(Circulation. 1999;99:1325-1330.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Pulmonary Embolism
One-Year Follow-Up With Echocardiography Doppler and Five-Year Survival Analysis
From the Departments of Clinical Physiology (A.R., A.J.-D., L.J.), Haematology (P.L.), and Cardiovascular Medicine (H.J.), Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Correspondence to Dr Ary Ribeiro, Department of Clinical Physiology, Thoracic Clinics, Karolinska Hospital, 171 76 Stockholm, Sweden. E-mail ari{at}thfys.ks.se
Background—The long-term prognosis for patients with pulmonary embolism (PE) is dependent on the underlying disease, degree of pulmonary hypertension (PH), and degree of right ventricular (RV) dysfunction. A precise description of the time course of pulmonary artery pressure (PAsP)/RV function is therefore of importance for the early identification of persistent PH/RV dysfunction in patients treated for acute PE. Other objectives were to identify variables associated with persistent PH/RV dysfunction and to analyze the 5-year survival rate for patients alive 1 month after inclusion.
Methods and Results—Echocardiography
Doppler was performed in 78 patients with acute PE at the time of
diagnosis and repeatedly during the next year. A 5-year survival
analysis was made. The PAsP decreased exponentially until the
beginning of a stable phase, which was 
38 days. The recovery of RV
function occurred during the same time period. Risk factors for
persistent PH/RV dysfunction and the 5-year mortality rate were
analyzed using multiple logistic regression models. A PAsP of
>50 mm Hg at the time of diagnosis of acute PE was associated
with persistent PH after 1 year. The 5-year mortality rate was
associated with underlying disease. Only patients with persistent PH in
the stable phase required pulmonary
thromboendarterectomy within 5 years.
Conclusions—An echocardiography Doppler investigation performed 6 weeks after diagnosis of acute PE can identify patients with persistent PH/RV dysfunction and may be of value in planning the follow-up and care of these patients.
Key Words: pulmonary heart disease • echocardiography • follow-up studies • statistics
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