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...................... Off-label combination of drugs approved for pulmonary arterial hypertension has been proposed for CTEPH patients presenting with severe haemodynamic compromise, but only limited prospective data are available to date.470

Medical therapy is not indicated in symptomatic survivors of acute PE with documented post-thrombotic obstructions but an absence of PH at right heart catheterization at rest (CTED). 10.3 Strategies for patient follow-up after

pulmonary embolism Figure 8 displays a proposed follow-up strategy for survivors of acute PE following discharge from hospital. Evaluation of the patients 36 months after the acute PE episode is recommended to assess the persistence (or new onset) and severity of dyspnoea or functional limitation, and to check for possible signs of VTE recurrence, cancer,

©ESC 2019

DIAGNOSIS OF ACUTE PE

Refer to PH/CTEPH expert centre for further diagnostic

work-up

V/Q SCAN: Mismatched perfusion defects?

Anticoagulate

TTE: Determine probability of PHc

FOLLOW-UP AT 3–6 MONTHSa

Dyspnoea and/or functional limitationb?

CONSIDER: 1) Elevated NT-proBNP 2) Risk factors for CTEPHd 3) Abnormal CPET resultse

Low Intermediate

No

Yes

No Yes

High

None present None present

≥1 present ≥1 present: may consider TTE

Seek alternative causes of dyspnoeaf and/or common causes of PH Focus on anticoagulation and secondary prophylaxis;

advise to return if symptoms appear

ASSESS: Risk factors for CTEPHd

Figure 8 Follow-up strategy and diagnostic workup for long-term sequelae of pulmonary embolism. CPET= cardiopulmonary exercise testing; CTEPH = chronic thromboembolic pulmonary hypertension; NT-proBNP= N-terminal pro B-type natriuretic peptide; PE= pulmonary embolism; PH= pulmonary hypertension; TTE = transthoracic echocardiography/echocardiogram; V/Q = ventilation/perfusion (lung scintigraphy). aAssess the persistence (or new onset) and severity of dyspnoea or functional limitation, and also check for possible signs of VTE recurrence, cancer, or bleeding complications of anticoagulation. bThe Medical Research Council scale can be used to standardize the evaluation of dyspnoea;160 alternatively, the World Health Organization functional class can be determined (Supplementary Data Table16).289 cAs defined by the ESC/ERS guidelines on the diagnosis and treatment of Pulmonary Hypertension (Supplementary Data Tables 17 and 18).289 dRisk factors and predisposing conditions for CTEPH are listed in Table 13. eCardiopulmonary exercise testing, if appropriate expertise and resources are available on site; abnormal results include, among others, reduced maximal aerobic capacity (peak oxygen consumption), increased ventilatory equivalent for carbon dioxide, and reduced end-tidal carbon dioxide pressure. fConsider CPET in the diagnostic work-up. Downloaded from academic.oup.com/eurheartj/article/41/4/543/5556136 by guest on 07 October 2026