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Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study

BACKGROUND: We aimed to determine the clinical, echocardiographic and hemodynamic correlates of syncope as a presenting symptom in pulmonary embolism and its impact on in-hospital and long-term outcomes. METHODS: Between July 2012 and October 2019, a total of 641 patients with PE (277 males, 364 fem...

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Autores principales: Keskin, Berhan, Tokgöz, Hacer Ceren, Akbal, Özgür Yaşar, Hakgör, Aykun, Karagöz, Ali, Kültürsay, Barkın, Tanyeri, Seda, Külahçıoğlu, Seyhmuş, Halil Tanboğa, İbrahim, Özdemir, Nihal, Kaymaz, Cihangir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bayçınar Medical Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580286/
https://www.ncbi.nlm.nih.gov/pubmed/36303697
http://dx.doi.org/10.5606/tgkdc.dergisi.2022.22798
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author Keskin, Berhan
Tokgöz, Hacer Ceren
Akbal, Özgür Yaşar
Hakgör, Aykun
Karagöz, Ali
Kültürsay, Barkın
Tanyeri, Seda
Külahçıoğlu, Seyhmuş
Halil Tanboğa, İbrahim
Özdemir, Nihal
Kaymaz, Cihangir
author_facet Keskin, Berhan
Tokgöz, Hacer Ceren
Akbal, Özgür Yaşar
Hakgör, Aykun
Karagöz, Ali
Kültürsay, Barkın
Tanyeri, Seda
Külahçıoğlu, Seyhmuş
Halil Tanboğa, İbrahim
Özdemir, Nihal
Kaymaz, Cihangir
author_sort Keskin, Berhan
collection PubMed
description BACKGROUND: We aimed to determine the clinical, echocardiographic and hemodynamic correlates of syncope as a presenting symptom in pulmonary embolism and its impact on in-hospital and long-term outcomes. METHODS: Between July 2012 and October 2019, a total of 641 patients with PE (277 males, 364 females; median age: 65 years; range, 51 to 74 years) in whom the diagnostic work-up and risk-based management were performed according to the current pulmonary embolism guidelines were retrospectively analyzed. Clinical, laboratory and imaging data of the patients were obtained from hospital database system. RESULTS: Syncope was noted in 193 (30.2%) of patients on admission, and was associated with a significantly higher-risk status manifested by elevated troponin and D-dimer levels, a higher Pulmonary Embolism Severity Index scores, deterioration of right-to-left ventricular diameter ratio, right ventricular longitudinal contraction measures, the higher Qanadli score, and higher rates of thrombolytic therapies (p<0.001) and rheolytic-thrombectomy (p=0.037) therapies. In-hospital mortality (p=0.007) and minor bleeding (p<0.001) were significantly higher in syncope subgroup. Multivariate logistic regression analysis showed that higher Pulmonary Embolism Severity Index scores and right-to-left ventricular diameter ratio were independently associated with syncope, while aging and increased heart rate predicted in-hospital mortality. Malignancy and right-to-left ventricular diameter ratio at discharge, but not syncope, were independent predictors of cumulative mortality during follow-up. CONCLUSION: Syncope as the presenting symptom is associated with a higher risk due to more severe obstructive pressure load and right ventricular dysfunction requiring more proactive strategies in patients with pulmonary embolism. However, with appropriate risk-based therapies, neither in-hospital mortality nor long-term mortality can be predicted by syncope.
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spelling pubmed-95802862022-10-26 Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study Keskin, Berhan Tokgöz, Hacer Ceren Akbal, Özgür Yaşar Hakgör, Aykun Karagöz, Ali Kültürsay, Barkın Tanyeri, Seda Külahçıoğlu, Seyhmuş Halil Tanboğa, İbrahim Özdemir, Nihal Kaymaz, Cihangir Turk Gogus Kalp Damar Cerrahisi Derg Original Article BACKGROUND: We aimed to determine the clinical, echocardiographic and hemodynamic correlates of syncope as a presenting symptom in pulmonary embolism and its impact on in-hospital and long-term outcomes. METHODS: Between July 2012 and October 2019, a total of 641 patients with PE (277 males, 364 females; median age: 65 years; range, 51 to 74 years) in whom the diagnostic work-up and risk-based management were performed according to the current pulmonary embolism guidelines were retrospectively analyzed. Clinical, laboratory and imaging data of the patients were obtained from hospital database system. RESULTS: Syncope was noted in 193 (30.2%) of patients on admission, and was associated with a significantly higher-risk status manifested by elevated troponin and D-dimer levels, a higher Pulmonary Embolism Severity Index scores, deterioration of right-to-left ventricular diameter ratio, right ventricular longitudinal contraction measures, the higher Qanadli score, and higher rates of thrombolytic therapies (p<0.001) and rheolytic-thrombectomy (p=0.037) therapies. In-hospital mortality (p=0.007) and minor bleeding (p<0.001) were significantly higher in syncope subgroup. Multivariate logistic regression analysis showed that higher Pulmonary Embolism Severity Index scores and right-to-left ventricular diameter ratio were independently associated with syncope, while aging and increased heart rate predicted in-hospital mortality. Malignancy and right-to-left ventricular diameter ratio at discharge, but not syncope, were independent predictors of cumulative mortality during follow-up. CONCLUSION: Syncope as the presenting symptom is associated with a higher risk due to more severe obstructive pressure load and right ventricular dysfunction requiring more proactive strategies in patients with pulmonary embolism. However, with appropriate risk-based therapies, neither in-hospital mortality nor long-term mortality can be predicted by syncope. Bayçınar Medical Publishing 2022-07-29 /pmc/articles/PMC9580286/ /pubmed/36303697 http://dx.doi.org/10.5606/tgkdc.dergisi.2022.22798 Text en Copyright © 2022, Turkish Society of Cardiovascular Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Article
Keskin, Berhan
Tokgöz, Hacer Ceren
Akbal, Özgür Yaşar
Hakgör, Aykun
Karagöz, Ali
Kültürsay, Barkın
Tanyeri, Seda
Külahçıoğlu, Seyhmuş
Halil Tanboğa, İbrahim
Özdemir, Nihal
Kaymaz, Cihangir
Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
title Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
title_full Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
title_fullStr Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
title_full_unstemmed Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
title_short Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
title_sort clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: a single-center study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580286/
https://www.ncbi.nlm.nih.gov/pubmed/36303697
http://dx.doi.org/10.5606/tgkdc.dergisi.2022.22798
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