title: The risk factor age in normotensive patients with pulmonary embolism: Effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients.
abstract: BACKGROUND
  Right ventricular dysfunction (RVD), submassive pulmonary embolism (PE), elevated systolic pulmonary artery pressure (sPAP), elevated cardiac troponin I (cTnI) and old age are well-known risk factors for poor outcome in acute normotensive PE. The aim of this analysis was to calculate age cut-off values to predict submassive PE, cardiac injury, RVD and elevated sPAP in normotensive PE patients.
  
  
  METHODS
  Retrospective analysis of clinical, laboratory, radiological and echocardiographic data of normotensive PE patients (2006-2011) was performed. Receiver operating characteristic (ROC) curves and Youden indexes were used to test the effectiveness of using patients' ages at the PE event to predict a submassive PE, cardiac injury (elevated cTnI >0.1ng/ml), RVD and elevated sPAP (>30mmHg) in normotensive PE patients and to calculate optimal cut-off values. Patients >76years were compared to those aged ≤76years.
  
  
  RESULTS
  129 normotensive PE patients (59.7% women) met the inclusion criteria and were included in this analysis. The optimal cut-off value for patient ages to predict submassive PE, cardiac injury (elevated cTnI >0.1ng/ml), RVD and elevated sPAP (>30mmHg) was 76.5, 81.5, 66.5 and 66.5years, respectively, with moderate effectiveness (AUC 0.69, 0.58, 0.71 and 0.69, respectively). Patients >76years old had higher percentages of submassive PE (91.1% vs. 63.1%, P=0.000680), RVD (91.1% vs. 58.3%, P=0.000119), sPAP (42.64±16.70 vs. 29.24±17.56mmHg, P=0.000044) and cTnI (0.22±0.40 vs. 0.10±0.25ng/ml, P=0.00488).
  
  
  CONCLUSIONS
  Age is an important prognostic factor in acute normotensive PE. In addition to cTn and RVD, age should be taken into account in determining the risk stratification for acute PE.
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Germany; Centrum for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de.
authors.forename: Karsten
authors.initials: K
authors.lastname: Keller
authors.affiliation: Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Beule
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Germany; Centrum for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Coldewey
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Geyer
authors.affiliation: Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM), Germany; Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main, Germany.
authors.forename: Jörn Oliver
authors.initials: JO
authors.lastname: Balzer
authors.affiliation: Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dippold
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D004452:Echocardiography / Q000379:methods; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology*
chemical_list: D019210:Troponin I
keywords: Age; Ageing; Cardiac troponin; Pulmonary embolism; Right ventricular dysfunction; Thrombosis