Publication details
Role of echocardiography and cardiac biomarkers in prediction of in-hospital mortality and long-term risk of brain infarction in pulmonary embolism patients
| Authors | |
|---|---|
| Year of publication | 2018 |
| Type | Article in Periodical |
| Magazine / Source | cor et Vasa |
| MU Faculty or unit | |
| Citation | |
| Doi | http://dx.doi.org/10.1016/j.crvasa.2017.04.003 |
| Keywords | Pulmonary embolism; Mortality; Brain infarction; Cardiac troponin; Natriuretic peptides; Echocardiography; Magnetic resonance imaging |
| Description | Introduction: The aim of prospective study was to evaluate the ability of echocardiography and cardiac biomarkers to predict in-hospital mortality and the risk of brain infarction during a 12-month follow-up period (FUP) with anticoagulation in pulmonary embolism (PE) patients. Methods: Eighty-eight consecutive acute PE patients (39 men, mean age 63 years) were enrolled; 78 underwent baseline echocardiography and brain magnetic resonance imaging (MRI). After a 12-month FUP, 58 underwent brain MRI. In-hospital mortality and the rates of new ischemic brain lesions (IBL) on MRI with clinical ischemic stroke (IS) events were predicted based on echocardiography (patent foramen ovale presence with right-to-left shunt - PFO/RLS; right/left ventricle diameter ratio - RV/LD; tricuspid annulus plane systolic excursion - TAPSE; tricuspid annulus systolic velocity - S-T; pulmonary artery systolic pressure - PASP) and biomarkers results (amino-terminal fragment of brain natriuretic peptide - NT-proBNP and cardiac troponin T - cTnT). Results: Our series involved 88 patients, of whom 11 (12.5%) presented high-risk PE, 24 (27.3%) intermediate-high risk PE, 19 (21.6%) intermediate-low risk PE and 34 (38.6%) patients had low risk PE. Nine patients (10.2%) died during hospitalization including high-risk PE [6/9 (66.6%)] and intermediate-high-risk PE [3/24 (12.5%)]. cTnT [odds ratio (OR) 4.3; 95% confidence interval 0.59-31.3, P = 0.014], NT-proBNP (OR 14.2 [1.5-133.4], P = 0.02), RV/LD = >= 0.79 (OR 36.6 [4.2316.4], P = 0.001), TAPSE (OR 0.55 [0.34-0.92, P = 0.022) and PASP = >= 51.5 mmHg (OR 33.3 [3.8-292.6], P = 0.022) were predictors of in-hospital mortality. Seventeen patients (19.3%) experienced IS (n = 8) or new IBL (n = 9). On multivariate analysis, PFO/RLS (OR 27.1 [3.0-245.3], P = 0.003) and S-T = <= 14.5 cm/s (OR 34.1 [CI 3.4-344.0], P = 0.003) were independent predictors of IS and IBL risk. Conclusions: High blood troponin T, NT-proBNP, RV dilatation/systolic dysfunction and pulmonary hypertension predicted in-hospital mortality. PFO/RLS presence and S-T were predictors of clinically apparent/silent brain infarction. (c) 2017 The Czech Society of Cardiology. Published by Elsevier Sp. z o. o. All rights reserved. |