Evaluation of the Short, Medium and Long-term Prognosis of Pulmonary Embolism

Abstract

Introduction: Pulmonary Embolism (PE) is the most severe form of venous thromboembolic disease. This is a serious condition not only because of its mortality but also its sequelae. Methodology: The aim of this study is to evaluate the prognosis of patients who had an episode of PE, hospitalized in the cardiology department of the Aristide Le Dantec University Hospital in Dakar. We performed a cohort study that included all patients admitted for pulmonary embolism during the period of May 1, 2011 to February 29, 2016. Subjects were contacted for a re-evaluation during the period of August 1st to September 1st 2016. We evaluated the status of patients (death or alive), to look for signs of chronic pulmonary heart based on the electrocardiogram (right atrial and ventricular hypertrophies, aspect S1S2S3, right bundle branch) and especially on the echocardiogram (right cavitary and parietal dimensions, measurement of the PASP). Results: A total of 77 pulmonary embolism cases were counted during the study period; 70 files were retained. It was a predominantly female population, with an average age of 51.2. Low risk forms (PESI I-II) accounted for 85.7% of the sample, versus 14.3% of PESI III-IV-V forms. At the re-evaluation, we counted 18 deaths (25.7%); twenty-two patients were lost to follow up. No recurrence was noted since hospitalization. Two patients had bilateral, noninflammatory edema. Dyspnea was found in 3 patients. No patient had any sign of right heart failure. Doppler echocardiography showed dilatation of the right ventricle along parasternal long axis in 6 cases and along apical section in 5 cases respectively. Right ventricular wall hypertrophy was noted in 6 patients. The systolic function of the right ventricle was normal in all cases. The right atrium was dilated in 5 cases. Pulmonary hypertension and increased pulmonary vascular resistance were noted in 7 cases, respectively. The overall mortality factors were acute circular insufficiency, right ventricular systolic dysfunction, PESI score of at least 1, tachycardia, PASP value greater than 50 mmHg, right heart failure and dilatation of the right atrium. Conclusion: Wall dilatation and hypertrophy of the right ventricle as well as pulmonary hypertension are frequent sequelae. The parameters of the hemodynamic impact of pulmonary embolism constitute the main prognostic factors.