Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism
2021; Elsevier BV; Volume: 161; Issue: 2 Linguagem: Inglês
10.1016/j.chest.2021.08.059
ISSN1931-3543
AutoresAna Jaureguízar, David Jiménez, Behnood Bikdeli, Pedro Ruiz‐Artacho, Alfonso Muriel, Victor F. Tapson, Raquel López-Reyes, B. Valero, Gili Kenet, Manuel Monréal, Manuel Monréal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Peter Verhamme, Joseph A. Caprini, My Bui, María Dolores Adarraga, Jesús Aibar, M.A. Aibar, J. Alonso, Cristina Amado, J.I. Arcelus, A Asuero, Pedro María Azcárate-Agüero, Aitor Ballaz, Raquel Barba, C. Barbagelata, M. Barrón, B. Barrón‐Andrés, Á. Blanco-Molina, Fahd Beddar Chaib, A.M. Camón, Joaquín Castro, Leyre Chasco, Juan Criado, Cristina de Ancos, J. del Toro, Pablo Demelo‐Rodríguez, A.M. Díaz-Brasero, Carmen Díaz‐Pedroche, J.A. Díaz‐Peromingo, M Campli, Álvaro Dubois-Silva, J.C. Escribano, F. Espósito, Ana Isabel Farfán‐Sedano, Carmen Fernández‐Capitán, José Luis Fernández‐Reyes, M.A. Fidalgo, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, M.A. García, F. García‐Bragado, Marta García de Herreros, Rocío García de la Garza, Cristina García Díaz, A. Gil-Díaz, Covadonga Gómez‐Cuervo, M. Giménez-Suau, E Grau, L. Guirado, Juan Mata, Luis Blasco, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Carmen Jiménez-Alfaro, M.D. Joya, S. Lainez-Justo, A. Latorre, Jorge Roberto Perrout de Lima, J.L. Lobo, Luciano López-Jiménez, Patricia López-Miguel, Juan J. López-Núñez, Raquel López-Reyes, J.B. López‐Sáez, A. Lorenzo, Olga Madridano, Ana Maestre, Pablo Javier Marchena, M. Martín del Pozo, F. Martín‐Martos, Diego Martínez‐Urbistondo, C Mella, María Inés Mercado, Jorge Moisés, Manuel Monréal, Miriam Estébanez, Arturo Muñoz Blanco, José Antonio Nieto, Ester Nofuentes Pérez, M.J. Núñez-Fernández, M. Olid-Velilla, M.C. Olivares, Jeisson Osorio, S. Otálora, Remedios Otero, José María Pedrajas, G. Pellejero, José Antonio Porras, Joaquin Portillo, Consolación Rodríguez-Matute, V. Rosa, Pedro Ruiz‐Artacho, Justo Ruiz-Ruiz, G. Salgueiro, R. Sánchez‐Martínez, J.F. Sánchez‐Muñoz‐Torrero, Teresa Sancho, S. Soler, Beatriz Suárez-Rodríguez, José María Suriñach, Marı́a Isabel Torres, C. Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, B. Valero, R. Valle, José F. Varona, Lydia Vela, J. Vela, G. Vidal, A. Villalobos, Paula Villares, C Zamora, Cihan Ay, Stephan Nopp, Ingrid Pabinger, Thomas Vanassche, Christophe Vandenbriele, Peter Verhamme, Jana Hirmerová, Radován Malý, Sandrine Accassat, Nassim Ait Abdallah, Laurent Bertoletti, A. Bura-Rivière, Judith Catella, Françis Couturaud, Benjamin Crichi, P. Debourdeau, Olivier Espitia, Dominique Farge, C. Grangé, H. L. Helfer, Karine Lacut, Raphaël Le Mao, Isabelle Mahé, Pierre‐Emmanuel Morange, Farès Moustafa, Géraldine Poenou, G. Sarlon-Bartoli, Pierre Suchon, I. Quéré, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Gili Kenet, Inna Tzoran, Manuela Basaglia, Franca Bilora, Cristiano Bortoluzzi, B. Brandolin, Maurizio Ciammaichella, Antonina De Angelis, Pierpaolo Di Micco, Egidio Imbalzano, Simona Merla, Raffaele Pesavento, Paolo Prandoni, Carmine Siniscalchi, Antonella Tufano, A. Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Yuji Nishimoto, Yukihito Sato, J. Birzulis, Andris Skride, A. Zaicenko, S. Fonseca, Filipa Abreu Martins, J. Meireles, Marijan Bosevski, Gorjan Krstevski, Henri Bounameaux, Lucia Mazzolai, Behnood Bikdeli, Joseph A. Caprini, My Bui,
Tópico(s)Atrial Fibrillation Management and Outcomes
ResumoBackground The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE. The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Does an association exist between baseline HR and PE outcome across the continuum of HR values? The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE. Prognostic Implication of Resting Heart Rate and Its Modulation in Patients With Acute Pulmonary EmbolismCHESTVol. 161Issue 2PreviewWe have read with great interest the article in this issue of CHEST by Jaureguízar et al1 that demonstrated that higher resting heart rate was associated with worse outcomes in patients with acute pulmonary embolism. Modification of the heart rate cutoff in the clinical prognostic score with the use of their findings improved prognostication. We have two concerns that should improve their findings. Full-Text PDF ResponseCHESTVol. 161Issue 2PreviewWe thank Dr Izumida and colleagues for their thoughtful comments about our study on the association between heart rate and prognosis in patients with acute pulmonary embolism (PE).1 Previous studies have shown an association between both preexisting and newly incident atrial fibrillation and adverse outcomes in patients with acute symptomatic PE.2 Importantly, when we repeated the analysis after excluding patients with atrial fibrillation, tachycardia was still associated with a three-fold increased risk of dying (see Table 4 in the original article). Full-Text PDF
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