Change in Body-Mass-Index and Persisting Symptoms After Pulmonary Embolism
Authors: Mäkelburg Anja B.U. , Hoendermis Elke S. , Veeger Nic J.G.M. , Kluin-Nelemans J.C. , Meijer Karina 
Published: October 2019

Abstract
Abstract 3389

Introduction
Two third of patients experience persisting symptoms after pulmonary embolism (PE). No distinct (cardiopulmonary) pathology is detectable in most of them. We previously reported that patients with persisting symptoms had a higher body-mass-index (BMI). In this study, we evaluated whether patients developing persisting symptoms had a higher BMI at time of PE or a larger gain of weight than patients without persisting symptoms, or both.

Methods
In patients at least one year after PE, height and weight were measured. Medical charts were reviewed for weight at time of PE. Patients were regarded as overweight if BMI was 25–30 kg/m2 and as obese with a BMI >30 kg/m2. Patients were classified as having increased tiredness when they reported any increase in tiredness with or without loss of condition after PE; their daily routine had to be unchanged. Patients were classified as having decreased performance when reporting any change in daily routine due to residual symptoms following PE. All other patients were classified as having no symptoms.

Results
Between May 2008 and December 2010 129 patients were evaluated. Median age at time of PE was 52.2 (range 20.8–86.7) years and median time passed since PE was 2.0 (range 1.0–14.9) years, 55 (43%) were female.
Median BMI at time of PE was 27.5 (range 17.3–46.1) kg/m2. At evaluation for this study, median BMI was 28.1 (range 17.9–50.3) kg/m2. Median gain in weight between PE and evaluation was 3.0 (range −19.0–28.0) kg. This resulted in a median increase in BMI of 0.9 (range −5.4–9.0) kg/m2.
In asymptomatic patients, median BMI was unchanged at 26.6 (range 17.9–43.5) kg/m2. In patients with increased tiredness BMI increased from 27.6 (range 18.7–42.1) kg/m2 to 28.4 (range 20.2–46.4) kg/m2, and in patients with decreased performance from 27.9 (range 20.7–46.1) kg/m2 to 28.9 (range 21.9–50.3) kg/m2 (p=0.049). In the asymptomatic group percentage of patients with normal BMI remained 35%. In the symptomatic groups BMI decreased from 28% to 21% and from 24% to 16%, respectively. Percentage of obese patients increased from 23% to 29% in asymptomatic patients, and from 33% and 32% it increased to 37% in both, patients with increased tiredness and in those with decreased performance. Median gain in weight was 2.0 (range −19.0–28.0) kg vs. 3.0 (range −15.0–27.0) kg vs. 3.8 (range −6.0–19.0) kg, respectively.
Women more often had persistent symptoms. Females accounted for 38% of asymptomatic patients, in symptomatic patients 28% with increased tiredness and 66% with decreased performance were female. This correlated with a higher percentage of obese women (40%) than men (20%) at time of PE, p=0.009. At time of evaluation, 42% of women and 28% of men were obese, p=0.057. No differences were observed between women and men regarding change in weight or BMI.

Conclusion
Patients with persisting symptoms were heavier than those without symptoms. This was explained by both a higher BMI at PE, and a greater gain in weight during follow-up. Patients without persisting symptoms had no increase in median BMI.

Disclosures:
No relevant conflicts of interest to declare.