Significant Pulmonary Hypertension in Acute Pulmonary Embolism: Concepts and Facts

Background & Aims: 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.
Materials & Methods: 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.
Results: 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).
Conclusion: 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.