Prospective Evaluation of Right Ventricular Function and Functional Status Six Months After Acute Submassive Pulmonary Embolism: Frequency of Persistent or Subsequent Elevation in Estimated Pulmonary Artery Pressure.
Chest. 2009 Jun 19;
Authors: Kline JA, Steuerwald MT, Marchick MR, Hernandez-Nino J, Rose GA
Background No published data have systematically documented pulmonary artery pressure over an intermediate time period after submassive pulmonary embolism (PE). The aim of this work was to document the rate of pulmonary hypertension, as assessed noninvasively by estimated right ventricular systolic pressure (RVSP) >/=40 mm Hg six months after diagnosis of submassive PE. Methods We enrolled 200 normotensive patients with CT angiography-proven PE and a baseline echocardiogram for RVSP. All patients received unfractionated heparin initially, but 21 later received alteplase in response to circulatory shock or respiratory failure. Patients returned at 6 months for repeat RVSP, and assessment of the New York Heart Association (NYHA) score and six minute walk distance (6MWD). Results Six months after diagnosis, 162 of 180 survivors (90%) returned for follow up, including 144 treated with heparin and 18 treated with heparin plus alteplase. Among heparin-only patients, the RVSP at diagnosis was >/= 40 mm Hg in 50/144 (35%, 95%: CI 27 to 43%), compared with 10/144 (7%, 95% CI: 3-12%) at follow up. However, follow up RVSP was greater than baseline RVSP in 39/144 (27%, 95% CI 9-35%), and 18 of these 39 had a NYHA score >/= 3 or exercise intolerance (6MWD < 330 m). Among heparin plus alteplase patients, the RVSP was >/= 40 mm Hg in 11/18 (61% 95% CI: 36-83%) at diagnosis, compared with 2/18 (11%, 95% CI: 1-35%) at follow up. RVSP at follow up was not higher than at the time of diagnosis in any of the heparin plus alteplase patients (95% CI: 0-18%). Conclusions Six months after submassive PE, a significant proportion of patients had echocardiographic and functional evidence of pulmonary hypertension.
PMID: 19542256 [PubMed - as supplied by publisher]