title: Pulmonary embolism in patients with chronic obstructive pulmonary disease or congestive heart failure.
abstract: BACKGROUND
  The diagnosis of pulmonary embolism (PE) is often unreliable in patients with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF).
  
  
  METHODS
  Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, the clinical characteristics, laboratory findings, and clinical outcomes of all enrolled patients with acute PE, with or without underlying cardiopulmonary diseases, were compared and contrasted. In addition, the performance of 2 clinical models for the diagnosis of PE was retrospectively evaluated.
  
  
  RESULTS
  As of January 2005, 4444 patients with symptomatic PE have been enrolled in RIETE. Of those, 632 patients (14%) had COPD and 422 (9.5%) had CHF. Significant differences were found in clinical presentation and 3-month outcomes among the 3 groups. With the Geneva model, there was a lower percentage of PE patients with COPD (relative risk [RR] 0.82; 95% confidence interval [CI], 0.66-1.02) or CHF (RR 0.73; 95% CI, 0.56-0.95) who fell into the low pretest probability category, compared with patients with neither. Besides, the percentage of patients with high probability of PE was similar among the 3 patient groups. The frequency of COPD (61%) and CHF (72%) patients with a high pretest probability for PE increased when using the Pisa score, but the percentage of COPD patients into the high probability group was lower (RR 0.60; 95% CI, 0.51-0.71).
  
  
  CONCLUSIONS
  Significant differences exist in PE patients with and without underlying cardiopulmonary diseases. The performance of the 2 clinical prediction models varied according to the presence or absence of underlying COPD or CHF.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. mmonreal.germanstrias@gencat.net
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
authors.forename: Juan Francisco Sanchez
authors.initials: JF
authors.lastname: Muñoz-Torrero
authors.forename: Virjanand S
authors.initials: VS
authors.lastname: Naraine
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.forename: Silvia
authors.initials: S
authors.lastname: Soler
authors.forename: Ramón
authors.initials: R
authors.lastname: Rabuñal
authors.forename: Pedro
authors.initials: P
authors.lastname: Gallego
mesh_terms: D003937:Diagnosis, Differential; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology*