Abstract
BackgroundA history of congestive heart failure has been used to determine the prognosis in patients with acute pulmonary embolism. Diastolic dysfunction is responsible for the half of congestive heart failure but has not been understood well.MethodsA total of 205 patients were reported admitted with acute pulmonary embolism from January 2009 to July 2011. We excluded hemodynamically unstable patients who received thrombolytics or underwent thromboembolectomy. We included hemodynamically stable patients who underwent echocardiogram within 72 hours of diagnosis. We reviewed medical records of 107 patients to investigate whether diastolic dysfunction increases in-hospital mortality or adverse clinical outcomes.ResultsOut of 107 patients, 10 patients died during hospitalization with in-hospital mortality rate of 9.3%. Among 84 patients without diastolic dysfunction as assessed by echocardiogram, six patients died with in-hospital mortality rate of 7.1%. Meanwhile, among 23 patients with diastolic dysfunction, four patients died with in-hospital mortality rate of 17.4%. The multivariable adjusted odds ratio was calculated as 2.71, with 95% confidence interval of 0.59 - 12.44.ConclusionsFor hemodynamically stable patients with acute pulmonary embolism, diastolic dysfunction as assessed by echocardiogram could increase in-hospital mortality 2.71 fold, although this was not statistically significant. Further study with a large patient population is needed to determine the statistically significant implications of diastolic dysfunction in patients with acute pulmonary embolism.
Highlights
A history of congestive heart failure has been used to determine the prognosis in patients with acute pulmonary embolism
We investigate whether diastolic dysfunction as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE)
We reviewed medical records to investigate whether diastolic dysfunction as assessed by echocardiogram increases in-hospital mortality or adverse clinical outcomes such as shock, need for vasopressor, intubation or cardiopulmonary resuscitation in patients with acute PE
Summary
A history of congestive heart failure has been used to determine the prognosis in patients with acute pulmonary embolism. Diastolic dysfunction is responsible for the half of congestive heart failure but has not been understood well. Acute pulmonary embolism (PE) is a potentially lifethreatening condition. Stable patients can be managed with anticoagulation alone, while hemodynamically unstable patients need thrombolytics or thromboembolectomy. Untreated patients can have a mortality rate of 30%, whereas treatment can lower the mortality rate down to 8% [1]. History of congestive heart failure (CHF) has been regarded as a negative prognostic factor according to the Pulmonary Embolism Severity Index (PESI) [2,3]. CHF is a clinically diagnosed entity with characteristic symptoms and physical findings.
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