Background:
Patients with acute pulmonary embolism (APE) with concomitant chronic heart failure (CHF) have a worse prognosis than patients without CHF. This study aims to evaluate and compare the impact of APE on the early and long-term prognosis of patients with all different degrees of CHF according to the left ventricle function (LV-F).
Methods:
Our study included 168 patients with confirmed APE and different degrees of LV-F. All patients received a diagnostic echocardiogram within 24 hours from Admission and patients were divided into four different groups according to the degree of the LV-F. Group 1 included patients with preserved LV-F (ejection fraction (EF) ≥ 55%), group 2 are Patients with mildly reduced LV-F (EF 45%-54%), group 3 Patients with moderate reduced LV-F (EF 30%-44%), and group 4 with severely reduced LV-F (EF <30%). The primary endpoint of the study was short and long-term mortality.
Results:
There was no significant difference in baseline characteristics between the different patient groups. Patients in group 4 presented initially with significantly more syncope and cardiogenic shock with more need for cardiopulmonary resuscitation (CPR) in comparison to other groups. During their hospital stay, they needed more hemodialysis and repeated CPR. Mortality was significantly higher in group 4 at 7-days, 30-days but did not differ at 6- and 12 months (Table 1). No significant difference was found in Troponin-T results.
Table (1)
|
|
Preserved LV-F
(EF ≥ 55%) |
mildly reduced LV-F
(EF45%-54%) |
moderate reduced LV-F
(EF 30%-44%) |
severely reduced LV-F
(EF <30%) |
p-value |
|
NT-proBNP |
2198±2986 |
3976±5204 |
6123±6628 |
6610±9229 |
0.025 |
|
Cardiogenic shock |
4/57 (7%) |
2/25 (8%) |
2/9 (22%) |
3/8 (38%) |
0.046 |
|
Resuscitation at admission |
1/58 (2%) |
2/25 (8%) |
1/9 (11%) |
2/7 (29%) |
0.033 |
|
Syncope |
12/57 (21%) |
1/24 (4%) |
0/9 (0%) |
3/8 (38%) |
0.048 |
|
Need for dialysis |
1/58 (2%) |
1/24 (4%) |
0/9 (0%) |
2/8 (25%) |
0.017 |
|
Resuscitation during hospitalization |
1/57 (2%) |
3/25 (12%) |
1/9 (11%) |
4/7 (57%) |
0.000 |
|
Death 7 days |
1/57 (2%) |
0/24 (0%) |
0/7 (0%) |
2/8 (25%) |
0.003 |
|
Death 30 days |
2/55 (4%) |
1/23 (4%) |
0/8 (0%) |
2/7 (29%) |
0.041 |
|
Death 6 months |
3/55 (6%) |
3/23 (13%) |
0/8 (0%) |
2/7 (29%) |
0.134 |
|
Death 12 months |
4/55 (7%) |
5/23 (22%) |
0/8 (0%) |
2/7 (29%) |
0.102 |
Conclusions:
Patients with APE and severely reduced LV-F have a worse in-hospital course, and significantly higher mortality rates at 7- and 30-days, in comparison to patients with preserved, mildly reduced, or moderately reduced LV-Function. However, mortality at 6- and 12-months did not differ between the different patient groups.