Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

Version 1 : Received: 6 February 2024 / Approved: 12 February 2024 / Online: 12 February 2024 (08:51:07 CET)

A peer-reviewed article of this Preprint also exists.

Farid-Zahran, M.; Méndez-Bailón, M.; Pedrajas, J.M.; Alonso-Beato, R.; Galeano-Valle, F.; Sendín Martín, V.; Marco-Martínez, J.; Demelo-Rodríguez, P. Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes. J. Clin. Med. 2024, 13, 1284. Farid-Zahran, M.; Méndez-Bailón, M.; Pedrajas, J.M.; Alonso-Beato, R.; Galeano-Valle, F.; Sendín Martín, V.; Marco-Martínez, J.; Demelo-Rodríguez, P. Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes. J. Clin. Med. 2024, 13, 1284.

Abstract

Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common condition associated with high morbidity and mortality. Although patients with heart failure (HF) are known to have an increased risk of PE, there is limited evidence regarding its specific impact on patients with acute PE, both in presentation and outcomes, and its relationship with left ventricular ejection fraction (LVEF). Material and Methods: A prospective observational study was conducted at two tertiary hospitals, including patients with symptomatic acute PE between January 2012 and December 2022. The primary objective of the study was the development of a composite outcome (mortality, major bleeding, and recurrence) within the first 30 days. The secondary objective was the development of early complications in patients with HF and reduced LVEF. Results: Out of 1991 patients included with symptomatic acute PE, 7.13% had a history of HF. Patients with HF were older and had more comorbidities. The HF group showed higher mortality (11.27% vs. 4.33%, p<0.001) and major bleeding (9.86% vs. 4.54%, p=0.005). In multivariate analysis, HF was an independent risk factor for the development of the composite outcome (HR 1.93; 95% CI: 1.35-2.76). Reduced LVEF was independently associated with a higher risk of bleeding (HR 3.44; 95% CI: 1.34-8.81). Conclusion: In patients with symptomatic acute pulmonary embolism, heart failure is independently associated with a higher risk of early complications. Additionally, heart failure with reduced LVEF is an independent risk factor for major bleeding.

Keywords

heart failure; venous thromboembolism; pulmonary embolism; mortality; bleeding; comorbidity; left ventricular ejection fraction (LVEF)

Subject

Medicine and Pharmacology, Hematology

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