Pulmonary embolism and heart failure: analysis of data from the Russian registry SIRENA

Aim. To study the effect of heart failure (HF) on the course of pulmonary embolism (PE) according to the Russian registry SIRENA.

Material and methods. The study was conducted based on the data of an observational prospective registry SIRENA. The registry included all consecutively hospitalized patients with PE diagnosed by any available means. The enrollment duration was 12 months. The hospital period of patient management was assessed. Information on the included patients was provided by 20 hospitals from 15 Russian cities.

Results. The present study included 495 patients with PE. HF was diagnosed in 38,6% of cases (n=191). Patients with a combination of PE and HF were characterized by a significantly higher prevalence of coronary artery disease (32,5%), hypertension (83,2%), atrial fibrillation (48,7%), diabetes (42,4%), prior cerebrovascular accident (17,3%), and stage 3 chronic kidney disease (49,7%). Physical examination of patients with PE and HF revealed reliable differences in lower limb edema (p=0,001), jugular vein distention (p=0,043), moist rales in lower lungs (p=0,001), tachypnea (p=0,001), cyanosis (p=0,001). In addition, patients with PE and HF were characterized by a lower level of saturation (p=0,001), systolic (p=0,006) and diastolic (p=0,005) blood pressure. When analyzing ECG data, the only significant difference in the compared groups was ST segment depression in the group of patients with PE and HF (22,5% versus 9,9%, p=0,036). According to echocardiography, pulmonary hypertension (p=0,041), right ventricular (p=0,048) and right atrial (p=0,023) dilation were more often detected in patients with PE and HF. The prevalence of acute heart failure, as one of the complications of PE, prevailed in the group of patients with PE and HF (p=0,023). Inhospital mortality in patients with PE and HF reached 15,2% and significantly differed from that in the PE group without HF — 4,6% (p=0,047).

Conclusion. HF in patients with PE is associated with a high level of comorbidity of patients complicated by the course of PE and, as a consequence, an increase in mortality. It is necessary to be wary of possible PE in patients with manifestations of decompensated HF.

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