हृदय रोग एवं निदान

Prognosis of Pulmonary Embolism with Right Ventricular Dysfunction

Abstract

Alain Rouge, Jeremie Lemarie, Aurelie Cravoisy-Popovic, Marie Conrad, Lionel Nace, Sebastien Gibot and Pierre Edouard Bollaert

Background: Mortality rate of pulmonary embolism (PE) at 3 months is over 15% for the high risk presentation and varies from 3% to 15% for the intermediate-risk presentation. Thrombolysis in intermediate-risk PE remains a matter of debate.

Methods: We undertook a retrospective study over a 11-year period including patients with high and intermediatehigh- risk PE, hospitalised in a medical ICU in a University hospital, to assess medium and long-term prognosis.

Results: Our series involved 145 patients, of whom 63 presented high risk PE and 82 had an intermediate-highrisk PE. Thirty-six patients (24.8%) died in the intensive care unit (ICU) including high-risk PE: 34/63 (53.9%), of whom 25 after inaugural cardiac arrest (CA); intermediate-high-risk PE: 2/82 (2.4%). On multivariate analysis, high blood lactates (OR: 1.88; IC 95% 1.18-3.02, p=0.0083), resuscitated CA (OR: 12.33; IC 95% 1.1-137.4, p=0.041), low subaortic velocity time integral (VTI) (OR: 9.22, IC 0.38-0.81, p=0.0024) were independent factors of in-ICU mortality. Twenty-seven patients died after ICU discharge. Echocardiographic checks were performed in 63 patients, in which 4 (6.3%) presented a chronic thromboembolic pulmonary hypertension (CTPH).

Conclusion: High-risk PE still has a high mortality rate in the ICU especially when revealed by a cardiac arrest. High blood lactates, resuscitated CA, and low subaortic VTI were independent predictive factors of mortality. In our retrospective cohort, long-term prognosis was good with only 4 cases of CTPH. The low mortality observed with anticoagulant-only treatment do not encourage thrombolysis for management of intermediate-high-risk PE patients.