Residual perfusion defects after acute pulmonary embolism mark patients at risk for complications

Residual perfusion defects normally persist following acute pulmonary embolism, indicating a more severe initial disease phenotype, according to a study.

“While not associated with early clinical outcomes, their presence identifies patients at risk for chronic thromboembolic complications, supporting a targeted follow-up imaging strategy,” the authors said.

In this study involving 325 patients (median age 62 years, 47 percent male), residual perfusion defects were observed in 235 individuals (72 percent) over a mean follow-up of 3 months.

Older age, bilateral and higher-risk pulmonary embolism, and deep vein thrombosis significantly correlated with residual perfusion defects. Patients with such defects showed higher inflammatory and thrombotic biomarkers, as well as more pronounced right ventricular dysfunction with elevated pulmonary pressures.

Independent predictors or residual perfusion defects were as follows: prior venous thromboembolism (odds ratio [OR] 7.61), intermediate-high/high-risk pulmonary embolism (OR, 3.66), older age, and elevated C-reactive protein. On the other hand, major provoking factors were protective.

No between-group differences were noted for dyspnoea and mortality. Notably, only patients with residual perfusion defects experienced chronic thromboembolic pulmonary disease or pulmonary hypertension.

This retrospective cohort study included consecutive patients hospitalized with confirmed acute pulmonary embolism (2012‒2024) who underwent baseline and follow-up V/Q scintigraphy.

The authors classified patients by perfusion recovery or persistent residual perfusion defects. They then compared clinical, laboratory, imaging, and outcome data and identified independent predictors via multivariable logistic regression.