title: Right ventricular dysfunction and pulmonary hypertension following sub-massive pulmonary embolism.
abstract: OBJECTIVE
  Persistent right ventricular dysfunction (RVD) and pulmonary hypertension (PHT) are important outcomes following sub-massive pulmonary embolism (PE). The aims were to determine the rates and factors associated with RVD and/or PHT on echocardiography (ECHO) and the rate of 30-day and 1-year all-cause mortality following sub-massive PE. Patients who received thrombolysis and non-thrombolysis were also compared.
  
  
  METHODS
  Consecutive patients with sub-massive PE over a five year period with at least 1-year follow-up were retrospectively identified. Regression analysis was performed to identify predictors of outcomes.
  
  
  RESULTS
  Eighty-seven patients met inclusion criteria. Sixty-one (70%) had admission ECHOs with a follow-up ECHO in 42 (48.3%) at a mean of 7.6 months (SD 5.2). Fifty-one had RVD (58.6%) and 35 (40.2%) had PHT on admission. The rates of persistent RVD and raised right ventricular systolic pressure in this study population were 12% and 17%, respectively. Thrombolysis was associated with a trend towards improvement of PHT (53.3% PHT on admission to 0% PHT on follow-up in the thrombolysis group, P = 0.29). The rate of 30-day and 1-year all-cause mortality were 12.6% and 21.8%, respectively. Thirty-day all-cause mortality was independently predicted by the presence of right heart strain on computed tomography pulmonary angiography [OR 3.7 (P = 0.045)], echocardiographic evidence of RVD [OR 3.9 (P = 0.041)] and age.
  
  
  CONCLUSIONS
  The majority of patients with RVD and PHT at the time of sub-massive PE improve on follow-up; however, there is a subset who remain abnormal. Future studies are needed to identify modifiable risk factors for these complications.
authors.affiliation: Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Chinthaka B
authors.initials: CB
authors.lastname: Samaranayake
authors.affiliation: Department of Haematology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Gordon
authors.initials: G
authors.lastname: Royle
authors.affiliation: Department of Haematology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Sharon
authors.initials: S
authors.lastname: Jackson
authors.affiliation: Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Elaine
authors.initials: E
authors.lastname: Yap
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology
keywords: pulmonary hypertension; right ventricular dysfunction; sub-massive pulmonary embolism; thrombolysis