Left ventricular systolic dysfunction during acute pulmonary embolism

Rafael Cires-Drouet; Allison LaRocco; Danielle Soldin; Thomas John; Shahab Toursavadkohi; Khanjan Nagarsheth; Siamak Dahi; Justin Marsella; Minerva Mayorga-Carlin; John D Sorkin; Kevin Jones; Daniel Haase; Susie N Hong; Brajesh K Lal; Bartley Griffith; Gautam Ramani; Bradley Taylor

doi:10.1016/j.thromres.2023.01.011

Left ventricular systolic dysfunction during acute pulmonary embolism

Rafael Cires-Drouet, Allison LaRocco, Danielle Soldin, Thomas John, Shahab Toursavadkohi, Khanjan Nagarsheth, Siamak Dahi, Justin Marsella, Minerva Mayorga-Carlin, John D Sorkin, Kevin Jones, Daniel Haase, Susie N Hong, Brajesh K Lal, Bartley Griffith, Gautam Ramani, Bradley Taylor

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Heart failure increases the risk of death in acute pulmonary embolism (PE). The role of the left ventricle (LV) in acute PE is not well defined.

OBJECTIVE: To identify the prevalence of LV systolic dysfunction, morphology, and prognosis of the LV during an acute PE.

METHODS: Retrospective study (26-months) of patients diagnosed with an acute PE presenting with LV systolic dysfunction at the University of Maryland.

RESULTS: Among 769 acute PE patients, 78 (10.5 %) had LV systolic dysfunction and 42 (53.8 %) had history of cardiac disease. Patients without history of cardiac disease were younger (mean age [SD] 54.9 [16.8] vs. 62.6 [16.6]; p = 0.04), had a higher BMI (31.2 [12.2] vs. 29.2 [7.7]; p = 0.005), and less hypertension (20 [34.5 %] vs. 38 [65.5 %]; p = 0.0005). A massive PE was most common in patients without history of cardiac disease (8[22.2 %] vs. 2[4.7 %], p = 0.02). There was no difference in clot burden, but right ventricular strain was more frequently seen in patients without history cardiac disease in the initial CT (p = 0.001). The median troponin and lactate were similar in both groups. In 41 patients with follow-up echocardiograms, improvement in LVEF% was observed in patients without cardiac history (median Δ LVEF% [IQR]; 20 [6.2-25.0]). While patients with cardiac disease did not demonstrate similar changes (median Δ LVEF% [IQR]; 0 [-5-17.5]; p = 0.01). In hospital mortality was 12.8 % with no difference between both groups (p = 0.17).

CONCLUSION: Pulmonary embolism can be associated with LV systolic dysfunction, even in patients without history of cardiac disease.

Original language	English
Pages (from-to)	1-6
Number of pages	6
Journal	Thrombosis research
Volume	223
DOIs	https://doi.org/10.1016/j.thromres.2023.01.011
State	Published - Mar 2023
Externally published	Yes

Keywords

Humans
Retrospective Studies
Pulmonary Embolism/diagnosis
Ventricular Dysfunction, Left/complications
Acute Disease
Echocardiography
Ventricular Dysfunction, Right

Access to Document

10.1016/j.thromres.2023.01.011

Cite this

Cires-Drouet, R., LaRocco, A., Soldin, D., John, T., Toursavadkohi, S., Nagarsheth, K., Dahi, S., Marsella, J., Mayorga-Carlin, M., Sorkin, J. D., Jones, K., Haase, D., Hong, S. N., Lal, B. K., Griffith, B., Ramani, G., & Taylor, B. (2023). Left ventricular systolic dysfunction during acute pulmonary embolism. Thrombosis research, 223, 1-6. https://doi.org/10.1016/j.thromres.2023.01.011

Cires-Drouet, R, LaRocco, A, Soldin, D, John, T, Toursavadkohi, S, Nagarsheth, K, Dahi, S, Marsella, J, Mayorga-Carlin, M, Sorkin, JD, Jones, K, Haase, D, Hong, SN, Lal, BK, Griffith, B, Ramani, G & Taylor, B 2023, 'Left ventricular systolic dysfunction during acute pulmonary embolism', Thrombosis research, vol. 223, pp. 1-6. https://doi.org/10.1016/j.thromres.2023.01.011

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title = "Left ventricular systolic dysfunction during acute pulmonary embolism",

abstract = "BACKGROUND: Heart failure increases the risk of death in acute pulmonary embolism (PE). The role of the left ventricle (LV) in acute PE is not well defined.OBJECTIVE: To identify the prevalence of LV systolic dysfunction, morphology, and prognosis of the LV during an acute PE.METHODS: Retrospective study (26-months) of patients diagnosed with an acute PE presenting with LV systolic dysfunction at the University of Maryland.RESULTS: Among 769 acute PE patients, 78 (10.5 \%) had LV systolic dysfunction and 42 (53.8 \%) had history of cardiac disease. Patients without history of cardiac disease were younger (mean age [SD] 54.9 [16.8] vs. 62.6 [16.6]; p = 0.04), had a higher BMI (31.2 [12.2] vs. 29.2 [7.7]; p = 0.005), and less hypertension (20 [34.5 \%] vs. 38 [65.5 \%]; p = 0.0005). A massive PE was most common in patients without history of cardiac disease (8[22.2 \%] vs. 2[4.7 \%], p = 0.02). There was no difference in clot burden, but right ventricular strain was more frequently seen in patients without history cardiac disease in the initial CT (p = 0.001). The median troponin and lactate were similar in both groups. In 41 patients with follow-up echocardiograms, improvement in LVEF\% was observed in patients without cardiac history (median Δ LVEF\% [IQR]; 20 [6.2-25.0]). While patients with cardiac disease did not demonstrate similar changes (median Δ LVEF\% [IQR]; 0 [-5-17.5]; p = 0.01). In hospital mortality was 12.8 \% with no difference between both groups (p = 0.17).CONCLUSION: Pulmonary embolism can be associated with LV systolic dysfunction, even in patients without history of cardiac disease.",

keywords = "Humans, Retrospective Studies, Pulmonary Embolism/diagnosis, Ventricular Dysfunction, Left/complications, Acute Disease, Echocardiography, Ventricular Dysfunction, Right",

author = "Rafael Cires-Drouet and Allison LaRocco and Danielle Soldin and Thomas John and Shahab Toursavadkohi and Khanjan Nagarsheth and Siamak Dahi and Justin Marsella and Minerva Mayorga-Carlin and Sorkin, \{John D\} and Kevin Jones and Daniel Haase and Hong, \{Susie N\} and Lal, \{Brajesh K\} and Bartley Griffith and Gautam Ramani and Bradley Taylor",

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doi = "10.1016/j.thromres.2023.01.011",

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T1 - Left ventricular systolic dysfunction during acute pulmonary embolism

AU - Cires-Drouet, Rafael

AU - LaRocco, Allison

AU - Soldin, Danielle

AU - John, Thomas

AU - Toursavadkohi, Shahab

AU - Nagarsheth, Khanjan

AU - Dahi, Siamak

AU - Marsella, Justin

AU - Mayorga-Carlin, Minerva

AU - Sorkin, John D

AU - Jones, Kevin

AU - Haase, Daniel

AU - Hong, Susie N

AU - Lal, Brajesh K

AU - Griffith, Bartley

AU - Ramani, Gautam

AU - Taylor, Bradley

PY - 2023/3

Y1 - 2023/3

N2 - BACKGROUND: Heart failure increases the risk of death in acute pulmonary embolism (PE). The role of the left ventricle (LV) in acute PE is not well defined.OBJECTIVE: To identify the prevalence of LV systolic dysfunction, morphology, and prognosis of the LV during an acute PE.METHODS: Retrospective study (26-months) of patients diagnosed with an acute PE presenting with LV systolic dysfunction at the University of Maryland.RESULTS: Among 769 acute PE patients, 78 (10.5 %) had LV systolic dysfunction and 42 (53.8 %) had history of cardiac disease. Patients without history of cardiac disease were younger (mean age [SD] 54.9 [16.8] vs. 62.6 [16.6]; p = 0.04), had a higher BMI (31.2 [12.2] vs. 29.2 [7.7]; p = 0.005), and less hypertension (20 [34.5 %] vs. 38 [65.5 %]; p = 0.0005). A massive PE was most common in patients without history of cardiac disease (8[22.2 %] vs. 2[4.7 %], p = 0.02). There was no difference in clot burden, but right ventricular strain was more frequently seen in patients without history cardiac disease in the initial CT (p = 0.001). The median troponin and lactate were similar in both groups. In 41 patients with follow-up echocardiograms, improvement in LVEF% was observed in patients without cardiac history (median Δ LVEF% [IQR]; 20 [6.2-25.0]). While patients with cardiac disease did not demonstrate similar changes (median Δ LVEF% [IQR]; 0 [-5-17.5]; p = 0.01). In hospital mortality was 12.8 % with no difference between both groups (p = 0.17).CONCLUSION: Pulmonary embolism can be associated with LV systolic dysfunction, even in patients without history of cardiac disease.

AB - BACKGROUND: Heart failure increases the risk of death in acute pulmonary embolism (PE). The role of the left ventricle (LV) in acute PE is not well defined.OBJECTIVE: To identify the prevalence of LV systolic dysfunction, morphology, and prognosis of the LV during an acute PE.METHODS: Retrospective study (26-months) of patients diagnosed with an acute PE presenting with LV systolic dysfunction at the University of Maryland.RESULTS: Among 769 acute PE patients, 78 (10.5 %) had LV systolic dysfunction and 42 (53.8 %) had history of cardiac disease. Patients without history of cardiac disease were younger (mean age [SD] 54.9 [16.8] vs. 62.6 [16.6]; p = 0.04), had a higher BMI (31.2 [12.2] vs. 29.2 [7.7]; p = 0.005), and less hypertension (20 [34.5 %] vs. 38 [65.5 %]; p = 0.0005). A massive PE was most common in patients without history of cardiac disease (8[22.2 %] vs. 2[4.7 %], p = 0.02). There was no difference in clot burden, but right ventricular strain was more frequently seen in patients without history cardiac disease in the initial CT (p = 0.001). The median troponin and lactate were similar in both groups. In 41 patients with follow-up echocardiograms, improvement in LVEF% was observed in patients without cardiac history (median Δ LVEF% [IQR]; 20 [6.2-25.0]). While patients with cardiac disease did not demonstrate similar changes (median Δ LVEF% [IQR]; 0 [-5-17.5]; p = 0.01). In hospital mortality was 12.8 % with no difference between both groups (p = 0.17).CONCLUSION: Pulmonary embolism can be associated with LV systolic dysfunction, even in patients without history of cardiac disease.

KW - Humans

KW - Retrospective Studies

KW - Pulmonary Embolism/diagnosis

KW - Ventricular Dysfunction, Left/complications

KW - Acute Disease

KW - Echocardiography

KW - Ventricular Dysfunction, Right

U2 - 10.1016/j.thromres.2023.01.011

DO - 10.1016/j.thromres.2023.01.011

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JO - Thrombosis research

JF - Thrombosis research

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