Aims This study aimed to investigate whether the risk of short-term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). Methods and results Predictive value of HFrEF or HFpEF for 7-day (intrahospital) and 30-day all-cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline-proposed criteria. A 7-day (intrahospital) and 30-day all-cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7-day mortality (hazard ratio 2.22, 95% confidence interval 1.25-4,38.41, P = 0.021) and neither HFrEF or HFpEF was an independent predictor for 30-day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P = 0.01), and right ventricle systolic pressure (P = 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days. Conclusions Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.
Background/Aim. The evaluation of blood levels of cardiac troponin-I (cTnI), D-dimer, B-type natriuretic peptide (BNP) and C-reactive protein (CRP) at admission and during the treatment of pulmonary embolism (PE) are the part of routine diagnostic process and estimation of mortality risk. The aim of this study was to evaluate the predictive value of these biomarkers at admission for all-cause 30-day mortality in consecutive PE patients regarding whether they classified as spontaneous, transiently provoked and permanently provoked PE. Methods. This retrospective analysis is gained from the data of 590 PE patients from the Serbian University Multicenter Pulmonary Embolism Registry (SUPER). Patients had at least one of these biomarkers (BNP, CRP, cTnI and D-dimer) measurements during the first 24 hours from the admission. Results. ROC curve analyses demonstrated that BNP had the highest prognostic accuracy for 30-day mortality in patients (N=219) who had data for all examined biomarkers. BNP provided an AUC of 0.785 (p<0.001). Separately BNP had the highest c-statistic for all three groups of patients. CRP had modest predictive value for the 30-day all-cause mortality in the group with transient provoked PE. Troponin I had very modest predictive value for the 30-day all-cause mortality only in patients with spontaneous PE and D-dimer was very weak predictor of this end-point only in patients with persistent provoked PE. Conclusion. Patients with spontaneous, transient provoked and persistent provoked PE have significantly different profile of blood biomarkers level with different prognostic significance for early all-cause mortality.
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