Volume 34, Issue 6 (September 2023)
Studies in Medical Sciences 2023, 34(6): 321-329 |
Back to browse issues page
Ethics code: IR.UMSU.REC.1397.055
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Behnemoon M, Laleh E. SIGNIFICANT PULMONARY HYPERTENSION IN ACUTE PULMONARY EMBOLISM: CONCEPTS AND FACTS. Studies in Medical Sciences 2023; 34 (6) :321-329
URL: http://umj.umsu.ac.ir/article-1-5929-en.html
URL: http://umj.umsu.ac.ir/article-1-5929-en.html
Assistant Professor of Cardiology, Department of Cardiology, Urmia University of Medical Science, Urmia, Iran (Corresponding Author) , behnamoon.mahsa870@gmail.com
Abstract: (639 Views)
Background & Aims: Acute pulmonary thromboembolism with a mortality of about 15-20% is the third leading cause of death from vascular disease after myocardial infarction and cerebrovascular disease. Considering the ominous nature of the disease and our experience of observing significant degrees of pulmonary hypertension among these patients, we decided to evaluate the prevalence of echocardiographic findings and its relationship with in-hospital mortality of affected patients.
Materials & Methods: In this cross-sectional study, we enrolled 183 patients with a definitive diagnosis of pulmonary embolism having admission echocardiography. Clinical and echocardiographic findings were extracted from patients' medical records. Patients were grouped as survivors to hospital discharge and non-survivors, and the relationship between echocardiographic findings and in-hospital mortality was evaluated. All data analysis was performed using SPSS software version 22 and the significance level was considered less than 0.05.
Results: In-hospital mortality rate of our patients was 20.2%. Dyspnea and chest pain were the most prevalent symptoms, while tachycardia, tachypnea and hypotension were the most frequent signs. Average systolic pulmonary artery pressure was about 50.82±22.88 mmHg with significant difference between deceased and discharged subjects. We also reported a significant relationship between in-hospital mortality and TR severity and right ventricular dysfunction. Severe pulmonary hypertension was present in 42% of the patients, and about one third of them didn't survive to the hospital discharge. However, only 14 patients with less than severe PH on presentation expired during hospital stay (p=0.002).
Conclusion: High frequency of severe pulmonary hypertension observed in our acute presenting patients could be a sign of combined PH etiologies and warrant further evaluation of secondary causes.
Materials & Methods: In this cross-sectional study, we enrolled 183 patients with a definitive diagnosis of pulmonary embolism having admission echocardiography. Clinical and echocardiographic findings were extracted from patients' medical records. Patients were grouped as survivors to hospital discharge and non-survivors, and the relationship between echocardiographic findings and in-hospital mortality was evaluated. All data analysis was performed using SPSS software version 22 and the significance level was considered less than 0.05.
Results: In-hospital mortality rate of our patients was 20.2%. Dyspnea and chest pain were the most prevalent symptoms, while tachycardia, tachypnea and hypotension were the most frequent signs. Average systolic pulmonary artery pressure was about 50.82±22.88 mmHg with significant difference between deceased and discharged subjects. We also reported a significant relationship between in-hospital mortality and TR severity and right ventricular dysfunction. Severe pulmonary hypertension was present in 42% of the patients, and about one third of them didn't survive to the hospital discharge. However, only 14 patients with less than severe PH on presentation expired during hospital stay (p=0.002).
Conclusion: High frequency of severe pulmonary hypertension observed in our acute presenting patients could be a sign of combined PH etiologies and warrant further evaluation of secondary causes.
Keywords: Acute Pulmonary Embolism, Echocardiography, Pulmonary Artery Pressure, Right Ventricular Dysfunction
Type of Study: Research |
Subject:
قلب و عروق
References
1. Kistner RL, Ball J, Nordyke RA, Freeman GC. Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities. Am J Surg 1972;124(2):169-76. [DOI:10.1016/0002-9610(72)90009-8] [PMID]
2. Kearon C, Julian JA, Math M, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. Ann Intern Med 1998;128(8):663-77. [DOI:10.7326/0003-4819-128-8-199804150-00011] [PMID]
3. Tapson VF. Acute pulmonary embolism. N Engl J Med 2008;358(10):1037-52.
https://doi.org/10.1056/NEJMra072753 [DOI:10.1056/nejmra072753] [PMID]
4. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch intern Med 2000;160(6):809-15. [DOI:10.1001/archinte.160.6.809] [PMID]
5. Alpert JS, Smith R, Carlson J, Ockene IS, Dexter L, Dalen JE. Mortality in patients treated for pulmonary embolism. JAMA 976;236(13):1477-80. [DOI:10.1001/jama.236.13.1477] [PMID]
6. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;326(19):1240-5. doi:10.1056/NEJM199205073261902 [DOI:10.1056/NEJM199205073261902] [PMID]
7. Kostadima E, Zakynthinos E. Pulmonary embolism: pathophysiology, diagnosis, treatment. Hellenic J Cardiol 2007;48(2):94-107. [Google Scholar]
8. Teimouri A, Majidi SE. Assessment of the Relative Frequency of Pulmonary Embolism and Common Risk Factors in Patients with Pulmonary Embolism (PE) Referring to Emergency Department of Alzahra Hospital, Isfahan, Iran, in Year 2017. J Isfahan Med Sch 2019;37(540):1007-12. [Google Scholar]
9. Tofighi ZH, Mostafazadeh B, Gharedaghi J, Saleki S, Sheikh ahmad F. Evaluation of the prevalence of pulmonary thromboembolism in corpses referred to the Tehran Forensic Medicine Center with a history of admission leading to death in the hospital. Iranian J Forensic Med 1386;13(1):45-6. [DOI:10.1016/j.jflm.2007.12.017] [PMID]
10. Stein PD, Gottschalk A, Sostman HD, et al. Methods of prospective investigation of pulmonary embolism diagnosis III (PIOPED III). Elsevier; 2008:462-70. [DOI:10.1053/j.semnuclmed.2008.06.003] [PMID] [PMCID]
11. Meyer G. Effective diagnosis and treatment of pulmonary embolism: Improving patient outcomes. Arch Cardiovasc Dis 2014;107(6-7):406-14. [DOI:10.1016/j.acvd.2014.05.006] [PMID]
12. Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991;100(3):598-603. [DOI:10.1378/chest.100.3.598] [PMID]
13. Kelley MA, Carson JL, Palevsky HI, Schwartz JS. Diagnosing pulmonary embolism: new facts and strategies. Ann Intern Med 1991;114(4):300-6. [DOI:10.7326/0003-4819-114-4-300] [PMID]
14. Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003;123(6):1947-52. [DOI:10.1378/chest.123.6.1947] [PMID]
15. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000;36(5):1632-6.
https://doi.org/10.1016/S0735-1097(00)00905-0 [DOI:10.1016/s0735-1097(00)00905-0] [PMID]
16. Sanchez O, Trinquart L, Colombet I, et al. Prognostic value of right ventricular dysfunction in patients with hemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 2008;29(12):1569-77. [DOI:10.1093/eurheartj/ehn208] [PMID]
17. Horlander KT, Leeper KV. Troponin levels as a guide to treatment of pulmonary embolism. Curr Opin Pulm Med 2003;9(5):374-7. [DOI:10.1097/00063198-200309000-00006] [PMID]
18. Lankeit M, Friesen D, Aschoff J, et al. Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J 2010;31(15):1836-44. [DOI:10.1093/eurheartj/ehq234] [PMID]
19. Giannitsis E, Müller-Bardorff M, Kurowski V, et al. independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000;102(2):211-17.
https://doi.org/10.1161/01.CIR.102.2.211 [DOI:10.1161/01.cir.102.2.211] [PMID]
20. Jardin F, Dubourg O, Bourdarias J-P. Echocardiographic pattern of acute cor pulmonale. Chest 1997;111(1):209-17. [DOI:10.1378/chest.111.1.209] [PMID]
21. Zakynthinos E, Zakynthinos S. Contemporary diagnosis and therapy of pulmonary hypertension. Hellenic J Cardiol 1991;32:111-23.
22. Darze ES, Casqueiro JB, Ciuffo LA, Santos JM, Magalhães IR, Latado AL. Pulmonary embolism mortality in Brazil from 1989 to 2010: Gender and regional disparities. Arq Bras Cardiol 2016;106(1):4-12. [DOI:10.5935/abc.20160001] [PMID] [PMCID]
23. Khemasuwan D, Yingchoncharoen T, Tunsupon P, et al. Right ventricular echocardiographic parameters are associated with mortality after acute pulmonary embolism. J Am Soc Echocardiogr 2015;28(3):355-62 [DOI:10.1378/chest.1984291]
24. Kurnicka K, Lichodziejewska B, Goliszek S, et al. Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients. J Am Soc Echocardiogr 2016;29(9):907-13. [DOI:10.1016/j.echo.2016.05.016] [PMID]
25. Bajaj N, Bozarth AL, Guillot J, et al. Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data. J Thromb Thrombolysis. 2014;37(3):287-92. [DOI:10.1007/s11239-013-0942-8] [PMID]
26. Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000;101(24):2817-22.
https://doi.org/10.1161/01.CIR.101.24.2817 [DOI:10.1161/01.cir.101.24.2817] [PMID]
27. Matthews JC, McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Curr Cardiol Rev 2008;4(1):49-59. [DOI:10.2174/157340308783565384] [PMID] [PMCID]
28. Wood K.E. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121(3):877-905. [DOI:10.1378/chest.121.3.877] [PMID]
29. Ende-Verhaar YM, Cannegieter SC, Vonk Noordegraaf A, et al. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature. Eur Respir J. 2017;49(2). [DOI:10.1183/13993003.01792-2016] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
