Prognostic Analysis Of Hemodynamically Stable Patients With Acute Pulmonary Embolism

Objective: Acute pulmonary embolism is a serious cardiovasculardisease hazard to human health, and the clinical manifestations are complexand outcomes are quite diverse. The high incidence, high mortality and highrate of misdiagnosis increasingly aroused the concern of clinicians.Hemodynamically unstable patients with acute pulmonary embolism requirethrombolysis or intervention, hemodynamically stable patients at low risk aremerely need anticoagulant therapy. In this study, we analyze clinicalmanifestations, laboratory tests, echocardiagraphy and clinical outcomes ofhemodynamically stable patients with pulmonary embolism aimed at finding aconvenient and effective method to assess their clinical outcomes.Methods: A retrospective analysis of61hemodynamically stable patientswith acute pulmonary embolism, including35male patients and26femalepatients. Inclusion criteria: the patients diagnosed with pulmonary embolismby pulmonary enhanced CT, pulmonary ventilation perfusion scanning andpulmonary angiography reference to the guideline of diagnosis and treatmentof pulmonary thromboembolism. Exclusion criteria:(1) hemodynamicinstability: systolic blood pressure less than <90mmHg or requirement ofvasoactive drugs to maintain blood pressure, or the existence sign of organhypoperfusion (2) received thrombolytic therapy (3) lack the date of brainnatriuretic peptide, troponin I, echocardiography, etc.(4) have the history ofcoronary heart disease, pulmonary hypertension, chronic heart failure, renalinsufficiency.According to the outcome, the patients were divided into EVENT group andnon-EVENT group. Composite outcomes events include:(1) all-cause death(2) cardiogenic shock (3) escalate of regimen, such as thrombolysis, intervention or surgery(4) application of vasoactive drugs. The clinicalcharacteristic of disease, clinical manifestations, ECG, blood gas analysis, theD-dimer, echocardiography, and plasma BNP and cTnI level in the two groupswere compared. The SPSS19.0statistical package was applied for statisticalanalysis, and P <0.05was considerd as significant difference.Results: A total of61hemodynamically stable patients with pulmonaryembolism from January1,2011to December31,2011in the Second Hospitalof Hebei Medical University enrolled in the study, who had complete clinicaldata, including35male patients and26female patients, aged24to83yearsold (61.4±17.3years old).23patients had EVENT,3death,4cardiogenicshock,7thrombolysis and9used vasoactive drugs.1.There were no significant difference between the two groups in gender,hypertension, diabetes, smoking, the existence of deep vein thrombosis, recenttrauma fractures, limb immobilization (all P>0.05). There was a significantdifference in age (65.9±10.5years old vs58.6±13.6years old, P=0.034).2.Clinical chief complaint including dyspnea, chest pain, hemoptysis, cough,had no significant difference between the two groups,and systolic bloodpressure on admission between the two groups was similar.(P>0.05). Theincidence of Syncope in EVENT was higher (30.4%vs7.8%, P=0.050).3.ECG on admissions presented precordial T wave inversion, sinustachycardia, complete or incomplete right bundle branch block and SIQIIITIIIand there were no significant difference between the two groups; blood gasanalysis of pH, PO2, PCO2, and D-dimer also had no difference between thetwo groups (all P>0.05).4.Plasma cTnI increased in22patients (36.1%),14in EVENT group and8innon-EVENT group, the cTnI positive rate between the two groups weredifferent (60.7%vs.21.1%, P=0.004). The plasma cTnI levels was lower innon-EVENT group (3.24ng/ml,0.03-19.8ng/ml vs0.67ng/ml,0.05-6.92ng/ml).BNP elevated in25cases (40.9%),16in EVENT group,9in non-EVENTgroup. BNP elevating rate between the two groups was diffrence (69.6%vs23.7%， P=0.001)and in EVENT group BNP plasma level was higher (205.3pg/ml,6.8-1349pg vs45.2pg/ml,5.0-1720pg/ml). Presence of rightventricular dysfunction was found in25cases,15in EVENT group,10innon-EVENT group.The incidence of RVD between the two groups hadstatistically significance (65.2%vs26.3%, P=0.006).5.Univariate regression analysis showed that age, syncope, RVD and cTnIelevation, BNP elevation were risk factors for adverse clinical events,multivariate regression analysis showed that syncope, RVD and cTnIelevation, BNP elevation were independent risk factors for adverse clinicalevents.Conclusions:1Age is a risk indication for poor prognosis of hemodynamically stablepatients with pulmonary embolism.2Syncope is an independent risk factor for patients with pulmonary embolismin hemodynamic stability,as a result, the clinicians should pay more attentionto the patient who has syncope.3The hemodynamically stable patients with pulmonary embolism who haveelevated plasma BNP or elevated plasma cTnI or RVD have a higher risk ofadverse clinical events, could be defined as a high-risk subgroup.