دورية أكاديمية
Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup.
| العنوان: | Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup. |
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| المؤلفون: | Santos AR; Internal Medicine Department, Hospital de São Francisco Xavier, Portugal., Freitas P; Cardiology Department, Hospital de Santa Cruz, Portugal., Ferreira J; Cardiology Department, Hospital de Santa Cruz, Portugal., Oliveira A; Cardiology Department, Hospital de Santa Cruz, Portugal., Gonçalves M; Cardiology Department, Hospital de Santa Cruz, Portugal., Faria D; Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Portugal., Bicho Augusto J; Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Portugal., Simões J; Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Portugal., Santos A; Radiology Department, Centro Hospitalar Lisboa Ocidental, Portugal., Gago M; Radiology Department, Centro Hospitalar Lisboa Ocidental, Portugal., Oliveira J; Radiology Department, Centro Hospitalar Lisboa Ocidental, Portugal., Antunes RM; Radiology Department, Centro Hospitalar Lisboa Ocidental, Portugal., Correia D; Radiology Department, Centro Hospitalar Lisboa Ocidental, Portugal., Lynce A; Internal Medicine Department, Hospital de São Francisco Xavier, Portugal., Brito J; Cardiology Department, Hospital de Santa Cruz, Portugal., Morais C; Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Portugal., Campos L; Internal Medicine Department, Hospital de São Francisco Xavier, Portugal., Mendes M; Cardiology Department, Hospital de Santa Cruz, Portugal. |
| المصدر: | European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2020 Jun; Vol. 9 (4), pp. 279-285. Date of Electronic Publication: 2019 Apr 24. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 101591369 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2048-8734 (Electronic) Linking ISSN: 20488726 NLM ISO Abbreviation: Eur Heart J Acute Cardiovasc Care Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2021- : [Oxford] : Oxford University Press Original Publication: London : SAGE Publications, 2012- |
| مواضيع طبية MeSH: | Natriuretic Peptide, Brain/*blood , Pulmonary Embolism/*diagnosis , Risk Assessment/*methods , Thrombolytic Therapy/*methods , Troponin I/*blood, Acute Disease ; Aged ; Aged, 80 and over ; Biomarkers/blood ; Computed Tomography Angiography ; Echocardiography ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Pulmonary Embolism/blood ; Pulmonary Embolism/therapy ; Retrospective Studies |
| مستخلص: | Background: Patients with acute pulmonary embolism are at intermediate-high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate-high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction. Methods: We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n =58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n =40). Results: Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P <0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P <0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P <0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3-10.3; P =0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5-5.2; P =0.001) as independent predictors of events. In the intermediate-high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8-6.2; P =0.003). Conclusions: Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate-high risk subgroup. |
| فهرسة مساهمة: | Keywords: NT-proBNP; Pulmonary embolism; biomarkers; risk assessment; troponin |
| المشرفين على المادة: | 0 (Biomarkers) 0 (Troponin I) 114471-18-0 (Natriuretic Peptide, Brain) |
| تواريخ الأحداث: | Date Created: 20190425 Date Completed: 20210427 Latest Revision: 20220417 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1177/2048872619846506 |
| PMID: | 31017472 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2048-8734 |
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| DOI: | 10.1177/2048872619846506 |