0
Clinical Investigations: PULMONARY VASCULATURE |

Prognostic Factors in Medically Treated Patients With Chronic Pulmonary Embolism*

Jerzy Lewczuk, MD, PhD; Piotr Piszko, MB; Jacek Jagas, MB; Adam Porada, MB; Sławomir Wójciak, MB; Bożena Sobkowicz, MD, PhD; Krzysztof Wrabec, MD, PhD
Author and Funding Information

From the Cardiology and Medicine Department (Drs. Lewczuk, Piszko, Jagas, Porada, Wójciak, and Sobkowicz), County Hospital, Wrocław; and Wrocław Medical University (Dr. Wrabac), Faculty of Postgraduate Education, Wrocław, Poland.

Correspondence to: Jerzy Lewczuk, MD, PhD, Cardiology and Medicine Department, County Hospital, ul. Kamieñskiego 73a, 51–124 Wrocław, Poland; e-mail: lewczuk@ch.wssk.wroc.pl



Chest. 2001;119(3):818-823. doi:10.1378/chest.119.3.818
Text Size: A A A
Published online

Objective: To evaluate risk factors in medically treated patients with chronic pulmonary embolism (CPE) who are not suitable candidates for definitive surgical therapy.

Study design: A total of 53 consecutive patients with angiographically confirmed CPE were involved. Four patients underwent pulmonary endarterectomy, and 49 patients received continuous anticoagulation therapy and were followed up over an average period of 18.7 months (range, 6 to 72 months).

Results: Sixteen patients died during the follow-up period, mostly from progressive right ventricle failure. Among the nonsurvivors, 12.5% had distal CPE and 87.5% had proximal CPE (p = 0.03). The survivors had a higher (mean ± SD) level of Pao2 (59.3 ± 11 mm Hg) than the nonsurvivors (50.8 ± 9 mm Hg; p = 0.02), a lower mean pulmonary artery pressure (mPAP; 30.3 ± 15 mm Hg vs 51 ± 21 mm Hg; p = 0.0004), a lower hematocrit value (40.0 ± 6 vs 44.2 ± 6; p = 0.03), and better exercise tolerance (4.8 ± 3 multiples of resting O2 consumption [METs] vs 2.5 ± 1 METs; p = 0.02) achieved during the maximal symptom-limited exercise. The patients with coexisting COPD had a higher mortality rate (62.5%) than those without COPD (37.5%; p = 0.04). Independent risk factors in the Cox analysis were as follows: mPAP (p = 0.04), exercise tolerance (p = 0.02), and COPD (p = 0.04). In the Kaplan-Meier analysis, the patient group with lower mortality achieved > 2 METs (p = 0.02) and had mPAP < 30 mm Hg (p = 0.04).

Conclusion: The prognosis for the medically treated CPE patients, particularly those with pulmonary hypertension, was unfavorable. The prognostic factors for these patients were mPAP, coexistence of COPD, and severe exercise intolerance.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543