SIGNIFICANT PULMONARY HYPERTENSION IN ACUTE PULMONARY EMBOLISM: CONCEPTS AND FACTS

Acute pulmonary thromboembolism with a mortality of about 15-20% is the third leading cause of death from vascular disease after myocardial infarction and cerebrovascular disease. Considering the ominous nature of the disease and our experience of observing significant degrees of pulmonary hypertension among these patients, we decided to evaluate the prevalence of echocardiographic findings and its relationship with in-hospital mortality of affected patients.

In this cross-sectional study, we enrolled 183 patients with a definitive diagnosis of pulmonary embolism having admission echocardiography. Clinical and echocardiographic findings were extracted from patients' medical records. Patients were grouped as survivors to hospital discharge and non-survivors, and the relationship between echocardiographic findings and in-hospital mortality was evaluated. All data analysis was performed using SPSS software version 22 and the significance level was considered less than 0.05.

In-hospital mortality rate of our patients was 20.2%. Dyspnea and chest pain were the most prevalent symptoms, while tachycardia, tachypnea and hypotension were the most frequent signs. Average systolic pulmonary artery pressure was about 50.82±22.88 mmHg with significant difference between deceased and discharged subjects. We also reported a significant relationship between in-hospital mortality and TR severity and right ventricular dysfunction. Severe pulmonary hypertension was present in 42% of the patients, and about one third of them didn't survive to the hospital discharge. However, only 14 patients with less than severe PH on presentation expired during hospital stay (p=0.002).

High frequency of severe pulmonary hypertension observed in our acute presenting patients could be a sign of combined PH etiologies and warrant further evaluation of secondary causes.