title: Long-term prognostic value of residual pulmonary vascular obstruction at discharge in patients with intermediate- to high-risk pulmonary embolism.
abstract: BACKGROUND
  We evaluated prognostic value at 6 months of residual pulmonary vascular obstruction (RPVO) measured before discharge in patients with intermediate- or high-risk pulmonary embolism (PE).
  
  
  RESULTS
  Prospective registry including 416 consecutive patients with intermediate- or high-risk PE who survived the acute phase. Patients with previous cardiopulmonary disease were excluded. Perfusion lung scans were performed within 6-8 days after the onset of treatment. Residual pulmonary vascular obstruction was graded as the proportion of the lung not perfused. Primary objective was a combined endpoint at 6 months, including death, recurrent PE, and appearance of signs of heart failure. At 6 months, 32 patients (7.7%) had at least one adverse event: 12 deaths (2.9%), 12 recurrent PE (2.9%), and 14 (3.4%) heart failure. Independent predictors of combined endpoint were: cancer [odds ratio (OR) 3.07 (1.22-7.85)]; renal insufficiency at admission [OR: 2.53 (1.17-5.8)]; persistent signs of right ventricular dysfunction at 48 h echography [OR: 3.99 (1.36-11.3)]. The severity of RPVO at discharge was significantly associated with an unfavourable outcome [OR: 2.66 (1.58-3.93)]. The incremental prognostic value of RPVO information was confirmed by significantly improved goodness-of-fit. Threshold RPVO for predicting adverse events was estimated at 35% [area under the curve = 0.76 (0.73-0.82)]. Patients with RPVO greater than threshold at discharge had a significantly higher risk of death at 6 months (P = 0.01).
  
  
  CONCLUSIONS
  Residual pulmonary vascular obstruction evaluated before hospital discharge in patients with intermediate- to high-risk PE is a powerful prognostic factor for a 6-month outcome. RPVO ≥35% is associated with an increased risk of adverse events at 6 months.
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon 25000, France. nicolas.meneveau@univ-fcomte.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.forename: Omar
authors.initials: O
authors.lastname: Ider
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Seronde
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.forename: Siamak
authors.initials: S
authors.lastname: Davani
authors.forename: Yvette
authors.initials: Y
authors.lastname: Bernard
authors.forename: François
authors.initials: F
authors.lastname: Schiele
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D009369:Neoplasms / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000401:mortality* / Q000517:prevention & control; D012008:Recurrence; D051437:Renal Insufficiency / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods; D054556:Venous Thromboembolism / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000401:mortality
chemical_list: D000925:Anticoagulants; D006493:Heparin