A comparison of clinical characteristics between radiological and hemodynamic massive pulmonary embolism

Abstract

To investigate the similarities and differences of massive pulmonary embolism (MPE) diagnosed by hemodynamic or radiological criteria, and therefore to improve physician's awareness of MPE from different aspects. The data were collected from a prospective, multi-center study for pulmonary thromboembolism. Fifty-three cases of MPE diagnosed by hemodynamic criteria were enrolled into group A, which was defined as shock and/or hypotension [systemic arterial pressure < 90 mm Hg (1 mm Hg = 0.133 kPa) or a pressure drop > or = 40 mm Hg] for > 15 min without new-onset arrhythmia, hypovolemia, or sepsis. MPE based on radiological criteria were enrolled into group B (n = 176), which was defined as pulmonary artery obstruction with more than 2 lobes or 7 segments. The baseline data of the 2 groups showed no difference. Common clinical manifestations included dyspnea, increase of respiratory rate, and accentuation of P(2), no significant differences between the 2 groups. There were no differences in central pulmonary artery emboli, more than 50% pulmonary artery obstruction and pulmonary artery obstruction index by CTPA, and indirect signs of emboli by doppler echocardiography as well (P > 0.05). However, the incidences of palpitation, syncope, horror-struck, tachycardia, cyanosis and elevated neck veins were higher in group A than those in group B (P < 0.05). Excluding right ventricular wall motion and inspiratory diameter of inferior vena cava, other indexes associated with right ventricular dysfunction revealed by the echocardiography were worse in group A than in group B (P < 0.01). Although the degree of vascular obstruction was consistent in the anatomical aspects between the 2 groups, the hemodynamic disorder was significantly different, suggesting that MPE based on radiological criteria was not exactly the same as hemodynamic MPE. Clinicians should be aware of these differences when assessing the severity of acute pulmonary embolism.