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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Right ventricular dysfunction on acute pulmonary embolism: predictors and prognostic impact.
Session:
Posters 2 - Écran 10 - Circulação / Embolia Pulmonar
Speaker:
Inês Grácio Almeida
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:
Inês Grácio De Almeida; Joana Simões; Daniel Faria; David Cabrita Roque; João Baltazar; Marco Beringuilho; Miguel Santos; Carlos Sequeira De Morais
Abstract
<p><strong>Introduction:</strong> Transthoracic echocardiogram (TTE) is an accessible method that allows a rapid evaluation of indirect signs of acute pulmonary embolism (PE), namely right ventricular dysfunction (RVD), described at 30-50% and leading to a double risk of mortality.</p> <p><strong>Objective: </strong>Evaluation of predictor factors (PF) for RVD and its impact on short and long term follow up in P presented with PE.</p> <p><strong>Material and methods: </strong>Retrospective observational case-control study of 483 P admitted with PE between 2014-16. P were divided into two groups: group 1 - with RVD and group 2 - without RVD, evaluated by TTE. Data was collected regarding clinical, laboratorial and echocardiographic parameters in both groups to predict in-hospital, 7-days (7d), 6-months (6m) and 1-year (1y) mortality.</p> <p><strong>Results: </strong>A total of 246 P were submitted for final analysis. Mean age 64.1 ± 18.4 years, 66.3% females. 45.5% (n=112) had RVD in TTE. There were no significant differences in age and gender between groups. At univariate analysis, the PF for RVD were: heart rate (HR) (<em>odds ratio</em> (OR) 1.020, p 0.003, (confidence interval) CI 1.007-1.034), pCO2 (OR 0.968, p 0.022, CI 0.942-0.995), lactate levels (OR 1.456, p 0.001, CI 1.177-1.802), troponin levels (OR 1.425, p 0.047, CI 1.004-2.023), NTproBNP levels (OR 1.000, p 0.009, CI 1.015-1.105), D-dimer levels (OR 1.000, p 0.001, CI 1.019-1.082), <em>shock index</em> (SI) (OR 6.602, p <0.001, CI 2.180-19.990), PE of central location (OR 2.966, p <0.001, CI 1.629-5.402), hemodynamic instability (OR 5.172, p <0.001, CI 2.142-12.489), shock (OR 4.290, p 0.003, CI1.649-11.162), cardiopulmonary arrest (CPR) (OR 5.000, p 0.045, CI 1.039-24.052) and fibrinolysis (OR 34.112, p 0.001, CI4.525-257.172). At multivariate analysis, the independent PF for RVD development were: pCO2 (P 0.008), lactate levels (p 0.013), NTproBNP levels (p 0.015), D-dimer levels (0.002), central PE (p 0.001), hemodynamic instability (p 0.042), shock (p 0.042), and fibrinolysis (p 0.008); excluding HR, troponin levels, SI and CPR. P with RVD had higher mortality: in-hospital (14.3 vs 5.3%, p 0.016), at 7d (13.4 vs 1.3%, p 0.026), at 6m (26 vs 11.3%, p 0.004) and at 1y (33.3 vs 19.4%, p 0.033).</p> <p><strong>Conclusion: </strong>In P not submitted to TTE, several other clinical and laboratorial parameters can predict RVD, associated with worse outcomes. </p>
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