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RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM

Year 2023, , 279 - 284, 31.08.2023
https://doi.org/10.24938/kutfd.1313498

Abstract

Objective:  Pulmonary embolism is a cardiopulmonary emergency commonly encountered in emergency departments with a high mortality rate. In cases of pulmonary embolism, the prompt and effortless implementation of echocardiography in the emergency department for the identification of right ventricular dysfunction, a significant predictor of mortality, is not always feasible. The aim of this study is to demonstrate the role of the readily available blood pressure index in determining right ventricular dysfunction and mortality in patients with pulmonary embolism.

Material and Methods: A total of 180 patients (90 females and 90 males) who were diagnosed with pulmonary embolism based on computed tomography pulmonary angiography in the emergency department between 2013 and 2019 and subsequently underwent echocardiography were included in the study. The blood pressure index was obtained by dividing the systolic blood pressure by the diastolic blood pressure.

Results: The average blood pressure index of the patients was calculated as 1.7±0.2. There was no statistically significant difference in terms of BPI between the two groups, one with right ventricular dysfunction and the other without right ventricular dysfunction, based on echocardiography (p=0.529). A total of 22.2% of the patients experienced 30-day mortality. There was no significant difference in terms of blood pressure index between the group with observed mortality and the group without observed mortality (p=0.438).

Conclusion: No significant relationship was identified between blood pressure index and right ventricular dysfunction or mortality in patients with pulmonary embolism. However, considering the ease of accessibility and applicability of blood pressure index in emergency departments, we believe it can be considered as a useful parameter. We anticipate that blood pressure index would yield more accurate results in determining right ventricular dysfunction and mortality, especially in patients with pulmonary embolism who have reduced systolic blood pressure.

Project Number

Yoktur.

References

  • George E, Kumamaru K, Ghosh N, Gonzalez Quesada C, Wake N, Bedayat A, et al. Computed  tomography and echocardiography in patients with acute pulmonary embolism part 2: Prognostic value. J Thorac Imaging. 2014;29(1):W7-12
  • Apfaltrer P, Henzler T, Meyer M, Roeger S, Haghi D, Gruettner J, et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. European Journal Radiology. 2012;81(10):2867-71.
  • Ferrari E, Baudouy M, Cerboni P, Tibi T, Gigner A, Leonetti J, et al. Clinical epidemiology of venous thrombo-embolic disease: Results of a French Multicentre Registry. European Heart Journanal. 1997;18(4):685-91.
  • Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. Guidelines on the diagnosis and management of acute pulmonary embolism. task force on pulmonary embolism, European Society of Cardiology. Europen Heart Journal. 2014;35(43):3033-73.
  • Arseven O, Ekim N, Müsellim B, Oğuzülgen I K, Okumuş N, Öngen G, et al. Consensus report on the diagnosis and treatment of pulmonary embolism. Turkish Thoracic Journal. 2015;16(1):44-8.
  • Ates H, Ates I, Kundi H, Arikan MF, Yilmaz FM. A novel clinical index for the assessment of RVD in acute pulmonary embolism: Blood pressure index. The American Journal of Emergency Medicine. 2017;35(10):1400-3.
  • Laporte S, Mismetti P, Décousus H, Ursendi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: Registry. Circulation. 2008;117(13):1711-6.
  • Aujesky D,  Jiménez, D, Mor MK, Geng M, Fine MJ Ibrahim SA. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation. 2009;119(7):962-8.
  • Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386-10.
  • Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101(24):2817-22.
  • Pollack CV,  Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011;57(6):700-6.
  • Erdem AB, Işık B. The Clinical Significance of d-Dimer/Troponin T ratio in patients with pulmonary thromboembolism. J Glob Health Nat Sci. 2021;4(1):58-64.
  • Wolde TM, Söhne M, Quak E, Mac Gillavry MR, Büller HR. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med. 2004;164(15):1685-9.
  • Kerkütlüoğlu M, Güneş H, Yücel O, Doğan Ö, Yılmaz MB. A new parameter for the determination of normal right ventricular function in patients with acute pulmonary embolism. J Surg Med. 2021;5(9):950-3.
  • Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation. 1996;93(12):2212-45.
  • Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: A systematic review and meta-analysis. Eur Heart J. 2019;40(11):902-10.

Pulmoner Emboli Hastalarında Kan Basıncı İndeksinin Sağ Ventrikül Disfonksiyonu ve Mortalite ile Olan İlişkisi

Year 2023, , 279 - 284, 31.08.2023
https://doi.org/10.24938/kutfd.1313498

Abstract

Amaç: Pulmoner emboli, acil servislerde sıkça karşılaşılan ve mortalitesi yüksek kardiyopulmoner bir acildir. Pulmoner emboli,  hastalarında mortaliteyi gösteren, sağ ventrikül disfonksiyonunun saptanmasında; Ekokardiyografinin (EKO) yapılması acil serviste her zaman hızlı ve kolay olmamaktadır. Bu çalışmadaki amaç; daha kolay elde edilebilen kan basıncı indeksinin, pulmoner emboli hastalarında sağ ventrikül disfonksiyonunun ve mortaliteyi belirlemedeki rolünü göstermektir.

Gereç ve Yöntemler: Çalışmaya 2013- 2019 tarihleri arasında acil serviste bilgisayarlı tomografi pulmoner anjiografi sonucunda pulmoner emboli tanısı alan ve sonrasında EKO’su yapılan 180 hasta (90 kadın ve 90 erkek) çalışmaya dahil edildi. Kan basıncı indeksini; sistolik kan basıncının diyastolik kan basıncına bölünmesi ile elde edildi.

Bulgular: Hastaların ortalama kan basıncı indeksini 1.7±0.2 olarak hesaplandı. EKO’da sağ ventrikül disfonksiyonu olan ve olmayan iki grup arasında kan basıncı indeksi yönünden istatistiksel olarak anlamlı farklılık saptanmadı (p=0.529). Hastaların %22.2’sinde 30 günlük mortalite gözlendi. Mortalite gözlenen ve gözlenmeyen grup arasında kan basıncı indeksi yönünden anlamlı fark yoktu (p=0.438).

Sonuç: Pulmoner embolide kan basıncı indeksi ile sağ ventrikül disfonksiyonu ve mortalite arasında anlamlı bir ilişki tespit edilmedi. Ancak kan basıncı indeksi acil servislerde kolay ulaşılabilen ve uygulanabilen bir yöntem olması nedeniyle kullanılabilir bir parametre olduğunu düşünmekteyiz. Kan basıncı indeksi; özellikle sistolik kan basıncını düşüren pulmoner emboli hastalarında sağ ventrikül disfonksiyonunu ve mortaliteyi belirlemede daha doğru sonuçlar ortaya koyacağını tahmin etmekteyiz.

Supporting Institution

Bu araştırmanın yapıldığı kurum dışında herhangi bir kurumdan destek alınmamıştır.

Project Number

Yoktur.

Thanks

Yazarlar dışında herhangi bir kişi veya kişlerden destek alınmamıştır.

References

  • George E, Kumamaru K, Ghosh N, Gonzalez Quesada C, Wake N, Bedayat A, et al. Computed  tomography and echocardiography in patients with acute pulmonary embolism part 2: Prognostic value. J Thorac Imaging. 2014;29(1):W7-12
  • Apfaltrer P, Henzler T, Meyer M, Roeger S, Haghi D, Gruettner J, et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. European Journal Radiology. 2012;81(10):2867-71.
  • Ferrari E, Baudouy M, Cerboni P, Tibi T, Gigner A, Leonetti J, et al. Clinical epidemiology of venous thrombo-embolic disease: Results of a French Multicentre Registry. European Heart Journanal. 1997;18(4):685-91.
  • Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. Guidelines on the diagnosis and management of acute pulmonary embolism. task force on pulmonary embolism, European Society of Cardiology. Europen Heart Journal. 2014;35(43):3033-73.
  • Arseven O, Ekim N, Müsellim B, Oğuzülgen I K, Okumuş N, Öngen G, et al. Consensus report on the diagnosis and treatment of pulmonary embolism. Turkish Thoracic Journal. 2015;16(1):44-8.
  • Ates H, Ates I, Kundi H, Arikan MF, Yilmaz FM. A novel clinical index for the assessment of RVD in acute pulmonary embolism: Blood pressure index. The American Journal of Emergency Medicine. 2017;35(10):1400-3.
  • Laporte S, Mismetti P, Décousus H, Ursendi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: Registry. Circulation. 2008;117(13):1711-6.
  • Aujesky D,  Jiménez, D, Mor MK, Geng M, Fine MJ Ibrahim SA. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation. 2009;119(7):962-8.
  • Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386-10.
  • Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101(24):2817-22.
  • Pollack CV,  Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011;57(6):700-6.
  • Erdem AB, Işık B. The Clinical Significance of d-Dimer/Troponin T ratio in patients with pulmonary thromboembolism. J Glob Health Nat Sci. 2021;4(1):58-64.
  • Wolde TM, Söhne M, Quak E, Mac Gillavry MR, Büller HR. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med. 2004;164(15):1685-9.
  • Kerkütlüoğlu M, Güneş H, Yücel O, Doğan Ö, Yılmaz MB. A new parameter for the determination of normal right ventricular function in patients with acute pulmonary embolism. J Surg Med. 2021;5(9):950-3.
  • Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation. 1996;93(12):2212-45.
  • Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: A systematic review and meta-analysis. Eur Heart J. 2019;40(11):902-10.
There are 16 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Özgün Araştırma
Authors

Bahattin Işık 0000-0003-2139-9113

Emine Sarcan 0000-0002-5789-9622

Eren Usul 0000-0003-3980-6768

Project Number Yoktur.
Publication Date August 31, 2023
Submission Date June 12, 2023
Published in Issue Year 2023

Cite

APA Işık, B., Sarcan, E., & Usul, E. (2023). RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM. The Journal of Kırıkkale University Faculty of Medicine, 25(2), 279-284. https://doi.org/10.24938/kutfd.1313498
AMA Işık B, Sarcan E, Usul E. RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM. Kırıkkale Üni Tıp Derg. August 2023;25(2):279-284. doi:10.24938/kutfd.1313498
Chicago Işık, Bahattin, Emine Sarcan, and Eren Usul. “RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM”. The Journal of Kırıkkale University Faculty of Medicine 25, no. 2 (August 2023): 279-84. https://doi.org/10.24938/kutfd.1313498.
EndNote Işık B, Sarcan E, Usul E (August 1, 2023) RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM. The Journal of Kırıkkale University Faculty of Medicine 25 2 279–284.
IEEE B. Işık, E. Sarcan, and E. Usul, “RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM”, Kırıkkale Üni Tıp Derg, vol. 25, no. 2, pp. 279–284, 2023, doi: 10.24938/kutfd.1313498.
ISNAD Işık, Bahattin et al. “RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM”. The Journal of Kırıkkale University Faculty of Medicine 25/2 (August 2023), 279-284. https://doi.org/10.24938/kutfd.1313498.
JAMA Işık B, Sarcan E, Usul E. RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM. Kırıkkale Üni Tıp Derg. 2023;25:279–284.
MLA Işık, Bahattin et al. “RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM”. The Journal of Kırıkkale University Faculty of Medicine, vol. 25, no. 2, 2023, pp. 279-84, doi:10.24938/kutfd.1313498.
Vancouver Işık B, Sarcan E, Usul E. RELATIONSHIP BETWEEN BLOOD PRESSURE INDEX AND RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM. Kırıkkale Üni Tıp Derg. 2023;25(2):279-84.

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