Analysis Of Influencing Factors For Prognosis Of Patients With Pulmonary Embolism

(Part ?)Rare variants in MTHFR predispose to occurrence and recurrence of pulmonary embolismBackground Rare genetic variants play a critical role in unprovoked pulmonary embolism(PE).However,the known risk genes only account a small proportion of patients with PE.The objective of this study was to investigate the relationship between the rare variants of gene encoding methylenetetrahydrofolate reductase(MTHFR)and the initiation and long-term clinical outcomes of PE.Methods The rare variants of MTHFR were detected by whole exome sequencing of DNA from 258 unprovoked PE cases and 11451 controls.Correlation of genotype and clinical phenotype and outcome were evaluated at baseline and after follow-up.Results MTHFR rare variants were found in 15 of 258 cases(5.81%)and 241 of 11451 controls(2.10%),conferring 2.87-fold greater odds of the PE occurrence(OR= 2.87,95%CI=1.68-4.91,P=5.6×10-5,chi-square test).The patients with MTHFR rare variants had higher plasma level of homocysteine than those without.During a follow-up of 3.0 years,a total of 84 events were identified.The recurrent PE(two or more events of PE)were significantly higher in patients carrying MTHFR rare variants(8/15,53.3%)compared with those without(55/239,23.0%)(P=0.023).Conclusion We speculate that MTHFR rare variants may increase the occurrence and recurrence of PE.(Part ?)Long-term survival in non-high-risk pulmonary embolism with coronary artery diseaseObjectives:The long-term survival of pulmonary embolism(PE)patients combined with coronary artery disease(CAD)is unclear.We investigated the long-term survival of non-high-risk PE with CAD and its clinical predictors for all-cause mortality.Methods:The 299 consecutively included participants had the diagnosis of PE with CAD in FuWai hospital between January 2013 to December 2018 and an annual follow-up was conducted.The demographic data and relevant clinical parameters orscores were recorded to explore their predictive value for all-cause death in non-high-risk PE with CAD patients.Results:Long-term(median 45.0 months)survival was assessed in 291 of 299(97.32%)patients.The 30-days mortality was 0.34%and the estimated survival rates at 1,3,5 and 7 years were,respectively,96.8%(95%CI 94.78-98.82),93.8%(95%CI 90.82-96.78),86.5%(95%CI 81.29-91.71)and 79.2%(95%CI 70.22-88.17).Multivariate Cox regression analysis showed that age?70 years old[hazard ratio(HR)2.361;95%confidence interval(CI)1.019-5.750],male(HR 2.459;95%CI 1.144-5.283),NT-proBNP?500 ng/L(HR 4.264;95%CI 1.433-12.690)and concomitant DVT(HR 4.083;95%CI 1.757-9.485)were independent predictors for all-cause mortality.Anticoagulant treatment for at least 3 months(HR 0.365;95%CI 0.155-0.859)was a protective factor.Conclusion:Total mortality of the cohort(median follow-up of 45 months)was 10.65%.Advanced age,male,NT-proBNP?500 ng/L and concomitant DVT were associated with increased all-cause death.Furthermore,these patients can benefit from the anticoagulation treatment with no increased bleeding risk.