Central versus peripheral pulmonary embolism: Analysis of the impact on the physiological parameters and long-term survival

Abstract

Background:Studies aimed at assessing whether the emboli lodged in the central pulmonary arteries carry a worse prognosis than more peripheral emboli have yielded controversial results.Aims:To explore the impact on survival and long-term prognosis of central pulmonary embolism.Patients and Methods:Consecutive patients diagnosed with acute symptomatic pulmonary embolism by means of computed tomography (CT) angiography were evaluated at episode index and traced through the computed system of clinical recording and following-up. Central pulmonary embolism was diagnosed when thrombi were seen in the trunk or in the main pulmonary arteries and peripheral pulmonary embolism when segmental or subsegmental arteries were affected.Results:A total of 530 consecutive patients diagnosed with pulmonary embolism were evaluated; 255 patients had central pulmonary embolism and 275 patients had segmental or subsegmental pulmonary embolism. Patients with central pulmonary embolism were older, had higher plasma levels of N-terminal of the prohormone brain natriuretic peptide (NT-ProBNP), troponin I, D-dimer, alveolar-arterial gradient, and shock index (P < .001 for each one). Patients with central pulmonary embolism had an all-cause mortality of 40% while patients with segmental or subsegmental pulmonary embolism (PE) had an overall mortality of 27% and odds ratio of 1.81 [confidence interval (CI) 95% 1.16-1.9]. Survival was lower in patients with central PE than in patients with segmental or subsegmental pulmonary embolism, even after avoiding confounders (P = .018).Conclusions:Apart from a greater impact on hemodynamics, gas exchange, and right ventricular dysfunction, central pulmonary embolism associates a shorter survival and an increased long-term mortality.

Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism

“…18,19 In these studies, less than a quarter of cases of PTE involved central arteries, which carry a worse prognosis compared to cases involving peripheral or segmental arteries. [20][21][22] Cases of isolated sub-segmental PTE were not seen in our cohort, in contrast to other studies that report prevalence rates between 5 and 16%. [23][24][25] In keeping with Use and diagnostic utility of clinical prediction rules…”

“…This frequency is variable across different hospital settings, with estimates in different studies ranging from 14 to 22% . In these studies, less than a quarter of cases of PTE involved central arteries, which carry a worse prognosis compared to cases involving peripheral or segmental arteries . Cases of isolated sub‐segmental PTE were not seen in our cohort, in contrast to other studies that report prevalence rates between 5 and 16% .…”

Clinical and Demographic Predictors of Acute Pulmonary Embolism in Central Africa Using 64-Rows Multi-Detector Computed Tomography Angiography

“…The distribution of complete filling and localization of the emboli are similar to prior reports (Martinez et al, 2016) with 47% of emboli located proximally and 53% distally. Pneumonia is a frequent infectious disease under the tropics (Ho, 2014).…”

“…Proximal PE was defined as thrombi visualized in the main trunk of the pulmonary artery and/or in the right or left main pulmonary arteries. Distal PE was defined as thrombi located exclusively in segmental or subsegmental pulmonary arteries (Martinez et al, 2016 …”

Pulmonary embolism - assessment of risk factors and emboli locations

“…However, the clinical studies carried out make it possible to broaden the range of factors taken into account when assessing the effects of pulmonary embolism. Patients with segmental or sub-segmental thrombosis had a longer survival at the age of 10, 26 and 96 months [22]. According to the authors' conclusions, a centrally located thrombus is associated with greater right ventricular stress, which leads to disturbances in gas exchange and haemodynamic state.…”