Central thromboembolism is a possible predictor of right heart dysfunction in normotensive patients with acute pulmonary embolism

Berghaus, T.M.; Haeckel, T.; Behr, W.; Wehler, M.; von Scheidt, W.; Schwaiblmair, M.

doi:10.1016/j.thromres.2010.06.009

« Previous Next »Thrombosis Research
Volume 126, Issue 3 , Pages e201-e205, September 2010

Central thromboembolism is a possible predictor of right heart dysfunction in normotensive patients with acute pulmonary embolism

T.M. Berghaus
- Department of Cardiology, Pneumology, Intensive Care and Endocrinology, Klinikum Augsburg, Germany
- Corresponding author. Department of Cardiology, Pneumology, Intensive Care and Endocrinology, Klinikum Augsburg, Stenglinstrasse 2, D – 86156 Augsburg, Germany. Tel.: +49 821 400 2531; fax: +49 821 400 2046.
T. Haeckel
- Department of Diagnostic Radiology and Neuroradiology, Klinikum Augsburg, Germany
W. Behr
- Institute of Laboratory Medicine, Klinikum Augsburg, Germany
M. Wehler
- Emergency Department, Klinikum Augsburg, Germany
W. von Scheidt
- Department of Cardiology, Pneumology, Intensive Care and Endocrinology, Klinikum Augsburg, Germany
M. Schwaiblmair
- Department of Cardiology, Pneumology, Intensive Care and Endocrinology, Klinikum Augsburg, Germany

Received 19 January 2010; received in revised form 7 June 2010; accepted 11 June 2010. published online 20 July 2010.

Abstract

Background

Right heart dysfunction is a crucial factor in risk stratification of normotensive patients with pulmonary embolism. Apart from biomarkers, determinants of right heart dysfunction in this group of patients are not yet well established.

Aim and method

In order to identify such determinants, we analysed data of 252 patients with acute pulmonary embolism admitted to our hospital in 2008.

Results

69 out of 140 patients showed right heart dysfunction by echocardiography within 24 hours after diagnosis, 71 did not. Right ventricular dysfunction was significantly more frequent in patients with central clots on computed tomography (p=0.004), a history of syncope (p<0.001) and among women on oral contraceptives (p=0.003). In multiple regression analysis, only central thromboembolism (p<0.001) was identified as individual predictor of right ventricular dysfunction. Age, gender, body mass index, idiopathic or recurrent thromboembolism, duration of symptoms, preceding surgery, room air oxygen saturation, carcinoma, hypertension, diabetes, renal disease, congestive left heart failure and concomitant lung disease were equally distributed. In comparison with NT-pro brain natriuretic peptide (PPV 67%, NPV 75%, p=0.782) and troponin I (PPV 76%, NPV 62%, p=0.336), central thromboembolism has shown to have a greater statistical power in predicting right heart dysfunction in normotensive patients with pulmonary embolism (PPV 78%, NPV 88%, p<0.001).

Conclusion

Among normotensive patients with acute pulmonary embolism, those with central clots seem to be at greater risk for echocardiographically evaluated right ventricular dysfunction.

Abbreviations: BNP, brain natriuretic peptide, CT, computed tomography, CRP, C reactive protein, SD, standard deviation, NPV, negative predictive value, PPV, positive predictive value