Abstract Number: PB2291
Meeting: ISTH 2020 Congress
Background: Computed Tomography Pulmonary Angiography (CTPA) provides an assessment of thrombus burden (ThB) in acute pulmonary embolism (PE). The Simplified Pulmonary Embolism Severity Index (sPESI) is used to predict mortality in PE. It is unclear if the presence of high- ThB correlates with in-hospital mortality (IHM) or right ventricular (RV) dysfunction in patients with low-risk sPESI scores.
Aims: Determine the correlation between the presence of high-ThB and IHM or RV dysfunction in patients with PE and low-risk sPESI score.
Methods: Single-center observational cohort registry performed at a University Hospital. Patients hospitalized with a diagnosis of PE between 2008-2018 were eligible. Images from CTPA were reviewed and ThB was quantified using the modified Miller score (MMS). Two groups were formed (High-ThB ≥ 23 points vs Low-ThB < 23 points). RV dysfunction was determined by echocardiography and defined as RV dilatation and concomitant reduced tricuspid annular plane systolic excursion or RV wall motion abnormalities. Information was collected related to clinical presentation, troponin levels and electrocardiographic (ECG) pattern. All statistical analysis was carried out using the STATA version 13.1
Results: 230 consecutive patients were hospitalized with a diagnosis of PE. 53 patients with low sPESI score were included. Mean age 53±14 years; 49% female. High-ThB was present in16 patients (30,1%). IHM was 6.5%. Univariate analysis showed that High-TB correlated with chest pain (31.2 vs 5.4%; p:0.01), negative T waves in ECG V1-V4 leads (31.2 vs 5.4%; p:0.01), RV dysfunction (37,5 vs 8,1%; p:0.001) and RV wall motion abnormalities (18,7 vs 2,7%; p:0.04). Multivariate analysis showed that High-ThB correlated with RV dysfunction (OR 8.4; CI 95% 15-47.3; p:0.01). No deaths were observed in low sPESI score patients.
Conclusions: In this cohort of patients with low-risk sPESI score, High-ThB correlated with RV dysfunction but not IHM. Quantification of ThB may be useful for PE risk stratification.
|Variable||Low thrombus burden (n:37)||High thrombus burden (n:16)||p value|
|Women||18 (48.6%)||8 (50%)||ns|
|EKG negative T waves (V1-V4)||2 (5.4%)||5 (31.2%)||0.01|
|Elevated troponin levels||6 (16.2%)||5 (31.2%)||ns|
|RV wall motion abnormalities||1 (2.7%)||3 (18.7%)||0.04|
|RV dilatation||3 (8.1%)||6 (37.5%)||0.001|
|MULTIVARIATE analysis||Odds ratio||CI 95%||p value|
[High vs Low thrombus burden. Univariate and Multivariate analysis]
To cite this abstract in AMA style:Bonorino J, Bilbao J, Fernandez H, Ferrario C, Melchiori R, Torres N, Iwanowski M, Alarcon P, Santucci J, Aris Cancela ME, Ortis E, Krause S, Della Cella R, Perez Caceres N, Sanchez A, Rubio P, Marquez S, Martinez Martinez J, Baratta S, Hita A. High Thrombus Burden and its Correlation with In-hospital Mortality or Right Ventricular Dysfunction in Patients with Acute Pulmonary Embolism and Low-risk Simplified-PESI Score [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/high-thrombus-burden-and-its-correlation-with-in-hospital-mortality-or-right-ventricular-dysfunction-in-patients-with-acute-pulmonary-embolism-and-low-risk-simplified-pesi-score/. Accessed November 30, 2021.
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