Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2001-09

AUTHORS

Antoine Vieillard-Baron, Bernard Page, Roch Augarde, Sebastien Prin, Salah Qanadli, Alain Beauchet, Olivier Dubourg, François Jardin

ABSTRACT

. Objective: The indications for the use of thrombolytic agents in massive pulmonary embolism (MPE) remain controversial and it has been suggested that transthoracic echocardiographic (TTE) examination, which is able to detect an associated right ventricular dysfunction, may cast light on this question. The goal of this study was to examine the incidence of acute cor pulmonale (ACP) in MPE, diagnosed on the basis of TTE criteria, its clinical implications and its resolution rate. Design: Ten-year retrospective clinical study. Setting: A medical and a coronary intensive care unit, university hospital. Patients: One hundred sixty-one patients with proven MPE. Interventions: Acute cor pulmonale was defined as right ventricular end-diastolic area / left ventricular end-diastolic area (RVEDA/LVEDA) ratio in the long axis greater than 0.6 associated with septal dyskinesia in the short axis. ACP patients were divided into three groups according to circulatory status: 32 patients without circulatory failure constituted group 1, 32 patients with circulatory failure requiring inotropic support, but free of metabolic acidosis, constituted group 2 and 34 patients in whom circulatory failure was associated with metabolic acidosis (defined by a base deficit >5 mEq/l) constituted group 3. Results: Acute cor pulmonale was present in 61% of patients with MPE and carried a 23% mortality, but this mortality was very different in stable patients (groups 1 and 2, 64 patients, 3% mortality) and in unstable patients (group 3, 34 patients, 59% mortality). A multivariate logistic regression analysis showed that the TTE results were not predictive of the risk of death. Conversely, the same analysis showed that the presence of metabolic acidosis was a powerful predictor of death. Conclusion: Because none of the TTE measurements in ACP could be used to stratify the severity of MPE, TTE was of no help in deciding on medical thrombolysis. However, depending on its severity, metabolic acidosis could justify a large cooperative study to assess the impact of thrombolytic therapy on mortality rate in this specific group. More... »

PAGES

1481-1486

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s001340101032

DOI

http://dx.doi.org/10.1007/s001340101032

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1041325122

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/11685341


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42 TTE results
43 University Hospital
44 acidosis
45 acute cor pulmonale
46 agents
47 analysis
48 area
49 area ratio
50 associated right ventricular dysfunction
51 axis
52 basis
53 care unit
54 circulatory failure
55 circulatory status
56 clinical implications
57 clinical studies
58 cor pulmonale
59 coronary intensive care unit
60 criteria
61 death
62 dysfunction
63 dyskinesia
64 echocardiographic examination
65 echocardiographic pattern
66 embolism
67 end-diastolic area
68 examination
69 failure
70 goal
71 group
72 group 1
73 group 2
74 group 3
75 help
76 hospital
77 impact
78 implications
79 incidence
80 indications
81 inotropic support
82 intensive care unit
83 large cooperative study
84 light
85 logistic regression analysis
86 long axis
87 massive pulmonary embolism
88 measurements
89 medical thrombolysis
90 metabolic acidosis
91 mortality
92 mortality rate
93 multivariate logistic regression analysis
94 patients
95 patterns
96 powerful predictor
97 predictors
98 presence
99 pulmonale
100 pulmonary embolism
101 questions
102 rate
103 ratio
104 recovery rate
105 regression analysis
106 resolution rate
107 results
108 retrospective clinical study
109 right ventricular dysfunction
110 right ventricular end-diastolic area
111 risk
112 risk of death
113 same analysis
114 septal dyskinesia
115 severity
116 short axis
117 specific groups
118 stable patients
119 status
120 study
121 support
122 therapy
123 thrombolysis
124 thrombolytic agents
125 thrombolytic therapy
126 transthoracic echocardiographic examination
127 units
128 unstable patients
129 use
130 ventricular dysfunction
131 ventricular end-diastolic area
132 ventricular end-diastolic area ratio
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