Open AccessRight ventricular dysfunction and pulmonary hypertension following sub‐massive pulmonary embolism
Author(s) -
Samaranayake Chinthaka B.,
Royle Gordon,
Jackson Sharon,
Yap Elaine
Publication year - 2017
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12429
Subject(s) - medicine , thrombolysis , pulmonary embolism , pulmonary hypertension , cardiology , pulmonary angiography , mortality rate , population , myocardial infarction , environmental health
Background and objectives Persistent right ventricular dysfunction (RVD) and pulmonary hypertension (PHT) are important outcomes following sub‐massive pulmonary embolism (PE). The aims were to determine the rates and factors associated with RVD and/or PHT on echocardiography (ECHO) and the rate of 30‐day and 1‐year all‐cause mortality following sub‐massive PE. Patients who received thrombolysis and non‐thrombolysis were also compared. Methods Consecutive patients with sub‐massive PE over a five year period with at least 1‐year follow‐up were retrospectively identified. Regression analysis was performed to identify predictors of outcomes. Results Eighty‐seven patients met inclusion criteria. Sixty‐one (70%) had admission ECHOs with a follow‐up ECHO in 42 (48.3%) at a mean of 7.6 months (SD 5.2). Fifty‐one had RVD (58.6%) and 35 (40.2%) had PHT on admission. The rates of persistent RVD and raised right ventricular systolic pressure in this study population were 12% and 17%, respectively. Thrombolysis was associated with a trend towards improvement of PHT (53.3% PHT on admission to 0% PHT on follow‐up in the thrombolysis group, P = 0.29). The rate of 30‐day and 1‐year all‐cause mortality were 12.6% and 21.8%, respectively. Thirty‐day all‐cause mortality was independently predicted by the presence of right heart strain on computed tomography pulmonary angiography [OR 3.7 ( P = 0.045)], echocardiographic evidence of RVD [OR 3.9 ( P = 0.041)] and age. Conclusion The majority of patients with RVD and PHT at the time of sub‐massive PE improve on follow‐up; however, there is a subset who remain abnormal. Future studies are needed to identify modifiable risk factors for these complications.