Prognostic value of right atrial dilation in patients with pulmonary embolism
Aims Right atrial (RA) dilation and stretch provide prognostic information in patients with cardiovascular diseases. We investigated the prevalence, confounding factors and prognostic relevance of RA dilation in patients with pulmonary embolism (PE). Methods Overall, 609 PE patients were consecutive...
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2021-05-01
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doaj-e1ff5bc01b7e4251937d4668f61ef7a22021-07-05T08:43:41ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-05-017210.1183/23120541.00414-202000414-2020Prognostic value of right atrial dilation in patients with pulmonary embolismMarkus H. Lerchbaumer0Matthias Ebner1Christian O. Ritter2Laura Steimke3Nina I.J. Rogge4Carmen Sentler5Aaron Thielmann6Lukas Hobohm7Karsten Keller8Joachim Lotz9Gerd Hasenfuß10Rolf Wachter11Bernd Hamm12Stavros V. Konstantinides13Galit Aviram14Mareike Lankeit15 Dept of Radiology, Charité – University Medicine Berlin, Berlin, Germany Dept of Nephrology and Medical Intensive Care, Charité – University Medicine Berlin, Berlin, Germany Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany Dept of Radiology, Charité – University Medicine Berlin, Berlin, Germany Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany Dept of Radiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Dept of Internal Medicine and Cardiology, Charité – University Medicine Berlin, Berlin, Germany Aims Right atrial (RA) dilation and stretch provide prognostic information in patients with cardiovascular diseases. We investigated the prevalence, confounding factors and prognostic relevance of RA dilation in patients with pulmonary embolism (PE). Methods Overall, 609 PE patients were consecutively included in a prospective single-centre registry between September 2008 and August 2017. Volumetric measurements of heart chambers were performed on routine non-electrocardiographic-gated computed tomography and plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) measured on admission. An in-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration. Results Patients with an adverse outcome (11.2%) had larger RA volumes (median 120 (interquartile range 84–152) versus 102 (78–134) mL; p=0.013), RA/left atrial (LA) volume ratios (1.7 (1.2–2.4) versus 1.3 (1.1–1.7); p<0.001) and MR-proANP levels (282 (157–481) versus 129 (64–238) pmol·L−1; p<0.001) compared to patients with a favourable outcome. Overall, 499 patients (81.9%) had a RA/LA volume ratio ≥1.0 and a calculated cut-off value of 1.8 (area under the curve 0.64, 95% CI 0.56–0.71) predicted an adverse outcome, both in unselected (OR 3.1, 95% CI 1.9–5.2) and normotensive patients (OR 2.7, 95% CI 1.3–5.6). MR-proANP ≥120 pmol·L−1 was identified as an independent predictor of an adverse outcome, both in unselected (OR 4.6, 95% CI 2.3–9.3) and normotensive patients (OR 5.1, 95% CI 1.5–17.6). Conclusions RA dilation is a frequent finding in patients with PE. However, the prognostic performance of RA dilation appears inferior compared to established risk stratification markers. MR-proANP predicted an in-hospital adverse outcome, both in unselected and normotensive PE patients, integrating different prognostic relevant information from comorbidities.http://openres.ersjournals.com/content/7/2/00414-2020.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Markus H. Lerchbaumer Matthias Ebner Christian O. Ritter Laura Steimke Nina I.J. Rogge Carmen Sentler Aaron Thielmann Lukas Hobohm Karsten Keller Joachim Lotz Gerd Hasenfuß Rolf Wachter Bernd Hamm Stavros V. Konstantinides Galit Aviram Mareike Lankeit |
spellingShingle |
Markus H. Lerchbaumer Matthias Ebner Christian O. Ritter Laura Steimke Nina I.J. Rogge Carmen Sentler Aaron Thielmann Lukas Hobohm Karsten Keller Joachim Lotz Gerd Hasenfuß Rolf Wachter Bernd Hamm Stavros V. Konstantinides Galit Aviram Mareike Lankeit Prognostic value of right atrial dilation in patients with pulmonary embolism ERJ Open Research |
author_facet |
Markus H. Lerchbaumer Matthias Ebner Christian O. Ritter Laura Steimke Nina I.J. Rogge Carmen Sentler Aaron Thielmann Lukas Hobohm Karsten Keller Joachim Lotz Gerd Hasenfuß Rolf Wachter Bernd Hamm Stavros V. Konstantinides Galit Aviram Mareike Lankeit |
author_sort |
Markus H. Lerchbaumer |
title |
Prognostic value of right atrial dilation in patients with pulmonary embolism |
title_short |
Prognostic value of right atrial dilation in patients with pulmonary embolism |
title_full |
Prognostic value of right atrial dilation in patients with pulmonary embolism |
title_fullStr |
Prognostic value of right atrial dilation in patients with pulmonary embolism |
title_full_unstemmed |
Prognostic value of right atrial dilation in patients with pulmonary embolism |
title_sort |
prognostic value of right atrial dilation in patients with pulmonary embolism |
publisher |
European Respiratory Society |
series |
ERJ Open Research |
issn |
2312-0541 |
publishDate |
2021-05-01 |
description |
Aims
Right atrial (RA) dilation and stretch provide prognostic information in patients with cardiovascular diseases. We investigated the prevalence, confounding factors and prognostic relevance of RA dilation in patients with pulmonary embolism (PE).
Methods
Overall, 609 PE patients were consecutively included in a prospective single-centre registry between September 2008 and August 2017. Volumetric measurements of heart chambers were performed on routine non-electrocardiographic-gated computed tomography and plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) measured on admission. An in-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration.
Results
Patients with an adverse outcome (11.2%) had larger RA volumes (median 120 (interquartile range 84–152) versus 102 (78–134) mL; p=0.013), RA/left atrial (LA) volume ratios (1.7 (1.2–2.4) versus 1.3 (1.1–1.7); p<0.001) and MR-proANP levels (282 (157–481) versus 129 (64–238) pmol·L−1; p<0.001) compared to patients with a favourable outcome. Overall, 499 patients (81.9%) had a RA/LA volume ratio ≥1.0 and a calculated cut-off value of 1.8 (area under the curve 0.64, 95% CI 0.56–0.71) predicted an adverse outcome, both in unselected (OR 3.1, 95% CI 1.9–5.2) and normotensive patients (OR 2.7, 95% CI 1.3–5.6). MR-proANP ≥120 pmol·L−1 was identified as an independent predictor of an adverse outcome, both in unselected (OR 4.6, 95% CI 2.3–9.3) and normotensive patients (OR 5.1, 95% CI 1.5–17.6).
Conclusions
RA dilation is a frequent finding in patients with PE. However, the prognostic performance of RA dilation appears inferior compared to established risk stratification markers. MR-proANP predicted an in-hospital adverse outcome, both in unselected and normotensive PE patients, integrating different prognostic relevant information from comorbidities. |
url |
http://openres.ersjournals.com/content/7/2/00414-2020.full |
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