Dynamics of clinical and instrumental parameters and predictors of adverse long-term outcomes in patients with pulmonary embolism

Introduction. Long‑term outcomes after acute pulmonary embolism (PE) remain insufficiently studied. Early identification of patients at high risk for adverse events is an unresolved clinical problem.
Objective: To evaluate the dynamics of clinical, laboratory, and echocardiographic parameters in the patients at 3 months after acute PE and to identify independent predictors of adverse outcome (AO) – all‑cause death, recurrent venous thromboembolism (VTE), or chronic thromboembolic pulmonary hypertension (CTEPH) – within 12 months of follow‑up.
Materials and methods. This retrospective‑prospective observational study included 212 consecutive patients with confirmed acute PE (median age 64 years, 56.6% male). Clinical, laboratory, and echocardiographic assessments were performed at hospital discharge and after 3 months of follow‑up. Multivariable logistic regression analysis was used to identify independent predictors.
Results. An adverse outcome occurred in 47 patients (22.2%): death – 10.8%, recurrent VTE – 11.8%, CTEPH – 7.5%. In patients with a favorable outcome, the prevalence of weakness decreased from 66.9% to 33.8% at 3 months (p <0.001), whereas in the AO group weakness persisted in 75% (p < 0.001 for between‑group difference). Over the 3‑month period, the AO group showed a decrease in estimated glomerular filtration rate (Δ -9.5 ml/min/1.73 m², p = 0.007), no increase in haemoglobin (p = 0.044), an increase in right ventricular size (Δ +2.1 mm, p = 0.037), and no reduction in systolic pulmonary artery pressure (SPAP) (between‑group p <0.001). Independent predictors of adverse outcome were: persistence of weakness at 3 months (OR 3.63, 95% CI: 1.41–9.38, p = 0.008), an increase in right ventricular size per 1 mm (OR 1.15, 95% CI: 1.05–1.26, p = 0.004), and lack of SPAP reduction per 1 mmHg (OR 1.05, 95% CI: 1.01–1.10, p = 0.010). Weakness persisting at 3 months likely reflects reduced exercise tolerance. The identified predictors make it possible to identify a high‑risk group already at an early stage of outpatient follow‑up.
Conclusion. Patients with persistent weakness, absence of regression of pulmonary hypertension, and right ventricular enlargement require dynamic follow‑up.

For citation: Musa HKD, Selivanov GA, Kokorin VA. Dynamics of clinical and instrumental parameters and predictors of adverse long-term outcomes in patients with pulmonary embolism. Therapy (Moscow). 2026;12(5S):10–16.
https://doi.org/10.18565/therapy.2026.5-s5.10-16

INTRODUCTION

Pulmonary embolism (PE) is a life-threatening manifestation of venous thromboembolism (VTE) and remains one of the leading causes of cardiovascular mortality and disability [1, 2]. Despite substantial advances in diagnosis and treatment, PE is associated not only with a high risk of early complications but also with adverse long-term outcomes [3, 4].

Long-term outcomes after PE are receiving increasing attention. In a substantial proportion of patients, clinical symptoms, particularly dyspnea and reduced exercise tolerance, persist or progress after the acute event [5]. Chronic thromboembolic pulmonary hypertension (CTEPH), right heart remodeling, and recurrent VTE may subsequently develop [6, 7]. Collectively, these conditions are considered manifestations of post-pulmonary embolism syndrome (post-PE syndrome) [3, 6, 7].

Current guidelines emphasize the need for follow-up after PE [8, 9]; however, data on changes in clinical, laboratory, and diagnostic parameters during follow-up remain limited. The association between changes in various parameters and the risk of adverse clinical outcomes has not been sufficiently studied.

Accordingly, studies aimed at comprehensively assessing changes in clinical symptoms and laboratory and diagnostic parameters in patients after PE, as well as identifying factors associated with the development of adverse long-term outcomes, are warranted.

The aim of this study was to assess changes in clinical, laboratory, and echocardiographic parameters 3 months after an episode of PE and to identify independent predictors of an adverse outcome – all-cause death, recurrent VTE, or CTEPH – over 12 months of follow-up.

METHODS

Study design

This combined retrospective and prospective observational study included 212 patients who had experienced an episode of pulmonary embolism (PE) and were discharged from the hospital for outpatient follow-up. Patients were identified and selected at Outpatient Clinic No. 2 of Kolomna Hospital (n = 84) and Outpatient Clinic No. 4 of Voskresensk Hospital (n = 128), both State Budgetary Healthcare Institutions of the Moscow Region.

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the RUDN University Medical Institute on January 17, 2025. All patient data were de-identified.

Study population and outcome definition

The diagnosis of pulmonary embolism (PE) was based on the clinical presentation and required confirmation by diagnostic imaging. In most patients, the diagnosis was confirmed by multidetector CT pulmonary angiography (CTPA). When contrast-enhanced imaging was contraindicated or CTPA could not be performed, the diagnosis was confirmed based on echocardiographic findings. Chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed in the presence of persistent pulmonary hypertension at least 3 months after an episode of PE while the patient was receiving adequate anticoagulant therapy. The diagnosis was supported by a combination of echocardiographic signs of elevated pulmonary artery pressure and residual thromboembolic changes detected by CTPA.

During hospitalization, all patients received anticoagulant therapy and, when indicated, thrombolytic therapy in accordance with the 2019 European Society of Cardiology (ESC) guidelines. After discharge, the anticoagulation regimen was individualized based on the risks of recurrent venous thromboembolism (VTE) and bleeding.

Clinical, laboratory, and instrumental parameters were assessed at hospital discharge and at the 3-month outpatient follow-up visit. The primary endpoint was an adverse outcome, defined as the occurrence of any of the following events within 12 months after discharge: death from any cause, recurrent VTE, or chronic thromboembolic pulmonary hypertension (CTEPH). Outcomes were assessed through in-person or telephone contact with the patients at 3 and 12 months after hospitalization. Based on the outcome, the patients were divided into two groups: the favorable-outcome (FO) group and the adverse-outcome (AO) group.

Statistical analysis

Categorical variables were presented as absolute counts and percentages. Quantitative variables were presented as medians and interquartile ranges (Me [IQR]) or as means and standard deviations (M ± SD), depending on the data d...

H.K.D. Musa, G.A. Selivanov, V.A. Kokorin