Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics

Libyan Journal of Medicine

article

Wanis H. Ibrahim¹  Shaikha D Al-Shokri²  Musa S. Hussein³  Antoun Kamel⁴  Lana M Abu Afifeh⁵  Gowri Karuppasamy³  Jessiya V. Parambil⁶  Farras M. Elasad³  Mohamed S. Abdelghani³  Ahmed Abdallah³  Mohammed E. Faris³ 

[1] Department of Medicine, Hamad General Hospital, Clinical Medicine, Qatar University and Weill-Cornell Medicine Doha Qatar;MetroHealth Medical Center, Case Western Reserve University;Department of Medicine, Hamad General Hospital;Hamad General Hospital;Qatar University;ST3 General Medicine, Milton Keynes University Hospital NHS

关键词: Pulmonary embolism;    saddlepulmonary embolism;    hemodynamics;    echocardiography;   

DOI  :  10.1080/19932820.2022.2044597

学科分类：社会科学、人文和艺术（综合）

来源: Co-Action Publishing

【 摘 要 】

The central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamicconsequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed toevaluate the clinical presentation, hemodynamic and echocardiographic effects, as well as the outcomes of saddle PE, and compare the results withthose of non-saddle type. This was a retrospective study of 432 adult patients with saddle and non-saddle PE. Overall, 432 patients were diagnosedwith PE by computed tomography pulmonary angiography (CTPA). Seventy-three (16.9%) had saddle PE, and 359 had non-saddle PE. Compared tothose with non-saddle PE, patients with saddle PE presented more frequently with tachycardia (68.5% vs. 46.2%, P= .001), and tachypnea (58.9% vs.42.1%, P= .009) on admission, required more frequent intensive care unit (ICU) admissions (45.8% vs. 26.6%, P= .001) and thrombolysis/thrombectomy use (19.1% vs. 6.7%, P= .001), and were at more risk of developing decompensation and cardiac arrest after their initial admission(15.3% vs. 5.9%, P= .006). On echocardiography, right ventricular (RV) enlargement (60% vs. 31.1%, P= .000), RV dysfunction (45.8% vs. 22%, P= .000),and RV systolic pressure (RVSP) of greater than 40 mmHg (61.5% vs. 39.2%, P= .003) were significantly more observed with saddle PE. The twogroups did not differ concerning the rates of hypotension (17.8% vs. 18.7%, P= .864) and hypoxemia (41.1% vs. 34.3%, P= .336) on admission andmortality rates. A logistic regression model indicated that the use of oral contraceptive pills (OCP), RVSP > 40 mmHg, and development ofhypotension and decompensation following admission were associated with an increased likelihood of having saddle embolus. Saddle PE accountsfor a higher proportion among all PE cases than previously reported. Patients with saddle PE tend to present more frequently with adversehemodynamic and echocardiographic changes and decompensate after their initial presentation. OCP use, development of hypotension, anddecompensation following admission and RVSP > 40 mmHg are significant predictors of saddle PE. These characteristics should not be overlookedwhen managing patients with saddle PE.

【 授权许可】

CC BY|CC BY-NC