| Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients. | |
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MedLine Citation:
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PMID: 17670755 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: We hypothesized that first-time submassive pulmonary embolism (PE) can cause persistent, significant cardiopulmonary problems, including right ventricular damage and worsened quality of life in patients with no prior cardiopulmonary disease. METHODS AND RESULTS: We prospectively enrolled 205 patients without end-stage comorbidity diagnosed with submassive PE (systolic blood pressure always > 100 mmHg). Using explicit criteria, we identified a subgroup of 127 'previously healthy' patients who were free of cardiopulmonary disease or other disabling process. All patients had transthoracic echocardiography (echo) at the time of diagnosis. Six months later, survivors returned for repeat echo, 6 min walk distance (6MWD), and a quality-of-life survey. We defined a significant cardiopulmonary problem as either: (i) abnormal RV on echo (RV dilation or RV hypokinesis); or (ii) NYHA score > II or a 6MWD < 330 m at 6 months. Of 127 study patients, five had inadequate echos, nine were lost to follow-up, and four died, leaving 109 with complete data. Of 109 patients, 45 (41%) had cardiopulmonary problems 6 months after PE: 18 of 109 (17%) had only an abnormal RV, 18 of 109 (17%) had only functional limitation, and nine of 109 (8%) had both. Twenty-two patients (20%) indicated at least one index of poor quality-of-life: health status worse, not currently shopping, or perceived need for oxygen at home. Patients with cardiopulmonary problems demonstrated a significant decrease in SaO(2)% after 6MWD (97 +/- 1.3 pre-6MWD vs. 96 +/- 1.8% post-6MWD, P = 0.004 by paired t-test). CONCLUSION: Six months after first-time PE, 41% of previously healthy patients had either an abnormal RV on echo, an NYHA score > II or a 6MWD < 330 m. Treatment studies of PE should include these persistent cardiopulmonary problems as study endpoints. |
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Authors:
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Brad G Stevinson; Jackeline Hernandez-Nino; Geoffrey Rose; Jeffrey A Kline |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2007-08-01 |
Journal Detail:
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Title: European heart journal Volume: 28 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2007 Oct |
Date Detail:
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Created Date: 2007-10-22 Completed Date: 2008-04-10 Revised Date: 2009-02-05 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 2517-24 Citation Subset: IM |
Affiliation:
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MS4, School of Medicine, Georgetown University, Washington DC, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cross-Sectional Studies Disease Progression Echocardiography / methods Female Heart Function Tests / methods Humans Male Middle Aged Prognosis Prospective Studies Pulmonary Embolism / complications*, ultrasonography Regression Analysis Ventricular Dysfunction, Right / etiology*, ultrasonography |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL074384/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 2007 Oct;28(20):2430-1
[PMID:
17827497
]
Eur Heart J. 2008 Aug;29(16):2059-60; author reply 2060 [PMID: 18559330 ] |
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