RT Journal Article
SR Electronic
T1 Echocardiography and PESI have independent prognostic role in pulmonary embolism
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj00975-2012
DO 10.1183/09031936.00097512
A1 Olivier Sanchez
A1 Ludovic Trinquart
A1 Benjamin Planquette
A1 Francis Couturaud
A1 Franck Verschuren
A1 Vincent Caille
A1 Nicolas Meneveau
A1 Gérard Pacouret
A1 Pierre-Marie Roy
A1 Marc Righini
A1 Arnaud Perrier
A1 Laurent Bertoletti
A1 Florence Parent
A1 Christine Lorut
A1 Guy Meyer
YR 2012
UL http://erj.ersjournals.com/content/early/2012/12/19/09031936.00097512.abstract
AB We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk-stratification in comparison to the PESI alone.The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of troponin and brain natriuretic peptide. Thirty-day adverse outcome was defined as death, recurrent PE or shock.529 patients were included, 25 (4.7%; 95% confidence interval (CI), 3.2% to 6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (P<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular (RV) dilatation. In multivariate analysis, the PESI (Odds Ratio (OR) III-IV versus I-II: 3.1; 95%CI, 1.2-8.3; OR V versus I-II: 5.5; 95%CI, 1.5–25.5) and echocardiography (RV/left ventricular ratio, OR for an increase of 0.1: 1.3; 95%CI, 1.1–1.5) were independent predictors of an adverse outcome.In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI.