Pulmonary embolism: One-year follow-up with echocardiography Doppler and five-year survival analysis

• Published in: Circulation (New York, N.Y.) Vol. 99; no. 10; pp. 1325 - 1330
• Main Authors: RIBEIRO, A, LINDMARKER, P, JOHNSSON, H, JUHLIN-DANNFELT, A, JORFELDT, L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 16-03-1999; American Heart Association, Inc
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Comorbidity; Echocardiography, Doppler; Endarterectomy; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary - epidemiology; Hypertension, Pulmonary - etiology; Logistic Models; Lung Diseases, Obstructive - epidemiology; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Neoplasms - epidemiology; Pneumology; Prognosis; Prospective Studies; Pulmonary Embolism - complications; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - epidemiology; Pulmonary Embolism - mortality; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Risk Factors; Severity of Illness Index; Survival Analysis; Sweden - epidemiology; Thromboembolism - epidemiology; Ventricular Dysfunction, Right - epidemiology; Ventricular Dysfunction, Right - etiology; Sonography; Human; Prognosis; Respiratory disease; Right ventricle; Cardiovascular disease; Duplex ultrasonography; Pulmonary hypertension; Vascular disease; Pulmonary embolism; Follow up study; Dysfunction; Medical imagery
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.99.10.1325

The long-term prognosis for patients with pulmonary embolism (PE) is dependent on the underlying disease, degree of pulmonary hypertension (PH), and degree of right ventricular (RV) dysfunction. A precise description of the time course of pulmonary artery pressure (PAsP)/RV function is therefore of importance for the early identification of persistent PH/RV dysfunction in patients treated for acute PE. Other objectives were to identify variables associated with persistent PH/RV dysfunction and to analyze the 5-year survival rate for patients alive 1 month after inclusion.
Echocardiography Doppler was performed in 78 patients with acute PE at the time of diagnosis and repeatedly during the next year. A 5-year survival analysis was made. The PAsP decreased exponentially until the beginning of a stable phase, which was </=38 days. The recovery of RV function occurred during the same time period. Risk factors for persistent PH/RV dysfunction and the 5-year mortality rate were analyzed using multiple logistic regression models. A PAsP of >50 mm Hg at the time of diagnosis of acute PE was associated with persistent PH after 1 year. The 5-year mortality rate was associated with underlying disease. Only patients with persistent PH in the stable phase required pulmonary thromboendarterectomy within 5 years.
An echocardiography Doppler investigation performed 6 weeks after diagnosis of acute PE can identify patients with persistent PH/RV dysfunction and may be of value in planning the follow-up and care of these patients.