Role of echocardiography and cardiac biomarkers in prediction of in-hospital mortality and long-term risk of brain infarction in pulmonary embolism patients

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute pulmonary embolism (n=88). Intervention: Patent foramen ovale with right-to-left shunt (PFO/RLS) vs. Absence of PFO/RLS. Primary outcome: Ischemic stroke or new ischemic brain lesions at 12 months (OR 27.1, 95% CI 3.0-245.3, p=0.003).

Q: What does this research mean for the field?

In patients with acute pulmonary embolism, the presence of a patent foramen ovale with right-to-left shunt independently predicts the risk of ischemic stroke and new ischemic brain lesions, while cardiac biomarkers and right ventricular dysfunction predict in-hospital mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

David Vindiš; Martin Hutyra; Daniel Šaňák; Michal Král; Eva Čecháková; Jana Zapletalová; Simona Littnerová; Tomáš Adam; Jan Přeček; Miloš Táborský

doi:10.1016/j.crvasa.2017.04.003

May 28, 2017Cor et VasaOpen Access

Role of echocardiography and cardiac biomarkers in prediction of in-hospital mortality and long-term risk of brain infarction in pulmonary embolism patients

View Full Paper

Ask AI

Bookmark

Share

Key result

Patent foramen ovale with right-to-left shunt linked to ~27-fold higher stroke risk in acute PE.

OR 27.1
95% CI 3.0-245.3
P=0.003
n=88

Why the study?

The prognostic value of echocardiography and cardiac biomarkers for in-hospital mortality and long-term brain infarction risk in acute pulmonary embolism patients treated with anticoagulation was unclear.

Key Points

To determine the prognostic utility of echocardiographic parameters and cardiac biomarkers in predicting in-hospital mortality and 12-month ischemic stroke or brain infarction risk in acute pulmonary embolism patients receiving anticoagulation.
Prospective cohort study enrolling 88 patients with acute pulmonary embolism (mean age 63 years) followed for 12 months.
Baseline evaluations included cardiac troponin T (cTnT), NT-proBNP, transthoracic and transesophageal echocardiography (TEE, n=78), and brain magnetic resonance imaging (MRI, n=78), with repeat MRI performed at 12 months in 58 patients.
In-hospital mortality occurred in 11 patients and was predicted by elevated cTnT (OR 4.3, 95% CI 0.59–31.3, p = 0.014), elevated NT-proBNP (OR 14.2, 95% CI 1.5–133.4, p = 0.02), RV/LV diameter ratio ≥ 0.79 (OR 36.6, 95% CI 4.2–316.4, p = 0.001), TAPSE (OR 0.55, 95% CI 0.34–0.92, p = 0.022), and PASP ≥ 51.5 mm Hg (OR 33.3, 95% CI 3.8–292.6, p = 0.022).
Ischemic stroke or new silent brain lesions occurred in 17 patients (19.3%), with patent foramen ovale with right-to-left shunt (OR 27.1, 95% CI 3.0–245.3, p = 0.003) and tricuspid annular peak systolic velocity ≤ 14.5 cm/s (OR 34.1, 95% CI 3.4–344.0, p = 0.003) independently predicting stroke risk.

Study Design

Type

Observational (n=88)

Multicenter

No

Structured PICO

P

Population

88 consecutive patients (mean age 63 years, 55.7% female) with acute pulmonary embolism treated with anticoagulation, followed for 12 months.

E

Exposure

Echocardiography (including transesophageal echocardiography) and cardiac biomarkers (NT-proBNP, cTnT) assessment

O

Outcome

In-hospital mortality and occurrence of ischemic strokes (CMP) or ischemic brain lesions (ILM) during 12-month follow-uphard clinical

Main Result

Odds Ratio: 27.1 (95% CI 3–245.3)

p-value: p=0.003

Echocardiographic parameters of right ventricular dysfunction and cardiac biomarkers predict in-hospital mortality, while patent foramen ovale with right-to-left shunt predicts stroke risk in patients with acute pulmonary embolism.

Limitations

Monocentric study design
Limited number of patients who completed the full study protocol including follow-up MRI
Low number of endpoint events (in-hospital mortality, ischemic strokes, and brain ischemic lesions) making the conclusions less robust

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Echo parameters and biomarkers may aid short-term PE risk stratification; hypothesis-generating for brain infarction prediction, requiring larger validation.

Abstract

Ăvod: CĂlem prospektivnĂ studie bylo stanovenĂ vĂ˝znamu echokardiografie a kardiomarkerĹŻ v predikci hospitalizaÄnĂ mortality a rizika mozkovĂ˝ch infarktĹŻ bÄhem 12mÄsĂÄnĂho sledovĂĄnĂ u pacientĹŻ s plicnĂ emboliĂ (PE) lĂŠÄenĂ˝ch antikoagulaÄnĂ terapiĂ.Metody: ProspektivnÄ bylo vyĹĄetĹeno 88 pacientĹŻ s akutnĂ PE (39 muĹžĹŻ, prĹŻmÄrnĂ˝ vÄk 63 let), kteĹĂ byli sledovĂĄni po dobu 12 mÄsĂcĹŻ. OsmasedmdesĂĄt pacientĹŻ bylo v Ăşvodu vyĹĄetĹeno magnetickou rezonancĂ (MR) mozku a transezofageĂĄlnĂ echokardiografiĂ (TEE).Po 12 mÄsĂcĂch sledovĂĄnĂ 58 pacientĹŻ podstoupilo kontrolnĂ MR mozku. HospitalizaÄnĂ mortalita a vĂ˝skyt ischemickĂ˝ch cĂŠvnĂch mozkovĂ˝ch pĹĂhod (CMP)/ischemickĂ˝ch lĂŠzĂ mozku (ILM) byly analyzovĂĄny na zĂĄkladÄ vĂ˝sledku echokardiografie (pĹĂtomnost patentnĂho foramen ovale s prĹŻkazem pravolevĂŠho zkratovĂŠho toku - PFO/RLS; pomÄr rozmÄru pravĂŠ a levĂŠ komory [right ventricular to left ventricular diameter ratio, RV/LD]; systolickĂĄ exkurze trikuspidĂĄlnĂho anulu [tricuspid annulus plane systolic excursion, TAPSE; vrcholovĂĄ systolickĂĄ rychlost trikuspidĂĄlnĂho anulu - ST; odhad systolickĂŠho tlaku v plicnici [pulmonary artery systolic pressure, PASP]) a vĂ˝slednĂ˝ch hodnot kardiomarkerĹŻ (N-terminĂĄlnĂ konec prohormonu natriuretickĂŠho peptidu B [N-terminal pro-B type natriuretic peptide, NT-proBNP] a srdeÄnĂ troponin T [cTnT]).VĂ˝sledky: Z 88 pacientĹŻ s PE byla u 11 (12,5 %) jedincĹŻ stanovena vysoce rizikovĂĄ forma PE, u 24 (27,3 %) PE s vyĹĄĹĄĂm stĹednĂm rizikem, u 19 (21,6 %) PE s niĹžĹĄĂm stĹednĂm rizikem a u 34 (38,6 %) pacientĹŻ nĂzkorizikovĂĄ forma PE. JedenĂĄct (10,2 %) pacientĹŻ zemĹelo v prĹŻbÄhu hospitalizace, z toho 6 z 9 (66,6 %) s vysoce rizikovou formou PE a 3 z 24 (12,5 %) s vyĹĄĹĄĂm stĹednĂm rizikem PE. cTnT (odds ratio [OR] 4,3; 95% interval spolehlivosti [CI] 0,59-31,3, p = 0,014), NT-proBNP (OR 14,2 [95% CI 1,5-133,4], p = 0,02), RV/LD ≥ 0,79 (OR 36,6 [95% CI 4,2-316,4], p = 0,001), TAPSE (OR 0,55 [95% CI 0,34-0,92], p = 0,022) a PASP ≥ 51,5 mm Hg (OR 33,3 [95% CI 3,8-292,6], p = 0,022) predikovaly hospitalizaÄnĂ mortalitu. SedmnĂĄct pacientĹŻ (19,3 %) prodÄlalo CMP (n = 8) nebo u nich byly zaznamenĂĄny novĂŠ ILM (n = 9). V multivariantnĂ analĂ˝ze byly PFO/RLS (OR 27,1 [95% CI 3,0-245,3], p = 0,003) a ST ≤ 14,5 cm/s (OR 34,1 [95% CI 3,4-344,0], p = 0,003) identifikovĂĄny jako nezĂĄvislĂŠ prediktory rizika CMP/infarktu myokardu (IM).ZĂĄvÄry: U pacientĹŻ s akutnĂ PE srdeÄnĂ troponin T, NT-proBNP, dilatace/systolickĂĄ dysfunkce pravĂŠ komory a plicnĂ hypertenze predikujĂ hospitalizaÄnĂ mortalitu. PĹĂtomnost PFO/RLS a ST jsou asociovĂĄny s rizikem CMP a rozvojem novĂ˝ch mozkovĂ˝ch ischemickĂ˝ch lĂŠzĂ.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Vindiš et al. (2017) conducted an observational in Acute pulmonary embolism (n=88). Patent foramen ovale with right-to-left shunt (PFO/RLS) vs. Absence of PFO/RLS was evaluated on Ischemic stroke or new ischemic brain lesions at 12 months (OR 27.1, 95% CI 3.0-245.3, p=0.003). The presence of a patent foramen ovale with right-to-left shunt independently predicted the 12-month risk of ischemic stroke and new ischemic brain lesions in patients with acute pulmonary embolism (OR 27.1).

synapsesocial.com/papers/6ab360b2957795469c384a21 https://doi.org/10.1016/j.crvasa.2017.04.003

View Full Paper

Ask AI

Bookmark

Share

Role of echocardiography and cardiac biomarkers in prediction of in-hospital mortality and long-term risk of brain infarction in pulmonary embolism patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Role of echocardiography and cardiac biomarkers in prediction of in-hospital mortality and long-term risk of brain infarction in pulmonary embolism patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading