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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Nanna Rolving, Aarhus University, Denmark
- Second opponent: Senior Consultant Arne Kristian Andreassen, Oslo University Hospital
- Third member and chair of the evaluation committee: Professor II Morten Rostrup, University of Oslo
Chair of the Defence
Professor Ketil Størdal, University of Oslo
Principal Supervisor
Professor II Waleed Khalid Yosif Ghanima, University of Oslo
Summary
Persistent dyspnoea, reduced quality of life, and impaired physical capacity is common following pulmonary embolism (PE). The underlying mechanisms are poorly understood, and optimal management of this patient group is unknown.
This thesis has two overarching goals: 1) To explore underlying mechanisms behind persistent dyspnoea following PE, and 2) to assess the effect of an exercise-based rehabilitation programme in those suffering with persistent dyspnoea following PE.
Participants underwent a comprehensive diagnostic work-up, including blood samples, cardiac ultrasound, pulmonary function tests, walking tests, and radiological imaging of the lungs. Almost half of the participants reported persistent dyspnoea that had appeared or worsened at the time of PE. Those with dyspnoea were younger, had higher body mass index, and were more likely to have recurrent venous thromboembolism. Reduced gas diffusion of the lung was the only cardiopulmonary variable associated with dyspnoea. Residual perfusion defects on scintigraphic imaging, suggesting areas of the lungs with impaired blood flow, were present in 25% of participants. This was associated with signs of increased pressure in the pulmonary circulation by cardiac ultrasound, but we found no link between residual perfusion defects and dyspnoea.
In further work, we performed a randomized controlled trial, where patients with persistent dyspnoea following PE were randomized to either an 8-week exercise-based rehabilitation programme or usual care. The rehabilitation group performed better on field walking tests and reported better quality of life at follow-up.
In conclusion, this thesis confirms that persistent dyspnoea is common following PE, and our results indicate that there are probably several mechanisms at play. Furthermore, we have demonstrated a positive effect of an exercise-based rehabilitation programme in PE-survivors with persistent dyspnoea.
Additional information
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