \{Thijs E.\} and Morris, \{Timothy A.\} and Maria Overbeek and \{van der Plas\}, Mart and Spruit, \{Martijn A.\} and Klok, \{Frederikus A.\} and \{Vonk Noordegraaf\}, Anton and Ninaber, \{Maarten K.\}",

note = "Funding Information: This work was supported by a grant from The Dutch Thrombosis Association (project number 2021-B) . Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = sep,

day = "1",

doi = "10.1016/j.chpulm.2025.100164",

language = "English",

volume = "3",

journal = "CHEST Pulmonary",

issn = "2949-7892",

publisher = "Elsevier BV",

number = "3",

}

Luijten, D, van Es, J, Abbink, JJ, Barco, S, van den Berg, JMW, Ghanima, W, Huisman, MV, van Kan, C, Langeveld, B, van der Lee, I, Mali, R, van Mens, TE, Morris, TA, Overbeek, M, van der Plas, M, Spruit, MA, Klok, FA, Vonk Noordegraaf, A & Ninaber, MK 2025, 'Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism', CHEST Pulmonary, vol. 3, no. 3, 100164. https://doi.org/10.1016/j.chpulm.2025.100164

TY - JOUR

T1 - Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism

AU - Luijten, Dieuwke

AU - van Es, Josien

AU - Abbink, Jannie J.

AU - Barco, Stefano

AU - van den Berg, Johanna M.W.

AU - Ghanima, Waleed

AU - Huisman, Menno V.

AU - van Kan, Coen

AU - Langeveld, Bas

AU - van der Lee, Ivo

AU - Mali, Rosa

AU - van Mens, Thijs E.

AU - Morris, Timothy A.

AU - Overbeek, Maria

AU - van der Plas, Mart

AU - Spruit, Martijn A.

AU - Klok, Frederikus A.

AU - Vonk Noordegraaf, Anton

AU - Ninaber, Maarten K.

PY - 2025/9/1

Y1 - 2025/9/1

N2 - Background: Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown. Research Question: What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE? Study Design and Methods: A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale = 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade = 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6, and a ventilatory equivalent for carbon dioxide = 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis. Results: There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold = 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities. Interpretation: There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes. Clinical Trial Registration: Dutch Trial Register; No.: NTR NL9615; URL: https://onderzoekmetmensen.nl/en/trial/54292

AB - Background: Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown. Research Question: What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE? Study Design and Methods: A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale = 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade = 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6, and a ventilatory equivalent for carbon dioxide = 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis. Results: There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold = 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities. Interpretation: There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes. Clinical Trial Registration: Dutch Trial Register; No.: NTR NL9615; URL: https://onderzoekmetmensen.nl/en/trial/54292

KW - exercise test

KW - exercise tolerance

KW - pulmonary embolism

U2 - 10.1016/j.chpulm.2025.100164

DO - 10.1016/j.chpulm.2025.100164

M3 - Article

SN - 2949-7892

VL - 3

JO - CHEST Pulmonary

JF - CHEST Pulmonary

IS - 3

M1 - 100164

ER -

Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism

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Keywords

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