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Clinical, echocardiographic, analytical and imaging parameters: which are the main prognostic factors in hospitalized patients with acute pulmonary embolism?
Session:
Comunicações Orais - Sessão 20 - Tromboembolismo pulmonar agudo
Speaker:
Fabiana Duarte
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Fabiana Silva Duarte; Inês Coutinho Dos Santos; M. Inês Barradas; André Viveiros Monteiro; Raquel Dourado; Dinis Martins
Abstract
<p>Background: Acute pulmonary thromboembolism (PE) is a life-threatening condition and an early diagnosis and adequate therapy are critical. Mortality in PE still remains very high in spite of progress in diagnostic tools. Several parameters for risk stratification have been reported with a variable importance on clinical practice.</p> <p>Purpose: To compare the performance of different parameters (clinical, echocardiographic, analytical and imaging parameters) in predicting adverse in-hospital events in acute PE.</p> <p>Methods: We retrospectively assessed consecutive patients from a single center registry who were hospitalized with acute PE. Four different parameters were determined: Clinical and echocardiographic (PESI class and PESI-Echo score), analytical (lactate and troponin I admission values) and anatomical imaging (central or peripheral thrombi location) parameters. A composite outcome of adverse in-hospital events (including cardiogenic shock, acute respiratory failure, severe bleeding events or in-hospital mortality) was determined. Discriminative power of each parameter was assessed by receiver operating characteristic curve analysis.</p> <p>Results: A total of 131 patients (mean age of 67.6 ± 15.3 years-old, female 71%) were included. Regarding baseline comorbidities, 63.4% of the patients had hypertension, 27.4% had a recent hospitalization or major surgery and 19.8% had a medical history of active cancer. Besides anticoagulation, 7 patients (5.3%) underwent fibrinolysis. Overall in-hospital mortality was 8.4% and 3.8% of the patients had a severe bleeding event, respiratory failure or cardiogenic shock. <br /> According to the PESI classification, 29.8% of the patients were included in class V, 26.7% in class III and 17.6% in class II. PESI classification had a weak positive correlation with the outcome (p<0.001; r=0.37), like PESI-Echo score (p 0.018; r=0.36). Attending to in-hospital adverse events, 72.2% occurred in PESI class V patients (p=0.020). Both analytical parameters (lactate and troponin I) determined at hospital admission had a good discriminative power in predicting the composite in-hospital outcome. Discriminative power was superior for lactate and troponin I (AUC 0.864, 95% CI 2.8 – 187; p <0.001) vs imaging data (AUC 0.64, p=0.12).<br /> Comparing all-four parameters, PESI-Echo score had the best discriminative power (AUC 1.0, p=0.008), followed by PESI class (AUC 0.925) and lactate value at hospital admission (AUC 0.856). The cut-off value for PESI-Echo was 211.</p> <p>Conclusion: Clinical, echocardiographic and analytical parameters showed overall good performance in stratifying in-hospital adverse events. Its routinely use for risk stratification had significant impact on prognosis.</p>
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