Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients

Brad G. Stevinson, Jackeline Hernandez-Nino, Geoffrey Rose, Jeffrey Kline

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Aims: We hypothesized that first-time submassive pulmonary embolism (PE) can cause persistent, significant cardiopulmonary problems, including right ventricular damage and worsened quality of life in patients with no prior cardiopulmonary disease. Methods and results: We prospectively enrolled 205 patients without end-stage comorbidity diagnosed with submassive PE (systolic blood pressure always > 100 mmHg). Using explicit criteria, we identified a subgroup of 127 'previously healthy' patients who were free of cardiopulmonary disease or other disabling process. All patients had transthoracic echocardiography (echo) at the time of diagnosis. Six months later, survivors returned for repeat echo, 6 min walk distance (6MWD), and a quality-of-life survey. We defined a significant cardiopulmonary problem as either: (i) abnormal RV on echo (RV dilation or RV hypokinesis); or (ii) NYHA score > II or a 6MWD <330 m at 6 months. Of 127 study patients, five had inadequate echos, nine were lost to follow-up, and four died, leaving 109 with complete data. Of 109 patients, 45 (41%) had cardiopulmonary problems 6 months after PE: 18 of 109 (17%) had only an abnormal RV, 18 of 109 (17%) had only functional limitation, and nine of 109 (8%) had both. Twenty-two patients (20%) indicated at least one index of poor quality-of-life: health status worse, not currently shopping, or perceived need for oxygen at home. Patients with cardiopulmonary problems demonstrated a significant decrease in SaO2% after 6MWD (97 ± 1.3 pre-6MWD vs. 96 ± 1.8% post-6MWD, P = 0.004 by paired t-test). Conclusion: Six months after first-time PE, 41% of previously healthy patients had either an abnormal RV on echo, an NYHA score > II or a 6MWD <330 m. Treatment studies of PE should include these persistent cardiopulmonary problems as study endpoints.

Original languageEnglish (US)
Pages (from-to)2517-2524
Number of pages8
JournalEuropean Heart Journal
Volume28
Issue number20
DOIs
StatePublished - Oct 2007
Externally publishedYes

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Pulmonary Embolism
Echocardiography
Quality of Life
Blood Pressure
Survivors
Comorbidity
Dilatation
Therapeutics

Keywords

  • Cardiac failure
  • Echocardiography
  • Fibrinolysis
  • Prognosis
  • Pulmonary embolism
  • Right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients. / Stevinson, Brad G.; Hernandez-Nino, Jackeline; Rose, Geoffrey; Kline, Jeffrey.

In: European Heart Journal, Vol. 28, No. 20, 10.2007, p. 2517-2524.

Research output: Contribution to journalArticle

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abstract = "Aims: We hypothesized that first-time submassive pulmonary embolism (PE) can cause persistent, significant cardiopulmonary problems, including right ventricular damage and worsened quality of life in patients with no prior cardiopulmonary disease. Methods and results: We prospectively enrolled 205 patients without end-stage comorbidity diagnosed with submassive PE (systolic blood pressure always > 100 mmHg). Using explicit criteria, we identified a subgroup of 127 'previously healthy' patients who were free of cardiopulmonary disease or other disabling process. All patients had transthoracic echocardiography (echo) at the time of diagnosis. Six months later, survivors returned for repeat echo, 6 min walk distance (6MWD), and a quality-of-life survey. We defined a significant cardiopulmonary problem as either: (i) abnormal RV on echo (RV dilation or RV hypokinesis); or (ii) NYHA score > II or a 6MWD <330 m at 6 months. Of 127 study patients, five had inadequate echos, nine were lost to follow-up, and four died, leaving 109 with complete data. Of 109 patients, 45 (41{\%}) had cardiopulmonary problems 6 months after PE: 18 of 109 (17{\%}) had only an abnormal RV, 18 of 109 (17{\%}) had only functional limitation, and nine of 109 (8{\%}) had both. Twenty-two patients (20{\%}) indicated at least one index of poor quality-of-life: health status worse, not currently shopping, or perceived need for oxygen at home. Patients with cardiopulmonary problems demonstrated a significant decrease in SaO2{\%} after 6MWD (97 ± 1.3 pre-6MWD vs. 96 ± 1.8{\%} post-6MWD, P = 0.004 by paired t-test). Conclusion: Six months after first-time PE, 41{\%} of previously healthy patients had either an abnormal RV on echo, an NYHA score > II or a 6MWD <330 m. Treatment studies of PE should include these persistent cardiopulmonary problems as study endpoints.",
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