open access

Vol 87, No 2 (2019)
ORIGINAL PAPERS
Published online: 2019-04-02
Submitted: 2018-09-17
Accepted: 2019-02-11
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Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism

Mehtap Pehlivanlar Küçük, Funda Öztuna, Yasin Abul, Savaş Özsu, Merih Kutlu, Tevfik Özlü
DOI: 10.5603/ARM.2019.0012
·
Pubmed: 31038716
·
Adv Respir Med 2019;87(2):69-76.

open access

Vol 87, No 2 (2019)
ORIGINAL PAPERS
Published online: 2019-04-02
Submitted: 2018-09-17
Accepted: 2019-02-11

Abstract

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute
phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution
width (RDW) and echocardiography (ECHO) for the prognosis of PTE.

Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients
were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had
RDW < 15.2%.

Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of
RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting
mortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value
was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (±
0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and
61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033).

Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE
levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that
developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in
determining the prognosis of pulmonary embolism.

Abstract

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute
phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution
width (RDW) and echocardiography (ECHO) for the prognosis of PTE.

Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients
were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had
RDW < 15.2%.

Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of
RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting
mortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value
was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (±
0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and
61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033).

Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE
levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that
developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in
determining the prognosis of pulmonary embolism.

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Keywords

chronic thromboembolic pulmonary hypertension, red cell distribution width, pulmonary embolism, tricuspid annular plane systolic excursion, tricuspid jet velocity

About this article
Title

Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 2 (2019)

Pages

69-76

Published online

2019-04-02

DOI

10.5603/ARM.2019.0012

Pubmed

31038716

Bibliographic record

Adv Respir Med 2019;87(2):69-76.

Keywords

chronic thromboembolic pulmonary hypertension
red cell distribution width
pulmonary embolism
tricuspid annular plane systolic excursion
tricuspid jet velocity

Authors

Mehtap Pehlivanlar Küçük
Funda Öztuna
Yasin Abul
Savaş Özsu
Merih Kutlu
Tevfik Özlü

References (17)
  1. Stein PD, Kayali F, Olson RE. Estimated case fatality rate of pulmonary embolism, 1979 to 1998. Am J Cardiol. 2004; 93(9): 1197–1199.
  2. Miniati M, Monti S, Pratali L, et al. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med. 2001; 110(7): 528–535.
  3. Miron MJ, Perrier A, Bounameaux H, et al. Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients. Eur Respir J. 1999; 13(6): 1365–1370.
  4. Fisher MR, Forfia PR, Chamera E, et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009; 179(7): 615–621.
  5. Zorlu A, Bektasoglu G, Guven FM, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol. 2012; 109(1): 128–134.
  6. Rudski L, Lai W, Afilalo J, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2010; 23(7): 685–713.
  7. Ozsu S, Abul Y, Gunaydin S, et al. Prognostic value of red cell distribution width in patients with pulmonary embolism. Clinical and applied thrombosis/hemostasis. Official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2014; 20(4): 365–370.
  8. Sen HS, Abakay O, Tanrikulu AC, et al. Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr. 2014; 126(11-12): 347–354.
  9. Zhang Z, Xu X, Ni H, et al. Red cell distribution width is associated with hospital mortality in unselected critically ill patients. J Thorac Dis. 2013; 5(6): 730–736.
  10. Felker GM, Allen LA, Pocock SJ, et al. CHARM Investigators. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007; 50(1): 40–47.
  11. Kato H, Ishida J, Imagawa S, et al. Enhanced erythropoiesis mediated by activation of the renin-angiotensin system via angiotensin II type 1a receptor. FASEB J. 2005; 19(14): 2023–2025.
  12. Brookes CI, White PA, Bishop AJ, et al. Validation of a new intraoperative technique to evaluate load-independent indices of right ventricular performance in patients undergoing cardiac operations. J Thorac Cardiovasc Surg. 1998; 116(3): 468–476.
  13. Park JH, Kim JH, Lee JH, et al. Evaluation of right ventricular systolic function by the analysis of tricuspid annular motion in patients with acute pulmonary embolism. J Cardiovasc Ultrasound. 2012; 20(4): 181–188.
  14. Pruszczyk P, Goliszek S, Lichodziejewska B, et al. Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC Cardiovasc Imaging. 2014; 7(6): 553–560.
  15. Pengo V, Lensing AWA, Prins MH, et al. Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004; 350(22): 2257–2264.
  16. Miniati M, Monti S, Bottai M, et al. Survival and restoration of pulmonary perfusion in a long-term follow-up of patients after acute pulmonary embolism. Medicine (Baltimore). 2006; 85(5): 253–262.
  17. Ribeiro A, Lindmarker P, Johnsson H, et al. Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. Circulation. 1999; 99(10): 1325–1330.

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