Impact of pulmonary infarction in pulmonary embolism on presentation and outcomes.

Autor: Kaptein FHJ; Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands., Kroft LJM; Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands., van Dam LF; Department of Emergency Medicine, Haga Teaching Hospital, The Hague, the Netherlands., Stöger JL; Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands., Ninaber MK; Department of Pulmonology, Leiden University Medical Centre, Leiden, the Netherlands., Huisman MV; Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands., Klok FA; Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: F.A.Klok@lumc.nl.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2023 Jun; Vol. 226, pp. 51-55. Date of Electronic Publication: 2023 Apr 21.
DOI: 10.1016/j.thromres.2023.04.005
Abstrakt: Background: Pulmonary infarction (PI) is relatively common in pulmonary embolism (PE). The association between PI and persistent symptoms or adverse events is largely unknown.
Aim: To evaluate the predictive value of radiological PI signs at acute PE diagnosis on 3-month outcomes.
Methods: We studied a convenience cohort with computed tomography pulmonary angiography (CTPA)-confirmed PE for whom extensive 3-month follow-up data were available. The CTPAs were re-evaluated for signs of suspected PI. Associations with presenting symptoms, adverse events (recurrent thrombosis, PE-related readmission and mortality) and self-reported persistent symptoms (dyspnea, pain and post-PE functional impairment) at 3-month follow-up were investigated using univariate Cox regression analysis.
Results: At re-evaluation of the CTPAs, 57 of 99 patients (58 %) had suspected PI, comprising a median of 1 % (IQR 1-3) of total lung parenchyma. Patients with suspected PI more often presented with hemoptysis (11 % vs. 0 %) and pleural pain (OR 2.7, 95%CI 1.2-6.2), and with more proximal PE on CTPA (OR 1.6, 95%CI 1.1-2.4) than patients without suspected PI. There was no association with adverse events, persistent dyspnea or pain at 3-month follow-up, but signs of PI predicted more functional impairment (OR 3.03, 95%CI 1.01-9.13). Sensitivity analysis with the largest infarctions (upper tertile of infarction volume) yielded similar results.
Conclusions: PE patients radiologically suspected of PI had a different clinical presentation than patients without those signs and reported more functional limitations after 3 months of follow-up, a finding that could guide patient counselling.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. F.A.K. has received research support from Bayer, BMS, BSCI, MSD, Leo Pharma, Actelion, The Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Association, The Dutch Heart Foundation and the Horizon Europe Program, all paid to his institution and independent of the current work. M.V.H. reports unrestricted grant support from The Netherlands Organisation for Health Research and Development (ZonMW), and unrestricted grant support and fees for presentations from Boehringer-Ingelheim, Pfizer-BMS, Bayer Health Care, Aspen, and Daiichi-Sankyo, all outside the submitted work. The other authors have no conflicts of interest to declare.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: