Prognosis in acute pulmonary embolism

doi:10.1016/S0140-6736(99)90053-3

The Lancet

Volume 353, Issue 9162, 24 April 1999, Pages 1375-1376

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Cited by (21)

Diuretics versus volume expansion in acute submassive pulmonary embolism
2017, Archives of Cardiovascular Diseases
Citation Excerpt :
We found in this study that one single bolus of 40 mg furosemide, administered without delay after diagnosis assessment, is well tolerated and is not associated with RV function worsening. When compared with careful VE, it was associated with a greater improvement in HR, BNP, troponin Ic and echocardiographical markers of RV dysfunction, which are powerful prognostic factors in acute PE [2,18–26]. Our study supports the findings of Ternacle et al. [15], who reported, in 2013, a potential benefit of a diuretic treatment in submassive PE, with significant improvement in SBP, simplified PE severity index, shock index and oxygen requirement in a retrospective study with 40 patients.
The benefit of volume expansion (VE) in submassive pulmonary embolism (PE) with right ventricular (RV) dysfunction is unclear.
To compare the effects of diuretic treatment versus VE in patients hospitalized for PE with RV dysfunction.
We prospectively included 46 consecutive patients with submassive PE treated on admission with a 40 mg bolus of furosemide (D group, n = 24) or 500 mL of saline infusion (VE group, n = 22). The primary endpoint was the timing of normalization of B-type natriuretic peptide and troponin Ic concentrations. The secondary endpoints were variations in RV function variables, recorded at baseline, at the 4th hour after treatment initiation (H4) and every day until discharge, and a clinical composite endpoint of thrombolysis or death at 7 and 30 days.
No differences were observed between patients at baseline. The primary endpoint occurred earlier in the D group than in the VE group (67.5 ± 34.8 vs 111.6 ± 63.3 hours; P = 0.006). Furosemide treatment on admission was well tolerated, and was not associated with serious adverse events. At H4, substantial improvements were observed in the D group versus the VE group in terms of heart rate reduction (–8.15 ± 21.0 vs –0.71 ± 6.30 beats/min; P < 0.01) and peak tricuspid annular systolic velocity (Doppler tissue imaging) (11.4 ± 2.10 vs 9.90 ± 2.80 cm/s; P = 0.02). There was no significant difference between groups in terms of severe outcomes at 7 and 30 days.
In the acute management of submassive PE patients, a single furosemide bolus on admission seems to produce significant and earlier improvements in RV function markers compared with VE, without adverse events.
Le bénéfice du remplissage dans l’embolie pulmonaire (EP) aiguë avec dysfonction ventriculaire droite (VD) est incertain. Nous avons comparé les effets d’un traitement diurétique versus un remplissage chez des patients hospitalisés pour EP avec dysfonction VD.
Nous avons prospectivement inclus 46 patients consécutifs hospitalisés pour une EP aiguë avec dysfonction VD traités à l’admission soit par un bolus de 40 mg de furosémide (groupe D, n = 24), soit un remplissage de 500 cm³ de chlorure de sodium (groupe R, n = 22). Le critère de jugement principal était le temps de normalisation du Brain natriuretic peptide (BNP) et de la troponine Ic. Les critères de jugement secondaires étaient l’analyse de paramètres cliniques, biologiques et échographiques enregistrés à l’admission, après 4 heures de traitement, puis quotidiennement jusqu’à la sortie d’hospitalisation et la survenue d’un critère clinique composite (décès ou thrombolyse) aux 7^e et 30^e jours.
Il n’y avait pas de différence significative entre les 2 groupes à l’admission. La normalisation du BNP et de la troponine Ic est survenue plus rapidement dans le groupe D que dans le groupe R (67,53 ± 4,8 vs 111,6 ± 63,3 heures, p = 0,006). L’administration de furosémide à l’admission était bien tolérée et ne s’est pas compliquée d’effets indésirables graves. À la 4^e heure, une réduction significative de la fréquence cardiaque et une amélioration significative du pic de vitesse systolique tricuspide (onde S, évaluée en doppler tissulaire pulsé) étaient observées dans le groupe D avec respectivement −8,15 ± 21,0 vs −0,71 ± 6,30 bpm dans le groupe R, p < 0,01 et 11,4 ± 2,10 vs 9,90 ± 2,80 cm/s dans le groupe R, p = 0,02. Il n’y avait pas de différence significative en termes de décès ou thrombolyse aux 7^e et 30^e jours entre les 2 groupes.
Dans la prise en charge de l’EP aiguë avec dysfonction VD, un bolus de furosémide à l’admission entraîne une amélioration rapide et significative de paramètres pronostics cliniques, biologiques et échographiques sans survenue d’effets indésirables graves.
Clinical implications of right ventricular dysfunction in patients with acute symptomatic pulmonary embolism: Short- and long-term clinical outcomes
2012, Journal of Critical Care
Citation Excerpt :
Acute pulmonary embolism (PE) is a common and life-threatening condition [1], with 3-month mortality rates of 8% to 18.6% in Western countries [2-6] and 11% in Korea [7].
Right ventricular dysfunction (RVD) has been found to have a negative impact on the short-term prognosis of patients with pulmonary embolism (PE). However, the long-term prognosis of such patients has not been well defined. We evaluated the effect of RVD on short- and long-term mortality in Korean patients with PE.
We retrospectively assessed 180 patients with PE who underwent transthoracic echocardiography to evaluate RVD between January 2004 and December 2008. Patients were categorized as hemodynamically stable without RVD (stable without RVD, n = 70), hemodynamically stable with RVD (stable with RVD, n = 74), or hemodynamically unstable with RVD (unstable with RVD, n = 36). The clinical courses of all patients were followed up in-hospital and after discharge.
Nineteen patients (10.5%) died during hospitalization, with the unstable with RVD group showing the highest rate of in-hospital mortality (27.8%, P < .05) and PE-related deaths (16.7%, P < .05), but no difference in these parameters was noted between the other 2 groups. Multivariate analysis showed that older age and hemodynamic instability were independent risk factors for poor in-hospital outcomes. Eleven patients died after discharge. Multivariate analysis showed that older age, immobilization, and malignancy were independent predictors of long-term mortality.
Right ventricular dysfunction without hemodynamic instability was not associated with short- or long-term mortality of patients with PE.
Complications of Heel Surgery
2010, Clinics in Podiatric Medicine and Surgery
Citation Excerpt :
Postoperative shortness of breath, diaphoresis, and general malaise in the absence of primarily an infection alerts physicians to a pulmonary embolism until proved otherwise. In some instances, death may be the sole finding of the pulmonary embolism.29 Complex regional pain syndrome (CRPS) does not have a predilection for calcaneal surgery but it must be included in any discussion.
The Evidence-Based Diagnosis of Deep Venous Thrombosis
2009, Annals of Emergency Medicine
The potential biomarkers for thromboembolism detected by SELDI-TOF-MS
2009, Thrombosis Research
Citation Excerpt :
The incidence of DVT is about 50–67 per 100 000 [2,3]. Despite adequate thrombolytic therapy, the mortalities of AMI and DVT patients, in whom cardiogenic shock or pulmonary embolism develops, remain to be high [4–6]. For suspected DVT, venous compression ultrasonography (CUS) is currently the noninvasive imaging test.
Few studies were concerned about searching for specific biomarkers for thromboembolic (arterial and venous) diseases by the use of Surface-Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOF-MS).
We screened for potential biomarkers in 69 plasma samples, including samples from 20 patients with idiopathetic deep vein thrombosis (DVT), 20 patients with acute myocardial infarction (AMI), and 29 healthy controls without a history of thromboembolism. Pretreated plasma samples were analyzed on the Protein Biology System IIc plus SELDI-TOF-MS (Ciphergen Biosystems, Fremont, CA). Proteomic spectra of mass to charge ratio (m/z) were generated by the application of plasma to immobilized metal affinity capture (IMAC-3) ProteinChip arrays activated with copper.
A pattern of three biomarkers (m/z: 2 667, 5 914, and 6 890 Da, respectively) with a total accuracy of 100% was selected based on their collective contribution to the optimal separation between patients with AMI and healthy controls. Another spattern consisting of only one biomarker (m/z: 5 914 Da) could totally discriminate patients with DVT and control subjects. For further analysis between patients with AMI and those with DVT, a pattern of four biomarkers (m/z: 3 418, 5 271, 33 378, and 68 125 Da, respectively) was selected with a total accuracy of 82.5%.
Plasma proteomic profiling with SELDI-TOF-MS and ProteinChip technologies provides high sensitivity and specificity in discriminating patients with thrombosis and healthy subjects. The discovered biomarkers might show great potential for early diagnosis of thromboembolic diseases.
Diagnosis of pulmonary embolism: When is imaging needed?
2003, Clinics in Chest Medicine

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CommentaryPrognosis in acute pulmonary embolism

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Prognosis in acute pulmonary embolism