title: Prognostic implications of diastolic dysfunction in patients with acute pulmonary embolism.
abstract: BACKGROUND
  A history of congestive heart failure has been used to determine the prognosis in patients with acute pulmonary embolism. Diastolic dysfunction is responsible for the half of congestive heart failure but has not been understood well.
  
  
  METHODS
  A total of 205 patients were reported admitted with acute pulmonary embolism from January 2009 to July 2011. We excluded hemodynamically unstable patients who received thrombolytics or underwent thromboembolectomy. We included hemodynamically stable patients who underwent echocardiogram within 72 hours of diagnosis. We reviewed medical records of 107 patients to investigate whether diastolic dysfunction increases in-hospital mortality or adverse clinical outcomes.
  
  
  RESULTS
  Out of 107 patients, 10 patients died during hospitalization with in-hospital mortality rate of 9.3%. Among 84 patients without diastolic dysfunction as assessed by echocardiogram, six patients died with in-hospital mortality rate of 7.1%. Meanwhile, among 23 patients with diastolic dysfunction, four patients died with in-hospital mortality rate of 17.4%. The multivariable adjusted odds ratio was calculated as 2.71, with 95% confidence interval of 0.59 - 12.44.
  
  
  CONCLUSIONS
  For hemodynamically stable patients with acute pulmonary embolism, diastolic dysfunction as assessed by echocardiogram could increase in-hospital mortality 2.71 fold, although this was not statistically significant. Further study with a large patient population is needed to determine the statistically significant implications of diastolic dysfunction in patients with acute pulmonary embolism.
authors.affiliation: Department of Hospital Medicine, Cleveland Clinic, 9500 Euclid Avenue, M2-Annex, Cleveland, OH 44195, USA. choj2@ccf.org.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Cho
authors.forename: Roop
authors.initials: R
authors.lastname: Kaw
authors.forename: Jatin
authors.initials: J
authors.lastname: Chhabra
authors.forename: Snigdha
authors.initials: S
authors.lastname: Kola
authors.forename: Indrajeet
authors.initials: I
authors.lastname: Mahata
authors.forename: Shobha
authors.initials: S
authors.lastname: Shahani
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Kocheril
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003971:Diastole; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000401:mortality / Q000503:physiopathology*