The following is a summary of “Impact of Baseline Heart Failure on Acute Pulmonary Embolism Risk Stratification and Clinical Outcomes,” published in the August 2023 issue of the Cardiovascular Disease by Katterle et al.

In individuals diagnosed with acute pulmonary embolism (PE), the presence of irregular cardiac biomarkers and an elevated ratio of right ventricular to left ventricular (RV/LV) diameter have been observed to be linked with heightened morbidity and mortality rates. Nevertheless, individuals with pre-existing heart failure (HF) exhibit irregularities in cardiac chamber measurements and biomarkers. Our objective was to delineate risk stratification variables in a cohort of individuals with acute pulmonary embolism (PE) and classify their heart failure (HF) status as follows: absence of HF, HF with reduced ejection fraction (HFrEF), or HF with preserved ejection fraction (HFpEF). 

A total of 182 participants were identified for this study, out of which 142 were classified as having no heart failure (HF), 16 as having heart failure with reduced ejection fraction (HFrEF), and 24 as having heart failure with preserved ejection fraction (HFpEF). The population’s median age was 65 years, with an interquartile range of 51 to 75 years—additionally, 43% of the individuals identified as male. Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) exhibited notably larger Left Ventricular (LV) diameters and a significantly lower Right Ventricular (RV) to LV diameter ratio compared to those without heart failure (HF) (no HF 0.94, HFrEF 0.65, HF with preserved Ejection Fraction (HFpEF) 0.89, P = 0.002). Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) exhibited notably elevated levels of B-type natriuretic peptide (HF absent 112 pg/mL, HFrEF 835 pg/mL, Heart Failure with Preserved Ejection Fraction (HFpEF) 241 pg/mL, P <0.001), along with increased rates of mortality within 90 days. 

Among individuals with acute pulmonary embolism (PE), those with baseline heart failure with reduced ejection fraction (HFrEF) exhibited significantly larger left ventricular (LV) diameter and a lower right ventricular (RV)/LV diameter ratio compared to patients with heart failure with preserved ejection fraction (HFpEF) or no heart failure. Furthermore, individuals with heart failure with reduced ejection fraction (HFrEF) exhibited notably elevated levels of B-type natriuretic peptides and experienced poorer survival outcomes within 90 days. In summary, these findings suggest that the risk assessment for pulmonary embolism (PE) using existing guidelines, particularly the reliance on the right ventricle to left ventricle ratio, is not precise in individuals with baseline heart failure with reduced ejection fraction (HFrEF).

Source: sciencedirect.com/science/article/abs/pii/S0002914923002795