Abstract
The prevalence of pulmonary embolism (PE) increases progressively with age. Less data about the impact of increasing age on the severity of PE are available. The objectives of this study were to investigate the impact of increasing age on the severity of normotensive PE. Retrospective analysis of clinical, laboratory, radiological and echocardiagraphic data of normotensive patients with PE was performed. According to patients’ age at the moment of acute PE event, the total number of 129 normotensive PE patients was subdivided into 4 age groups. In age groups 18–59, 60–69, 70–79 and 80–94 years were, respectively, a number of 30, 31, 33 and 35 patients included. Percentage of women in age groups increased with advanced age (P = 0.021). Systolic pulmonary artery pressure (PAP) (P < 0.0001) and frequency of incomplete or complete right bundle-branch block (RBBB) (P = 0.019), of right ventricular dysfunction (RVD) (P = 0.00031) and of submassive PE stadium with intermediate risk (P = 0.0016) increased significantly with growing age. Multivariable regression model confirmed an association between age and submassive PE [OR (per year) 1.04; 95 % CI, 1.02–1.07, P = 0.0020] as well as female gender and submassive PE (OR 2.45; 95 % CI, 1.10–5.50, P = 0.029) and tachycardia and submassive PE (OR 15.33; 95 % CI, 3.45–68.24, P = 0.00034). Advanced age, female gender and tachycardia are risk factors for a submassive PE with intermediate risk in normotensive PE patients. The percentage of PE patients with submassive PE, right ventricular overload, RVD, RBBB, elevated systolic PAP increases with advanced age.
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Abbreviations
- AHA:
-
American heart association
- CT:
-
Computed tomography
- cTn:
-
Cardiac troponin
- cTnI:
-
Cardiac troponin I
- DVT:
-
Deep vein thrombosis
- ECG:
-
Electrocardiography
- ESC:
-
European society of cardiology
- PE:
-
Pulmonary embolism
- RBBB:
-
Right bundle-branch block
- RVD:
-
Right ventricular dysfunction
- SD:
-
Standard deviation
- PAP:
-
Systolic pulmonary artery pressure
- PESI:
-
Pulmonary embolism severity index
- V/Q scan:
-
Ventilation–perfusion scan
- VTE:
-
Venous thromboembolism
References
Chalikias GK, Tziakas DN, Stakos DA, Konstantinides SV (2010) Managment of acute pulmonary embolism: a contemporary risk-tailored approach. Hellenic J Cardiol 51:437–450
Hsu JT, Chu CM, Chang ST, Cheng HW, Cheng NJ, Ho WC, Chung CM (2006) Prognostic role of alveolar-arterial oxygen pressure difference in acute pulmonary embolism. Circ J 70:1611–1616
Labyk A, Kalbarczyk A, Piaszczyk A, Kostrubiec M, Kaczynska A, Bochowicz A, Pruszczyk P (2007) Pulmonary embolism: a difficult diagnostic problem. Pol Arch Med Wewn 117:8–12
McRae S (2010) Pulmonary embolism. Aust Fam Physician 39:462–466
Ohigashi H, Haraguchi G, Yoshikawa S, Sasaki T, Kimura S, Inagaki H, Hachiya H, Hirao K, Isobe M (2010) Comparison of biomarkers for predicting disease severity and long-term respiratory prognosis in patients with acute pulmonary embolism. Int Heart J 51:416–420
Schellhaass A, Walther A, Konstantinides S, Bottiger BW (2010) The diagnosis and treatment of acute pulmonary embolism. Dtsch Arztebl Int 107:589–595
Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315
Keller K, Beule J, Schulz A, Dippold W (2013) Troponin I as risk stratification marker in acute pulmonary artery embolism. Phlebologie 42:261–269
Kaya Z, Ozdemir K, Kayrak M, Gul EE, Altunbas G, Duman C, Kiyici A (2012) Soluble CD40 ligand levels in acute pulmonary embolism: a prospective, randomized, controlled study. Heart Vessels 27:295–299
Jimenez D, Uresandi F, Otero R, Lobo JL, Monreal M, Marti D, Zamora J, Muriel A, Aujesky D, Yusen RD (2009) Troponin-based risk stratification of patients with acute nonmassive pulmonary embolism: systematic review and metaanalysis. Chest 136:974–982
Margato R, Carvalho S, Ribeiro H, Mateus P, Fontes P, Moreira JI (2009) Cardiac troponin I levels in acute pulmonary embolism. Rev Port Cardiol 28:1213–1222
Konstantinides S, Goldhaber SZ (2012) Pulmonary embolism: risk assessment and management. Eur Heart J 33(24):3014–3022
Kucher N, Rossi E, De Rosa M, Goldhaber SZ (2005) Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med 165:1777–1781
Becattini C, Vedovati MC, Agnelli G (2007) Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 116:427–433
Kreit JW (2004) The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest 125:1539–1545
Masotti L, Righini M, Vuilleumier N, Antonelli F, Landini G, Cappelli R, Ray P (2009) Prognostic stratification of acute pulmonary embolism: focus on clinical aspects, imaging, and biomarkers. Vasc Health Risk Manag 5:567–575
Yasuoka Y, Naito J, Hirooka K, Chin W, Miyatake K, Kusuoka H, Koretsune Y (2009) Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation. Heart Vessels 24:32–36
Goldhaber SZ (2008) Assessing the prognosis of acute pulmonary embolism: tricks of the trade. Chest 133:334–336
Giannitsis E, Muller-Bardorff M, Kurowski V, Weidtmann B, Wiegand U, Kampmann M, Katus HA (2000) Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 102:211–217
Jimenez D, Diaz G, Molina J, Marti D, Del Rey J, Garcia-Rull S, Escobar C, Vidal R, Sueiro A, Yusen RD (2008) Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism. Eur Respir J 31:847–853
Sanchez O, Trinquart L, Caille V, Couturaud F, Pacouret G, Meneveau N, Verschuren F, Roy PM, Parent F, Righini M, Perrier A, Lorut C, Tardy B, Benoit MO, Chatellier G, Meyer G (2010) Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study. Am J Respir Crit Care Med 181:168–173
Wu AH, Jaffe AS, Apple FS, Jesse RL, Francis GL, Morrow DA, Newby LK, Ravkilde J, Tang WH, Christenson RH, Cannon CP, Storrow AB (2007) National Academy of Clinical Biochemistry laboratory medicine practice guidelines: use of cardiac troponin and B-type natriuretic peptide or N-terminal proB-type natriuretic peptide for etiologies other than acute coronary syndromes and heart failure. Clin Chem 53:2086–2096
Haddad F, Doyle R, Murphy DJ, Hunt SA (2008) Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 117:1717–1731
Kucher N, Wallmann D, Carone A, Windecker S, Meier B, Hess OM (2003) Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism. Eur Heart J 24:1651–1656
Park JH, Park YS, Kim YJ, Lee IS, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW (2011) Differentiation between acute and chronic cor pulmonales with midventricular systolic strain of the right ventricle in the emergency department. Heart Vessels 26:435–439
Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, Meyer G (2008) Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 29:1569–1577
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830
Vieillard-Baron A, Page B, Augarde R, Prin S, Qanadli S, Beauchet A, Dubourg O, Jardin F (2001) Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med 27:1481–1486
Kucher N, Rossi E, De Rosa M, Goldhaber SZ (2006) Massive pulmonary embolism. Circulation 113:577–582
Konstantinides S (2008) Acute pulmonary embolism. N Engl J Med 359:2804–2813
Lankeit M, Konstantinides S (2010) Thrombolysis for pulmonary embolism: past, present and future. Thromb Haemost 103:877–883
Sekhri V, Mehta N, Rawat N, Lehrman SG, Aronow WS (2012) Management of massive and nonmassive pulmonary embolism. Arch Med Sci 8:957–969
Ota M, Nakamura M, Yamada N, Yazu T, Ishikura K, Hiraoka N, Tanaka H, Fujioka H, Isaka N, Nakano T (2002) Prognostic significance of early diagnosis in acute pulmonary thromboembolism with circulatory failure. Heart Vessels 17:7–11
Righini M, Goehring C, Bounameaux H, Perrier A (2000) Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 109:357–361
Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389
Mikulewicz M, Lewczuk J (2008) Importance of cardiac biomarkers in risk stratification in acute pulmonary embolism. Cardiol J 15:17–20
Jiang LB, Ying KJ (2007) The impact of right ventricular dysfunction on the clinical outcome of normotensive patients with pulmonary embolism. Zhonghua Nei Ke Za Zhi 46:111–113
Stein PD, Hull RD, Kayali F, Ghali WA, Alshab AK, Olson RE (2004) Venous thromboembolism according to age: the impact of an aging population. Arch Intern Med 164:2260–2265
Oger E (2000) Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d’Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 83:657–660
Kyrle PA, Eichinger S (2005) Deep vein thrombosis. Lancet 365:1163–1174
Hippisley-Cox J, Coupland C (2011) Development and validation of risk prediction algorithm (QThrombosis) to estimate future risk of venous thromboembolism: prospective cohort study. BMJ 343:d4656
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd (1998) Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 158:585–593
Kyrle PA, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S (2004) The risk of recurrent venous thromboembolism in men and women. N Engl J Med 350:2558–2563
Fimognari FL, Repetto L, Moro L, Gianni W, Incalzi RA (2005) Age, cancer and the risk of venous thromboembolism. Crit Rev Oncol Hematol 55:207–212
Matthews JC, McLaughlin V (2008) 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 4:49–59
Coutance G, Cauderlier E, Ehtisham J, Hamon M (2011) The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care 15:R103
Tapson VF (2012) Advances in the diagnosis and treatment of acute pulmonary embolism. F1000 Med Rep 4:9
Fremont B, Pacouret G, Jacobi D, Puglisi R, Charbonnier B, de Labriolle A (2008) Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients. Chest 133:358–362
Becattini C, Vedovati MC, Agnelli G (2010) Right ventricle dysfunction in patients with pulmonary embolism. Intern Emerg Med 5:453–455
Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, Conti A, Agnelli G, Berni G (2000) Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 101:2817–2822
Agewall S, Giannitsis E, Jernberg T, Katus H (2011) Troponin elevation in coronary vs. non-coronary disease. Eur Heart J 32:404–411
Uresandi F, Otero R, Cayuela A, Cabezudo MA, Jimenez D, Laserna E, Conget F, Oribe M, Nauffal D (2007) A clinical prediction rule for identifying short-term risk of adverse events in patients with pulmonary thromboembolism. Arch Bronconeumol 43:617–622
Laporte S, Mismetti P, Decousus H, Uresandi F, Otero R, Lobo JL, Monreal M (2008) Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 117:1711–1716
White RH, Zhou H, Murin S, Harvey D (2005) Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 93:298–305
Romualdi E, Squizzato A, Ageno W (2007) Abdominal obesity and the risk of recurrent deep vein thrombosis. Thromb Res 119:687–690
Gregor MF, Hotamisligil GS (2011) Inflammatory mechanisms in obesity. Annu Rev Immunol 29:415–445
Hotamisligil GS, Shargill NS, Spiegelman BM (1993) Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science 259:87–91
Poredos P, Jezovnik MK (2011) In patients with idiopathic venous thrombosis, interleukin-10 is decreased and related to endothelial dysfunction. Heart Vessels 26:596–602
Engbers MJ, van Hylckama Vlieg A, Rosendaal FR (2010) Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost 8:2105–2112
Datenbank SBO (2012) Bevölkerung der Bundesrepublik Deutschland nach Altersgruppen und Geschlecht. http://www.bpb.de/nachschlagen/zahlen-und-fakten/soziale-situation-in-deutschland/61538/altersgruppen
Geibel A, Olschewski M, Zehender M, Wilsch M, Odening K, Heinrich F, Kasper W, Konstantinides S (2007) Possible gender-related differences in the risk-to-benefit ratio of thrombolysis for acute submassive pulmonary embolism. Am J Cardiol 99:103–107
Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T (2009) Presence of lower limb deep vein thrombosis and prognosis in patients with symptomatic pulmonary embolism: preliminary report. Eur J Vasc Endovasc Surg 37:225–231
Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046
Aujesky D, Roy PM, Le Manach CP, Verschuren F, Meyer G, Obrosky DS, Stone RA, Cornuz J, Fine MJ (2006) Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 27:476–481
Dentali F, Riva N, Turato S, Grazioli S, Squizzato A, Steidl L, Guasti L, Grandi AM, Ageno W (2013) Pulmonary embolism severity index accurately predicts long-term mortality rate in patients hospitalized for acute pulmonary embolism. J Thromb Haemost 11:2103–2110
Zhou XY, Ben SQ, Chen HL, Ni SS (2012) The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respir Res 13:111
Kawut SM, Lima JA, Barr RG, Chahal H, Jain A, Tandri H, Praestgaard A, Bagiella E, Kizer JR, Johnson WC, Kronmal RA, Bluemke DA (2011) Sex and race differences in right ventricular structure and function: the multi-ethnic study of atherosclerosis-right ventricle study. Circulation 123:2542–2551
Jimenez D, Yusen RD, Otero R, Uresandi F, Nauffal D, Laserna E, Conget F, Oribe M, Cabezudo MA, Diaz G (2007) Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy. Chest 132:24–30
Jimenez D, Aujesky D, Moores L, Gomez V, Lobo JL, Uresandi F, Otero R, Monreal M, Muriel A, Yusen RD (2010) Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 170:1383–1389
Van Pottelbergh G, Bartholomeeusen S, Buntinx F, Degryse J (2012) The prevalence of chronic kidney disease in a Flemish primary care morbidity register. Age Ageing 41:231–233
Baylis C (2005) Changes in renal hemodynamics and structure in the aging kidney; sexual dimorphism and the nitric oxide system. Exp Gerontol 40:271–278
Baylis C (2012) Sexual dimorphism: the aging kidney, involvement of nitric oxide deficiency, and angiotensin II overactivity. J Gerontol A Biol Sci Med Sci 67(12):1365–1372
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Keller, K., Beule, J., Coldewey, M. et al. Impact of advanced age on the severity of normotensive pulmonary embolism. Heart Vessels 30, 647–656 (2015). https://doi.org/10.1007/s00380-014-0533-4
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DOI: https://doi.org/10.1007/s00380-014-0533-4