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Short- and long-term prognostic role of diastolic blood pressure in intermediate-high risk patients with acute pulmonary embolism

      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 [
      • 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.
      ]. 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 [
      • 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.
      ]. These subjects are characterized by the contemporary presence of right ventricular dysfunction (RVD) and positive markers of myocardial injury [
      • Schulman S.
      • Ageno W.
      • Konstantinides S.V.
      Venous thromboembolism: past, present and future.
      ]. 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 [
      • Zuin M.
      • Rigatelli G.
      • Faggian G.
      • Zonzin P.
      • Roncon L.
      Short-term outcome of patients with history of significant coronary artery disease following acute pulmonary embolism.
      ]. Moreover, the coronary artery perfusion, which occurs during the diastolic phase, could be seriously impaired in patients with acute PE [
      • Meyer T.
      • Binder L.
      • Hruska N.
      • Luthe H.
      • Buchwald A.B.
      Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction.
      ]. 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.

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