Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate–high risk subgroup
Background: Patients with acute pulmonary embolism are at intermediate–high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate–high risk patients with two elevated cardiac biomarkers and imaging signs...
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| Veröffentlicht in: | European heart journal. Acute cardiovascular care 2020-06, Vol.9 (4), p.279-285 |
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| creator | Santos, Ana Rita Freitas, Pedro Ferreira, Jorge Oliveira, Afonso Gonçalves, Mariana Faria, Daniel Bicho Augusto, João Simões, Joana Santos, Ana Gago, Miguel Oliveira, João Antunes, Ricardo Mamede Correia, David Lynce, Ana Brito, João Morais, Carlos Campos, Luís Mendes, Miguel |
| description | Background:
Patients with acute pulmonary embolism are at intermediate–high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate–high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction.
Methods:
We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40).
Results:
Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P |
| doi_str_mv | 10.1177/2048872619846506 |
| format | Article |
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Patients with acute pulmonary embolism are at intermediate–high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate–high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction.
Methods:
We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40).
Results:
Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P<0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P<0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P<0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3–10.3; P=0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5–5.2; P=0.001) as independent predictors of events. In the intermediate–high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8–6.2; P=0.003).
Conclusions:
Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate–high risk subgroup.</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872619846506</identifier><identifier>PMID: 31017472</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acute Disease ; Aged ; Aged, 80 and over ; Biomarkers - blood ; Computed Tomography Angiography ; Echocardiography ; Follow-Up Studies ; Humans ; Male ; Natriuretic Peptide, Brain - blood ; Prognosis ; Pulmonary Embolism - blood ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - therapy ; Retrospective Studies ; Risk Assessment - methods ; Thrombolytic Therapy - methods ; Troponin I - blood</subject><ispartof>European heart journal. Acute cardiovascular care, 2020-06, Vol.9 (4), p.279-285</ispartof><rights>The European Society of Cardiology 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-fa75283ed1679cfd023c97cf745f0f250e00c286e781f496213aa876a789cab23</citedby><cites>FETCH-LOGICAL-c407t-fa75283ed1679cfd023c97cf745f0f250e00c286e781f496213aa876a789cab23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872619846506$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872619846506$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31017472$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Santos, Ana Rita</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Ferreira, Jorge</creatorcontrib><creatorcontrib>Oliveira, Afonso</creatorcontrib><creatorcontrib>Gonçalves, Mariana</creatorcontrib><creatorcontrib>Faria, Daniel</creatorcontrib><creatorcontrib>Bicho Augusto, João</creatorcontrib><creatorcontrib>Simões, Joana</creatorcontrib><creatorcontrib>Santos, Ana</creatorcontrib><creatorcontrib>Gago, Miguel</creatorcontrib><creatorcontrib>Oliveira, João</creatorcontrib><creatorcontrib>Antunes, Ricardo Mamede</creatorcontrib><creatorcontrib>Correia, David</creatorcontrib><creatorcontrib>Lynce, Ana</creatorcontrib><creatorcontrib>Brito, João</creatorcontrib><creatorcontrib>Morais, Carlos</creatorcontrib><creatorcontrib>Campos, Luís</creatorcontrib><creatorcontrib>Mendes, Miguel</creatorcontrib><title>Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate–high risk subgroup</title><title>European heart journal. Acute cardiovascular care</title><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>Background:
Patients with acute pulmonary embolism are at intermediate–high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate–high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction.
Methods:
We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40).
Results:
Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P<0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P<0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P<0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3–10.3; P=0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5–5.2; P=0.001) as independent predictors of events. In the intermediate–high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8–6.2; P=0.003).
Conclusions:
Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate–high risk subgroup.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Computed Tomography Angiography</subject><subject>Echocardiography</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Prognosis</subject><subject>Pulmonary Embolism - blood</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - therapy</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Thrombolytic Therapy - methods</subject><subject>Troponin I - blood</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1qGzEUhUVJaILrfVdFy26mkTQaSZNdMUkTMARKsx5k-cqWMzOa6qeQXd6hb5gnqRynXgSixZW4fOeIcxD6TMk3SqW8YIQrJZmgreKiIeIDOt-vKiVrfnJ8M3GG5jHuSDmSCK7qj-ispoRKLtk5yj9dfMAxBZ2cdaZMP2I34tGHwScYo_sDWJucAE-5H_yowyOGYeV7Fwc8FR7GFC-x9SZHXLRpC0WfIAywdjrB89PfrdtscXj5J682wefpEzq1uo8wf71n6P766tfiplre_bhdfF9WhhOZKqtlw1QNaypka-yasNq00ljJG0ssawgQYpgSIBW1vBWM1lorKbRUrdErVs_Q14PvFPzvDDF1g4sG-l6P4HPsWFG0lMumLSg5oCb4GAPYbgpuKGk7Srp9393bvovky6t7XpW0R8H_dgtQHYCoN9DtfA5jSfu-4T9jVYqc</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Santos, Ana Rita</creator><creator>Freitas, Pedro</creator><creator>Ferreira, Jorge</creator><creator>Oliveira, Afonso</creator><creator>Gonçalves, Mariana</creator><creator>Faria, Daniel</creator><creator>Bicho Augusto, João</creator><creator>Simões, Joana</creator><creator>Santos, Ana</creator><creator>Gago, Miguel</creator><creator>Oliveira, João</creator><creator>Antunes, Ricardo Mamede</creator><creator>Correia, David</creator><creator>Lynce, Ana</creator><creator>Brito, João</creator><creator>Morais, Carlos</creator><creator>Campos, Luís</creator><creator>Mendes, Miguel</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202006</creationdate><title>Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate–high risk subgroup</title><author>Santos, Ana Rita ; Freitas, Pedro ; Ferreira, Jorge ; Oliveira, Afonso ; Gonçalves, Mariana ; Faria, Daniel ; Bicho Augusto, João ; Simões, Joana ; Santos, Ana ; Gago, Miguel ; Oliveira, João ; Antunes, Ricardo Mamede ; Correia, David ; Lynce, Ana ; Brito, João ; Morais, Carlos ; Campos, Luís ; Mendes, Miguel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-fa75283ed1679cfd023c97cf745f0f250e00c286e781f496213aa876a789cab23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>Computed Tomography Angiography</topic><topic>Echocardiography</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Prognosis</topic><topic>Pulmonary Embolism - blood</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - therapy</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Thrombolytic Therapy - methods</topic><topic>Troponin I - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Santos, Ana Rita</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Ferreira, Jorge</creatorcontrib><creatorcontrib>Oliveira, Afonso</creatorcontrib><creatorcontrib>Gonçalves, Mariana</creatorcontrib><creatorcontrib>Faria, Daniel</creatorcontrib><creatorcontrib>Bicho Augusto, João</creatorcontrib><creatorcontrib>Simões, Joana</creatorcontrib><creatorcontrib>Santos, Ana</creatorcontrib><creatorcontrib>Gago, Miguel</creatorcontrib><creatorcontrib>Oliveira, João</creatorcontrib><creatorcontrib>Antunes, Ricardo Mamede</creatorcontrib><creatorcontrib>Correia, David</creatorcontrib><creatorcontrib>Lynce, Ana</creatorcontrib><creatorcontrib>Brito, João</creatorcontrib><creatorcontrib>Morais, Carlos</creatorcontrib><creatorcontrib>Campos, Luís</creatorcontrib><creatorcontrib>Mendes, Miguel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Santos, Ana Rita</au><au>Freitas, Pedro</au><au>Ferreira, Jorge</au><au>Oliveira, Afonso</au><au>Gonçalves, Mariana</au><au>Faria, Daniel</au><au>Bicho Augusto, João</au><au>Simões, Joana</au><au>Santos, Ana</au><au>Gago, Miguel</au><au>Oliveira, João</au><au>Antunes, Ricardo Mamede</au><au>Correia, David</au><au>Lynce, Ana</au><au>Brito, João</au><au>Morais, Carlos</au><au>Campos, Luís</au><au>Mendes, Miguel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate–high risk subgroup</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2020-06</date><risdate>2020</risdate><volume>9</volume><issue>4</issue><spage>279</spage><epage>285</epage><pages>279-285</pages><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>Background:
Patients with acute pulmonary embolism are at intermediate–high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate–high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction.
Methods:
We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40).
Results:
Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P<0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P<0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P<0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3–10.3; P=0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5–5.2; P=0.001) as independent predictors of events. In the intermediate–high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8–6.2; P=0.003).
Conclusions:
Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate–high risk subgroup.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31017472</pmid><doi>10.1177/2048872619846506</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal. Acute cardiovascular care, 2020-06, Vol.9 (4), p.279-285 |
| issn | 2048-8726 2048-8734 |
| language | eng |
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| source | SAGE Complete A-Z List; Oxford University Press Journals All Titles (1996-Current); MEDLINE |
| subjects | Acute Disease Aged Aged, 80 and over Biomarkers - blood Computed Tomography Angiography Echocardiography Follow-Up Studies Humans Male Natriuretic Peptide, Brain - blood Prognosis Pulmonary Embolism - blood Pulmonary Embolism - diagnosis Pulmonary Embolism - therapy Retrospective Studies Risk Assessment - methods Thrombolytic Therapy - methods Troponin I - blood |
| title | Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate–high risk subgroup |
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