PB1329 - The predictive value of pulmonary infarction in patients with acute pulmonary embolism on persistent symptoms and adverse events

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Fleur H.J. Kaptein, MD

PhD student
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

LK

Lucia J.M. Kroft

Radiologist, MD, PhD
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Lv

LF van Dam

MD, PhD
Department of Thrombosis and Hemostasis, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
JS

JL Stöger

Department of Radiology
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
MN

Maarten K. Ninaber

MD, PhD
Department of Pulmonology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Frederikus A. Klok, MD, PhD

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Background: Pulmonary infarction (PI) is relatively common in acute pulmonary embolism (PE) with a reported incidence of nearly 30%. The impact on mortality and short-term outcomes seems limited, but the effect on persistent symptoms and functional impairment is largely unknown.

Aims: To evaluate the predictive value of suspected pulmonary infarction at acute PE diagnosis on long-term clinical outcomes.

Methods: We studied an existing cohort of 99 patients with computed tomography pulmonary angiography (CTPA) confirmed acute PE in whom 3-month follow-up data were available. The CTPAs were re-evaluated by an expert thoracic radiologist, who was blinded for clinical outcomes, for signs of PI (i.e. consistent with a peripheral wedge-shaped consolidation in a region of pulmonary embolism, with decreased contrast enhancement; Figure). We investigated the association between signs of PI at PE diagnosis and clinical symptoms at initial presentation, adverse events (recurrent venous thromboembolism, PE-related readmission and mortality) and self-reported persistent symptoms (dyspnea, pain and post-PE functional impairment, the latter defined as ‘new/progressive dyspnea, exercise intolerance and/or diminished functional status following adequately treated PE, without an apparent alternative explanation’) at 3-month follow-up using univariate Cox regression analysis.

Results: At PE diagnosis, 57 patients (58%) had suspected PI, comprising a median of 1% (IQR 1-3) of the total lung parenchyma. Patients with suspected PI presented more often with hemoptysis and pleural pain, and with more proximal PE on CTPA than patients without suspected PI (Table). There was no association with adverse events, persistent dyspnea or pain at 3-month follow-up, but signs of PI predicted more functional impairment (OR 3.0, 95%CI 1.0-9.1).

Conclusion(s): Patients with signs of PI had a different clinical presentation at acute PE diagnosis than patients without those signs, but no association with adverse events was found. Additionally, signs of PI predicted post-PE functional impairment.