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Prognostic importance of central thrombus in normotensive patients with pulmonary embolism
Session:
Posters 2 - Écran 10 - Circulação / Embolia Pulmonar
Speaker:
David Roque
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
David Cabrita Roque; Joana Simões; João Augusto; Daniel Candeias Faria; João Baltazar Ferreira; Hilaryano Ferreira; Marco Beringuilho; Pedro Magno; Carlos Sequeira De Morais
Abstract
<p><strong>BACKGROUND:</strong> Emboli in the pulmonary trunk and/or main pulmonary arteries (PA) are centrally located in pulmonary arterial tree. Clinical features, prognosis and the impact of the hemodynamic status in central acute pulmonary embolism (PE) are not well known.</p> <p><strong>PURPOSE:</strong> We aimed to assess (1) the impact of central acute PE on haemodynamic and (2) the prognostic significance of central acute PE in normotensive pts with and without hyperlactacidemia.</p> <p><strong>METHODS:</strong> We retrospectively studied 483 consecutive pts hospitalized for acute PE. We defined central PE as the presence of thrombi in at least 1 main PA, and non-central PE as the presence of thrombi in lobar, segmental and/or sub-segmental PA. We further divided central PE patients in those who were (1) normotensive with normal lactates, (2) normotensive with high lactates and (3) hypotensive. Admission data on haemodynamic, laboratory results and right ventricular (RV) function were collected. Haemodynamic decompensation within 7 days as well as all-cause mortality within 7, 30 and 90 days were recorded.</p> <p><strong>RESULTS:</strong> PE localization was determined in 356 patients. Mean age was 65.9±0.9 years, 37.9% (n=135) were male. Acute PE was central in 39.9% (n=142) and non-central in 60.1% (n=214). Central PE patients were more frequently haemodynamically unstable at initial presentation (14.1 vs 2.8%, p<0.001) and tended to have higher lactate values (median 1.51 vs 1.36mmol/L, p=0.074) than non-central PE patients. Regarding the 3 central PE groups: group 3 had higher shock index (median 0.96 vs 0.65 in group 1 vs 0.72 in group 2, p<0.001 for trend) and modified shock index (median 1.36 vs 0.91 in group 1 vs 1.00 in group 2, p<0.001 for trend); higher concentrations of NTproBNP (median 3928 vs 1379 in group 1 vs 3768pg/mL in group 2, p=0.005 for trend) as well as higher rates of RV dysfunction (75.0 vs 36.3% in group 1 vs 58.0% in group 2, p=0.005 for trend). In contrast, group 2 had higher concentrations of troponin I (median 0.22 vs 0.04 in group 1 vs 0.12ng/mL in group 3, p<0.001 for trend). Central PE patients were more likely to undergo fibrinolysis (11.3 vs 0.9% in non-central PE, p<0.001), namely group 3 (22.2 vs 10.3% in group 2 vs 2.3% in group 1, p=0.001 for trend). Outcomes were similar between central PE and non-central PE patients: haemodynamic decompensation within 7 days (9.2 vs 5.6%, respectively, p=0.210), all-cause mortality within 7, 30 and 90 days (p=0.528, p=0.703 and p=1.000, respectively). In the 3 groups of central PE the outcomes were similar in terms of haemodynamic decompensation within 7 days and all-cause mortality within 7 and 90 days (p=0.224, p=0.137 and p=0.093, respectively, all for trend). Of note, all-cause mortality rate at 30 days was higher in group 2 (18.4 vs 4.7% in group 1 vs 11.1% in group 3, p=0.002 for trend).</p> <p><strong>CONCLUSIONS:</strong> Normotensive patients with centrally-located acute PE and high lactates have the highest thirty-day all-cause mortality.</p>
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