Fragmented QRS Complex Predicts In-Hospital Adverse Events and Long-Term Mortality in Patients with Acute Pulmonary Embolism

AbstractPrevious studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan–Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.

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Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism

10.5152/anatoljcardiol.2021.99345 ◽

2021 ◽

Vol 25 (8) ◽

pp. 544-554

Author(s):

Abdulsamet Sandal ◽

◽

Elif Tugce Korkmaz ◽

Funda Aksu ◽

Deniz Koksal ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Severity Index ◽

Long Term Mortality

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Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-017-1540-y ◽

2017 ◽

Vol 44 (3) ◽

pp. 316-323 ◽

Cited By ~ 9

Author(s):

Hernan Polo Friz ◽

Valeria Corno ◽

Annalisa Orenti ◽

Chiara Buzzini ◽

Chiara Crivellari ◽

...

Keyword(s):

Pulmonary Embolism ◽

Elderly Patients ◽

Acute Pulmonary Embolism ◽

Short And Long Term ◽

Long Term Mortality

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Comparing the effect of cardiac biomarkers on the outcome of normotensive patients with acute pulmonary embolism

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2017.767 ◽

2017 ◽

Vol 87 (1) ◽

Author(s):

Yaser Jenab ◽

Marzieh Pourjafari ◽

Maryam Sotoudeh ◽

Masoumeh Lotfi-tokaldany ◽

Nasrin Etesamifard ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Adverse Outcome ◽

Mean Value ◽

Cardiac Biomarkers ◽

Short Term ◽

Fatty Acid Binding ◽

The Mean ◽

Long Term Mortality

Acute pulmonary embolism (PE) is a cardiovascular challenge with potentially fatal consequences. This study was designed to observe the association of novel cardiac biomarkers with outcome in this setting. In this prospective study, from 86 patients with a confirmed diagnosis of PE, 59 patients met the inclusion criteria (22 men, 37 women; mean age, 63.36±15.04 y).The plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), tenascin-C, and D-dimer were measured at the time of confirmed diagnosis. The endpoints of the study were defined as the short-term adverse outcome and long-term all-cause mortality. Totally, 11.8% (7/59) of the patients had the short-term adverse outcome. The mean value of logNT-proBNP was 6.40±1.66 pg/ml. Among all the examined biomarkers, only the mean value of logNT-proBNP was significantly higher in the patients with the short-term adverse outcome (7.88±0.67 vs. 6.22± 1.66 pg/ml; OR, 2.359; 95% CI, 1.037 to 5.367; P=0.041). After adjustment, a threefold increase in the short-term adverse outcome was identified (OR, 3.239; 95% CI, 0.877 to 11.967; P=0.078).Overall, 18.64% (11/59) of the patients had expired by the long-term follow-up. Moreover, adjustment revealed an evidence regarding association between increased logNT-proBNP levels and long-term mortality (HR, 2.163; 95%CI, 0.910 to 5.142; P=0.081). Our study could find evidences on association between increased level of NT-proBNP and short-term adverse outcome and/or long-term mortality in PE. This biomarker may be capable of improving prediction of outcome and clinical care in non-high-risk PE.

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PREDICTORS OF IN-HOSPITAL AND LONG TERM MORTALITY IN PATIENTS WITH ACUTE PULMONARY EMBOLISM

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)62119-6 ◽

2012 ◽

Vol 59 (13) ◽

pp. E2118 ◽

Cited By ~ 1

Author(s):

Ozlem Yildirimturk ◽

Zekeriya Nurkalem ◽

Kazim Serhan Özcan ◽

Servet Altay ◽

Seçkin Satilmis ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Long Term Mortality

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Is there Any Relationship Between Long-Term Mortality of Acute Pulmonary Embolism and Complete Blood Count Analysis?

Acibadem Universitesi Saglik Bilimleri Dergisi ◽

10.31067/acusaglik.832714 ◽

2020 ◽

Vol 12 (1) ◽

pp. 44-49

Author(s):

Fatma TOKGÖZ AKYIL ◽

Gökhan SÖĞÜT ◽

Murat Erdal OZANTÜRK ◽

Ahmet TOPBAŞ ◽

Hasan TÜTÜNCÜLER ◽

...

Keyword(s):

Pulmonary Embolism ◽

Blood Count ◽

Acute Pulmonary Embolism ◽

Complete Blood Count ◽

Long Term Mortality

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Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Medical Principles and Practice ◽

10.1159/000497436 ◽

2019 ◽

Vol 28 (3) ◽

pp. 264-272 ◽

Cited By ~ 2

Author(s):

Valdis Ģībietis ◽

Dana Kigitoviča ◽

Barbara Vītola ◽

Sintija Strautmane ◽

Andris Skride

Keyword(s):

Pulmonary Embolism ◽

Glomerular Filtration Rate ◽

Filtration Rate ◽

Acute Pulmonary Embolism ◽

All Cause Mortality ◽

Acute Pe ◽

D Dimer ◽

Active Cancer ◽

Long Term Mortality

Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

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