PMID- 19542256
OWN - NLM
STAT- MEDLINE
DCOM- 20100106
LR  - 20240317
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 136
IP  - 5
DP  - 2009 Nov
TI  - Prospective evaluation of right ventricular function and functional status 6 
      months after acute submassive pulmonary embolism: frequency of persistent or 
      subsequent elevation in estimated pulmonary artery pressure.
PG  - 1202-1210
LID - S0012-3692(09)60675-9 [pii]
LID - 10.1378/chest.08-2988 [doi]
AB  - BACKGROUND: No published data have systematically documented pulmonary artery 
      pressure over an intermediate time period after submassive pulmonary embolism 
      (PE). The aim of this work was to document the rate of pulmonary hypertension, as 
      assessed noninvasively by estimated right ventricular systolic pressure (RVSP) of 
      >or= 40 mm Hg 6 months after the diagnosis of submassive PE. METHODS: We enrolled 
      200 normotensive patients with CT angiography-proven PE and a baseline 
      echocardiogram to estimate RVSP. All patients received therapy with 
      unfractionated heparin initially, but 21 patients later received alteplase in 
      response to circulatory shock or respiratory failure. Patients returned at 6 
      months for repeat RVSP measurement, and assessments of the New York Heart 
      Association (NYHA) score and 6-min walk distance (6MWD). RESULTS: Six months 
      after receiving a diagnosis, 162 of 180 survivors (90%) returned for follow-up, 
      including 144 patients who had been treated with heparin (heparin-only group) and 
      18 patients who had been treated with heparin plus alteplase 
      (heparin-plus-alteplase group). Among the heparin-only patients, the RVSP at 
      diagnosis was >or= 40 mm Hg in 50 of 144 patients (35%; 95% CI, 27% to 43%), 
      compared with 10 of 144 patients at follow-up (7%; 95% CI, 3% to 12%). However, 
      the RVSP at follow-up was higher than the baseline RVSP in 39 of 144 patients 
      (27%; 95% CI, 9% to 35%), and 18 of these 39 patients had a NYHA score of >or= 3 
      or exercise intolerance (6MWD, < 330 m). Among heparin-plus-alteplase patients, 
      the RVSP was >or= 40 mm Hg in 11 of 18 patients at diagnosis (61%; 95% CI, 36% to 
      83%), compared with 2 of 18 patients at follow-up (11%; 95% CI, 1% to 35%). The 
      RVSP at follow-up was not higher than at the time of diagnosis in any of the 
      heparin-plus-alteplase patients (95% CI, 0% to 18%). CONCLUSIONS: Six months 
      after experiencing submassive PE, a significant proportion of patients had 
      echocardiographic and functional evidence of pulmonary hypertension.
FAU - Kline, Jeffrey A
AU  - Kline JA
AD  - Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC. 
      Electronic address: jkline@carolinas.org.
FAU - Steuerwald, Michael T
AU  - Steuerwald MT
AD  - Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
FAU - Marchick, Michael R
AU  - Marchick MR
AD  - Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
FAU - Hernandez-Nino, Jackeline
AU  - Hernandez-Nino J
AD  - Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
FAU - Rose, Geoffrey A
AU  - Rose GA
AD  - Carolinas Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC.
LA  - eng
GR  - R01 HL074384/HL/NHLBI NIH HHS/United States
GR  - R01HL074384/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20090619
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - VTD58H1Z2X (Dopamine)
SB  - IM
CIN - Chest. 2009 Nov;136(5):1193-4. PMID: 19892667
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Pressure
MH  - Dopamine/therapeutic use
MH  - Echocardiography
MH  - Fibrinolytic Agents/therapeutic use
MH  - Follow-Up Studies
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Hypertension, Pulmonary/*epidemiology
MH  - Middle Aged
MH  - Patient Selection
MH  - Pulmonary Artery/*physiopathology
MH  - Pulmonary Embolism/diagnostic imaging/drug therapy/mortality/*physiopathology
MH  - Survivors
MH  - Tissue Plasminogen Activator/therapeutic use
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Ventricular Function, Right/*physiology
MH  - Young Adult
PMC - PMC2818852
EDAT- 2009/06/23 09:00
MHDA- 2010/01/07 06:00
PMCR- 2010/11/01
CRDT- 2009/06/23 09:00
PHST- 2009/06/23 09:00 [entrez]
PHST- 2009/06/23 09:00 [pubmed]
PHST- 2010/01/07 06:00 [medline]
PHST- 2010/11/01 00:00 [pmc-release]
AID - S0012-3692(09)60675-9 [pii]
AID - 08-2988 [pii]
AID - 10.1378/chest.08-2988 [doi]
PST - ppublish
SO  - Chest. 2009 Nov;136(5):1202-1210. doi: 10.1378/chest.08-2988. Epub 2009 Jun 19.