In patients with acute pulmonary embolism (PE), both the prognostic stratification
and reperfusion treatment are mainly based on the hemodynamic profile at admission,
which is assessed using the systolic blood pressure (SBP) value [
[1]
]. However, SBP has some intrinsic limitations, being not able to evaluate two-thirds
of the cardiac cycle, represented by the diastolic phase. Intermediate-high risk PE
patients have generated a growing debate over the last years regarding the need of
a more aggressive treatment during the acute phase of the disease [
- Konstantinides S.V.
- Torbicki A.
- Agnelli G.
- Danchin N.
- Fitzmaurice D.
- Galiè N.
- Gibbs J.S.
- Huisman M.V.
- Humbert M.
- Kucher N.
- Lang I.
- Lankeit M.
- Lekakis J.
- Maack C.
- Mayer E.
- Meneveau N.
- Perrier A.
- Pruszczyk P.
- Rasmussen L.H.
- Schindler T.H.
- Svitil P.
- Vonk Noordegraaf A.
- Zamorano J.L.
- Zompatori M.
Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European
Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of
acute pulmonary embolism.
Eur Heart J. 2014; 35: 3033-3069
[2]
]. These subjects are characterized by the contemporary presence of right ventricular
dysfunction (RVD) and positive markers of myocardial injury [
- Meyer G.
- Vicaut E.
- Danays T.
- Agnelli G.
- Becattini C.
- Beyer-Westendorf J.
- Bluhmki E.
- Bouvaist H.
- Brenner B.
- Couturaud F.
- Dellas C.
- Empen K.
- Franca A.
- Galiè N.
- Geibel A.
- Goldhaber S.Z.
- Jimenez D.
- Kozak M.
- Kupatt C.
- Kucher N.
- Lang I.M.
- Lankeit M.
- Meneveau N.
- Pacouret G.
- Palazzini M.
- Petris A.
- Pruszczyk P.
- Rugolotto M.
- Salvi A.
- Schellong S.
- Sebbane M.
- Sobkowicz B.
- Stefanovic B.S.
- Thiele H.
- Torbicki A.
- Verschuren F.
- Konstantinides S.V.
- Investigators P.E.I.T.H.O.
Fibrinolysis for patients with intermediate-risk pulmonary embolism.
N Engl J Med. 2014; 370: 1402-1411
[3]
]. As we previously demonstrated, the presence of a previous coronary artery disease
(CAD) is related to a higher cardiovascular (CV) mortality in the long-term period
[
[4]
]. Moreover, the coronary artery perfusion, which occurs during the diastolic phase,
could be seriously impaired in patients with acute PE [
[5]
]. For these reasons, the evaluation of diastolic blood pressure (DBP) seems to be
a further appealing prognostic tool for intermediate-high-risk PE patients. Aim of
the present study is to evaluate the prognostic role of diastolic blood pressure (DBP)
in intermediate-high PE patients as a potential predictor of 30-day and 1-year cardiovascular
mortality.Keywords
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References
- Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J. 2014; 35: 3033-3069
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N Engl J Med. 2014; 370: 1402-1411
- Venous thromboembolism: past, present and future.Thromb Haemost. 2017; 117: 1219-1229
- Short-term outcome of patients with history of significant coronary artery disease following acute pulmonary embolism.Eur J Intern Med. 2016; 34: e16-e17
- Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction.J Am Coll Cardiol. 2000; 36: 1632-1636
- Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.Arch Intern Med. 2010; 170: 1383-1389
- Blood pressure for outcome prediction and risk stratification in acute pulmonary embolism.Am J Emerg Med. 2015; 33: 1617-1621
Article info
Publication history
Published online: July 17, 2018
Accepted:
July 12,
2018
Received:
July 10,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
