How do you decide if a patient should get follow-up perfusion imaging after acute PE when they are minimally symptomatic?

I practice essentially as reflected in the most recent AHA/ACC/ACCP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Diagnosis and Management of Acute Pulmonary Embolism in Adults.

Figure 8. Evaluating Ongoing Symptoms Following Acute PE - concisely outlines the workup of patients with ongoing symptoms following acute PE.

It is important to recognize the following in evaluating this type of patient:

1. The overall incidence of CTEPD after PE is low and has been reported from 1.6% to 5.75% (Valerio et al., PMID 35484821, Konstantinides et al., PMID 28335835, Held et al., PMID 36868431).
2. The negative predictive value of planar V/Q to exclude a diagnosis of CTEPD approaches 100% (He et al., PMID 22262242).
3. RPVO (residual pulmonary vascular occlusion)...