Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

Abstract

Aims This study aimed to investigate whether the risk of short-term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). Methods and results Predictive value of HFrEF or HFpEF for 7-day (intrahospital) and 30-day all-cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline-proposed criteria. A 7-day (intrahospital) and 30-day all-cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7-day mortality (hazard ratio 2.22, 95% confidence interval 1.25-4,38.41, P = 0.021) and neither HFrEF or HFpEF was an independent predictor for 30-day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P = 0.01), and right ventricle systolic pressure (P = 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days. Conclusions Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

“…In the bivariate analysis in our study, we observed higher mortality in the HF group (HR 2.70; 95% CI 1.58–4.63), but this difference was not present in the multivariate analysis, suggesting that other comorbidities may contribute to the observed mortality risk. It is described in the literature [ 9 , 18 , 19 , 24 , 25 , 26 ] that patients with chronic heart failure who present with acute PE are often older and more frequently have other comorbidities such as chronic obstructive pulmonary disease (COPD), anemia, or ischemic heart disease, which we also observed in our study. However, patients with HF have poorer pulmonary and cardiac reserve, resulting in lower tolerance to the acute PE episode and an inability to cope with its hemodynamic and ventilatory demands, potentially exacerbating outcomes in this population [ 18 , 19 , 24 , 26 ].…”

“…In exploring prognostic differences among patients with HF, increasing attention has been given to LVEF as a distinguishing factor, and several studies suggest considering patients with reduced LVEF as a subgroup with a worse prognosis [ 21 , 41 ]. In the context of PE, some authors claim that reduced LVEF has independent predictive value for in-hospital mortality, which is not the case for patients with preserved LVEF [ 9 , 25 , 42 ]. Additionally, reduced myocardial contractility and the use of beta-blockers in patients with reduced LVEF can worsen their inotropic and chronotropic responses to PE.…”

“…Previous studies have reported that HF is an independent risk factor for the development of VTE [ 5 , 6 ], largely due to the prothrombotic state observed in these patients [ 7 , 8 ]. It is estimated that chronic HF may be present in the medical history of up to 10–20% of patients who develop a thrombotic event [ 9 ]. Furthermore, various studies have demonstrated that a thrombotic event during a hospitalization for acute HF is associated with increased morbidity, mortality, and risk of readmission [ 10 , 11 , 12 ].…”

The predictive value of systemic immune inflammation index on long-term outcomes among acute pulmonary embolism patients

“…Since echocardiography is a subjective evaluation, it has been shown that RV diameters and RV/LV ratios measured by computed tomography are determinants in terms of mortality (28). Both the incidence of APE and the frequency of mortality increase significantly in heart failure patients with low LVEF (29,30).…”

Corrigendum

“…In the paper by Obradovic et al ., 1 the first name and surname of the authors have been interchanged.…”