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Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism

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Abstract

Background

An increase in short-term mortality can be found among older patients with hemodynamically stable acute pulmonary embolism (APE) who have signs of right ventricular (RV) dysfunction.

Aims

This study was designed to assess whether any difference exists among clinical, laboratory, electrocardiography and echocardiography parameters between older and younger patients diagnosed with APE.

Methods

The study sample included a total of 635 patients with confirmed APE who were divided into two groups of older (65 years and older) and younger (younger than 65 years) individuals. Comparisons were performed between these groups in terms of clinical, predisposing factors and laboratory, electrocardiographic and echocardiographic parameters.

Results

Analyses of 295 (46.4%) older and 340 (53.6%) younger patients diagnosed with APE were performed. Female sex, Pulmonary Embolism Severity Index score and baseline creatinine levels were higher in the older group. Also, the frequency of atrial fibrillation, RV outflow tract parasternal long-axis proximal diameter, RV end-diastolic diameter (RV-EDD) basal (apical four-chamber) and RV systolic pressure were significantly greater in older patients with APE. A total of 30 (4.7%) deaths were observed during the in-hospital period [21 (7.1%) older vs 9 (2.6%) younger patients; p < 0.01]. In the multivariate logistic regression analysis, age, white blood cell count (WBC), left ventricular ejection fraction (LVEF), RV-EDD basal and tricuspid annular plane systolic excursion (TAPSE) of less than 16 mm were found to be independently associated with in-hospital mortality.

Conclusion

Older patients might experience greater rates of RV dilatation, RV dysfunction and atrial fibrillation during APE. In addition to age; elevated WBC, low LVEF, increased RV-EDD basal and TAPSE of less than 16 mm were independent predictors of mortality among study population.

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References

  1. Konstantinides SV, Meyer G, Becattini C et al (2020) (Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology) 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 54:1901647

    Google Scholar 

  2. Robert-Ebadi H, Righini M (2014) Diagnosis and management of pulmonary embolism in the elderly. Eur J Intern Med 25:343–349

    Article  Google Scholar 

  3. Klingenberg R, Schlager O, Limacher A et al (2019) Risk stratification of elderly patients with acute pulmonary embolism. Eur J Clin Invest 49:e13154

    Article  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. Casazza F, Pacchetti I, Rulli E et al (2018) Prognostic significance of electrocardiogram at presentation in patients with pulmonary embolism of different severity. Thromb Res 163:123–127

    Article  CAS  Google Scholar 

  6. Dabbouseh NM, Patel JJ, Bergl PA (2019) Role of echocardiography in managing acute pulmonary embolism. Heart 105:1785–1792

    Article  Google Scholar 

  7. Fields JM, Davis J, Girson L, Au A, Potts J et al (2017) Transthoracic echocardiography for diagnosing pulmonary embolism: a systematic review and meta-analysis. J Am Soc Echocardiogr 30:714–723

    Article  Google Scholar 

  8. Hofmann E, Limacher A, Méan M et al (2016) Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism. Thromb Res 145:67–71

    Article  CAS  Google Scholar 

  9. Terluk AD, Trivedi SJ, Kritharides L et al (2019) Echocardiographic predictors of long-term mortality in patients presenting with acute pulmonary embolism. Am J Cardiol 124:285–291

    Article  Google Scholar 

  10. Burgos LM, Scatularo CE, Cigalini IM et al (2020) The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score. Eur Heart J Acute Cardiovasc Care. https://doi.org/10.1093/ehjacc/zuaa007

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bĕlohlávek J, Dytrych V, Linhart A (2013) Pulmonary embolism, part I: epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol 18:129

    PubMed  PubMed Central  Google Scholar 

  12. Secemsky E, Chang Y, Jain CC et al (2018) Contemporary management and outcomes of patients with massive and submassive pulmonary embolism. Am J Med 131:1506–1514

    Article  Google Scholar 

  13. Gupta R, Ammari Z, Dasa O et al (2020) Long-term mortality after massive, submassive, and low-risk pulmonary embolism. Vasc Med 25:141–149

    Article  Google Scholar 

  14. Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046

    Article  Google Scholar 

  15. Skjaerpe T, Hatle L (1986) Noninvasive estimation of systolic pressure in the right ventricle in patients with tricuspid regurgitation. Eur Heart J 7:704–710

    Article  CAS  Google Scholar 

  16. Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  Google Scholar 

  17. Naeije R (2015) Assessment of right ventricular function in pulmonary hypertension. Curr Hypertens Rep 17:35

    Article  Google Scholar 

  18. Meluzín J, Špinarová L, Bakala J et al (2001) Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion. a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J 22:340–348

    Article  Google Scholar 

  19. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2:1–138

  20. Bovill EG, Terrin ML, Stump DC et al (1991) Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction results of the thrombolysis in myocardial infarction (TIMI) phase II trial. Ann Intern Med 115:256–265

    Article  CAS  Google Scholar 

  21. Bolt L, Lauber S, Limacher A et al (2019) Prognostic value of electrocardiography in elderly patients with acute pulmonary embolism. Am J Med 132:e835–e843

    Article  Google Scholar 

  22. Masotti L, Ray P, Righini M et al (2008) Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation. Vasc Health Risk Manag 4:629–636

    Article  Google Scholar 

  23. Punukollu H, Khan IA, Punukollu G et al (2005) Acute pulmonary embolism in elderly: clinical characteristics and outcome. Int J Cardiol 99:213–216

    Article  Google Scholar 

  24. Kniffin WD, Baron JA, Barrett J et al (1994) The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 154:861–866

    Article  Google Scholar 

  25. Rodger M, Makropoulos D, Turek M et al (2000) Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 86:807–809

    Article  CAS  Google Scholar 

  26. Aziz EF, Kukin M, Javed F et al (2010) Right ventricular dysfunction is a strong predictor of developing atrial fibrillation in acutely decompensated heart failure patients ACAP–HF data analysis. J Card Fail 16:827–834

    Article  Google Scholar 

  27. Ptaszynska-Kopczynska K, Kiluk I, Sobkowicz B (2019) Atrial fibrillation in patients with acute pulmonary embolism: clinical significance and impact on prognosis. Biomed Res Int 2019:7846291

    Article  Google Scholar 

  28. Morella P, Sacco M, Carafa M et al (2019) Permanent atrial fibrillation and pulmonary embolism in elderly patients without deep vein thrombosis: is there a relationship? Aging Clin Exp Res 31:1121–1228

    Article  Google Scholar 

  29. Venetz C, Labarère J, Jiménez D et al (2013) White blood cell count and mortality in patients with acute pulmonary embolism. Am J Hematol 88:677–681

    Article  Google Scholar 

  30. Bovill EG, Bild DE, Heiss G et al (1996) White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study: correlations with baseline clinical and demographic characteristics. Am J Epidemiol 143:1107–1115

    Article  CAS  Google Scholar 

  31. Agterof MJ, Schutgens REG, Moumli N et al (2011) A prognostic model for short term adverse events in normotensive patients with pulmonary embolism. Am J Hematol 86:646–649

    Article  Google Scholar 

  32. Liteplo AS, Huang CK, Zheng H et al (2021) Left ventricular dysfunction correlates with mortality in pulmonary embolism. J Emerg Med 60:135–143

    Article  Google Scholar 

  33. Rydman R, Söderberg M, Larsen F et al (2010) Echocardiographic evaluation of right ventricular function in patients with acute pulmonary embolism: a study using tricuspid annular motion. Echocardiography 27:286–293

    Article  Google Scholar 

  34. Chung T, Emmett L, Khoury V et al (2006) Atrial and ventricular echocardiographic correlates of the extent of pulmonary embolism in the elderly. J Am Soc Echocardiogr 19:347–353

    Article  Google Scholar 

  35. Kanar BG, Göl G, Oğur E et al (2019) Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: a speckle tracking echocardiography-based study. Echocardiography 36:1298–1305

    Article  Google Scholar 

  36. Vitarelli A, Barillà F, Capotosto L et al (2014) Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography. J Am Soc Echocardiogr 27:329–338

    Article  Google Scholar 

  37. Spirk D, Husmann M, Hayoz D et al (2012) Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Eur Heart J 33:921–926

    Article  Google Scholar 

  38. Cefalo P, Weinberg I, Hawkins BM et al (2015) A comparison of patients diagnosed with pulmonary embolism who are ≥65 years with patients <65 years. Am J Cardiol 115:681–686

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Tibbiye street No: 13, Uskudar/Istanbul, Istanbul, 34668, Turkey

    Altuğ Ösken, Nizamettin Selçuk Yelgeç, Sena Sert Şekerci, Lale Dinç Asarcıklı, Şennur Ünal Dayı & Neşe Çam

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  1. Altuğ Ösken
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  2. Nizamettin Selçuk Yelgeç
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Correspondence to Altuğ Ösken.

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All procedures performed in studies involving human participants were done in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the Haydarpasa Numune Education and Research Hospital ethics committee (Approval No. 2021/92).

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Ösken, A., Yelgeç, N.S., Şekerci, S.S. et al. Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism. Aging Clin Exp Res 33, 2223–2230 (2021). https://doi.org/10.1007/s40520-021-01882-3

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  • DOI: https://doi.org/10.1007/s40520-021-01882-3

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