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Association of Persistent Right Ventricular Dysfunction at Hospital Discharge After Acute Pulmonary Embolism With Recurrent Thromboembolic Events
Stefano Grifoni, MD;
Simone Vanni, MD;
Simone Magazzini, MD;
Iacopo Olivotto, MD;
Alberto Conti, MD;
Maurizio Zanobetti, MD;
Gianluca Polidori, MD;
Filippo Pieralli, MD;
Nazerian Peiman, MD;
Cecilia Becattini, MD;
Giancarlo Agnelli, MD
Arch Intern Med. 2006;166:2151-2156.
Background In patients with acute pulmonary embolism, right ventricular dysfunction (RVD) on hospital admission is a predictor of adverse short-term clinical outcome. The aim of this study was to evaluate the prognostic value of RVD persistence at hospital discharge with regard to the likelihood of recurrent venous thromboembolism (VTE).
Methods Echocardiography was used to assess RVD on admission and before hospital discharge in 301 consecutive patients with the first episode of acute pulmonary embolism occurring from January 1998 through July 2004. Right ventricular dysfunction was diagnosed in the presence of 1 or more of the following: right ventricular dilation (without hypertrophy), paradoxical septal systolic motion, and Doppler evidence of pulmonary hypertension. Patients were followed up at 2, 6, and 12 months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE.
Results Patients were categorized as those (1) without RVD (155 patients [51.5%]), (2) with RVD regression (RVD on admission but not at discharge; 87 patients [28.9%]), and (3) with persistent RVD (RVD on admission and at discharge; 59 patients [19.6%]). After a mean ± SD of 3.1 ± 2.7 years, patients with RVD persistence showed an increased risk of recurrent VTE (14 patients, 9.2% patient-years) compared with those without RVD (15 patients, 3.1% patient-years) or RVD regression (3 patients, 1.1% patient-years) (P = .001). Six of 8 deaths related to pulmonary embolism occurred in patients with RVD persistence. At multivariate analysis, adjusted by anticoagulant treatment duration, RVD persistence was an independent predictor of recurrent VTE (hazard ratio, 3.79; P<.001).
Conclusion Persistent RVD at hospital discharge after an acute pulmonary embolism is associated with recurrent VTE.
Author Affiliations: Emergency Department (Drs Grifoni, Vanni, Magazzini, Conti, Zanobetti, Polidori, Pieralli, and Peiman) and Department of Cardiology (Dr Olivotto), Azienda Ospedaliero-Universitaria Careggi, Florence, and Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia (Drs Becattini and Agnelli), Italy.
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