Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism.

Details

Serval ID
serval:BIB_9E540AC90E1F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism.
Journal
Thorax
Author(s)
Jimenez David, Aujesky Drahomir, Moores Lisa, Gomez Vicente, Marti David, Briongos Sem, Monreal Manuel, Barrios Vivencio, Konstantinides Stavros, Yusen Roger D.
ISSN
1468-3296[electronic], 0040-6376[linking]
Publication state
Published
Issued date
2011
Volume
66
Number
1
Pages
75-81
Language
english
Abstract
Background: In haemodynamically stable patients with acute symptomatic pulmonary embolism (PE), studies have not evaluated the usefulness of combining the measurement of cardiac troponin, transthoracic echocardiogram (TTE), and lower extremity complete compression ultrasound (CCUS) testing for predicting the risk of PE-related death.
Methods: The study assessed the ability of three diagnostic tests (cardiac troponin I (cTnI), echocardiogram, and CCUS) to prognosticate the primary outcome of PE-related mortality during 30 days of follow-up after a diagnosis of PE by objective testing.
Results: Of 591 normotensive patients diagnosed with PE, the primary outcome occurred in 37 patients (6.3%; 95% CI 4.3% to 8.2%). Patients with right ventricular dysfunction (RVD) by TTE and concomitant deep vein thrombosis (DVT) by CCUS had a PE-related mortality of 19.6%, compared with 17.1% of patients with elevated cTnI and concomitant DVT and 15.2% of patients with elevated cTnI and RVD. The use of any two-test strategy had a higher specificity and positive predictive value compared with the use of any test by itself. A combined three-test strategy did not further improve prognostication. For a subgroup analysis of high-risk patients, according to the pulmonary embolism severity index (classes IV and V), positive predictive values of the two-test strategies for PE-related mortality were 25.0%, 24.4% and 20.7%, respectively.
Conclusions: In haemodynamically stable patients with acute symptomatic PE, a combination of echocardiography (or troponin testing) and CCUS improved prognostication compared with the use of any test by itself for the identification of those at high risk of PE-related death.
Keywords
Hemodynamically Stable Patients, Right-Ventricular Dysfunction, Deep-Vein Thrombosis, Multicenter Registry, Venous Thrombosis, Diagnosis, Echocardiography, Management, Model, Ultrasonography
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2011 16:41
Last modification date
20/08/2019 15:04
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