Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics
The central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamic consequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed to evaluate the clinical...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Libyan Journal of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/19932820.2022.2044597 |
| _version_ | 1819178418381520896 |
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| author | Wanis H Ibrahim Shaikha D Al-Shokri Musa S Hussein Antoun Kamel Lana M Abu Afifeh Gowri Karuppasamy Jessiya V Parambil Farras M Elasad Mohamed S Abdelghani Ahmed Abdallah Mohammed E Faris |
| author_facet | Wanis H Ibrahim Shaikha D Al-Shokri Musa S Hussein Antoun Kamel Lana M Abu Afifeh Gowri Karuppasamy Jessiya V Parambil Farras M Elasad Mohamed S Abdelghani Ahmed Abdallah Mohammed E Faris |
| author_sort | Wanis H Ibrahim |
| collection | DOAJ |
| description | The central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamic consequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed to evaluate the clinical presentation, hemodynamic and echocardiographic effects, as well as the outcomes of saddle PE, and compare the results with those of non-saddle type. This was a retrospective study of 432 adult patients with saddle and non-saddle PE. Overall, 432 patients were diagnosed with PE by computed tomography pulmonary angiography (CTPA). Seventy-three (16.9%) had saddle PE, and 359 had non-saddle PE. Compared to those with non-saddle PE, patients with saddle PE presented more frequently with tachycardia (68.5% vs. 46.2%, P= .001), and tachypnea (58.9% vs. 42.1%, P= .009) on admission, required more frequent intensive care unit (ICU) admissions (45.8% vs. 26.6%, P= .001) and thrombolysis/thrombectomy use (19.1% vs. 6.7%, P= .001), and were at more risk of developing decompensation and cardiac arrest after their initial admission (15.3% vs. 5.9%, P= .006). On echocardiography, right ventricular (RV) enlargement (60% vs. 31.1%, P= .000), RV dysfunction (45.8% vs. 22%, P= .000), and RV systolic pressure (RVSP) of greater than 40 mmHg (61.5% vs. 39.2%, P= .003) were significantly more observed with saddle PE. The two groups did not differ concerning the rates of hypotension (17.8% vs. 18.7%, P= .864) and hypoxemia (41.1% vs. 34.3%, P= .336) on admission and mortality rates. A logistic regression model indicated that the use of oral contraceptive pills (OCP), RVSP > 40 mmHg, and development of hypotension and decompensation following admission were associated with an increased likelihood of having saddle embolus. Saddle PE accounts for a higher proportion among all PE cases than previously reported. Patients with saddle PE tend to present more frequently with adverse hemodynamic and echocardiographic changes and decompensate after their initial presentation. OCP use, development of hypotension, and decompensation following admission and RVSP > 40 mmHg are significant predictors of saddle PE. These characteristics should not be overlooked when managing patients with saddle PE. |
| first_indexed | 2024-12-22T21:42:14Z |
| format | Article |
| id | doaj.art-9636e68583354fa58896a93b28448d91 |
| institution | Directory Open Access Journal |
| issn | 1993-2820 1819-6357 |
| language | English |
| last_indexed | 2024-12-22T21:42:14Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
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| series | Libyan Journal of Medicine |
| spelling | doaj.art-9636e68583354fa58896a93b28448d912022-12-21T18:11:36ZengTaylor & Francis GroupLibyan Journal of Medicine1993-28201819-63572022-12-0117110.1080/19932820.2022.2044597Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristicsWanis H Ibrahim0Shaikha D Al-Shokri1Musa S Hussein2Antoun Kamel3Lana M Abu Afifeh4Gowri Karuppasamy5Jessiya V Parambil6Farras M Elasad7Mohamed S Abdelghani8Ahmed Abdallah9Mohammed E Faris10Department of Medicine, Hamad General Hospital, Clinical Medicine, Qatar University and Weill-Cornell Medicine Doha QatarMetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USADepartment of Medicine, Hamad General Hospital, Doha, QatarHamad General Hospital, Doha, QatarQatar University, Doha, QatarDepartment of Medicine, Hamad General Hospital, Doha, QatarST3 General Medicine, Milton Keynes University Hospital NHS, Milton Keynes, UKHamad General Hospital, Doha, QatarHamad General Hospital, Doha, QatarHamad General Hospital, Doha, QatarHamad General Hospital, Doha, QatarThe central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamic consequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed to evaluate the clinical presentation, hemodynamic and echocardiographic effects, as well as the outcomes of saddle PE, and compare the results with those of non-saddle type. This was a retrospective study of 432 adult patients with saddle and non-saddle PE. Overall, 432 patients were diagnosed with PE by computed tomography pulmonary angiography (CTPA). Seventy-three (16.9%) had saddle PE, and 359 had non-saddle PE. Compared to those with non-saddle PE, patients with saddle PE presented more frequently with tachycardia (68.5% vs. 46.2%, P= .001), and tachypnea (58.9% vs. 42.1%, P= .009) on admission, required more frequent intensive care unit (ICU) admissions (45.8% vs. 26.6%, P= .001) and thrombolysis/thrombectomy use (19.1% vs. 6.7%, P= .001), and were at more risk of developing decompensation and cardiac arrest after their initial admission (15.3% vs. 5.9%, P= .006). On echocardiography, right ventricular (RV) enlargement (60% vs. 31.1%, P= .000), RV dysfunction (45.8% vs. 22%, P= .000), and RV systolic pressure (RVSP) of greater than 40 mmHg (61.5% vs. 39.2%, P= .003) were significantly more observed with saddle PE. The two groups did not differ concerning the rates of hypotension (17.8% vs. 18.7%, P= .864) and hypoxemia (41.1% vs. 34.3%, P= .336) on admission and mortality rates. A logistic regression model indicated that the use of oral contraceptive pills (OCP), RVSP > 40 mmHg, and development of hypotension and decompensation following admission were associated with an increased likelihood of having saddle embolus. Saddle PE accounts for a higher proportion among all PE cases than previously reported. Patients with saddle PE tend to present more frequently with adverse hemodynamic and echocardiographic changes and decompensate after their initial presentation. OCP use, development of hypotension, and decompensation following admission and RVSP > 40 mmHg are significant predictors of saddle PE. These characteristics should not be overlooked when managing patients with saddle PE.https://www.tandfonline.com/doi/10.1080/19932820.2022.2044597Pulmonary embolismsaddle pulmonary embolismhemodynamicsechocardiography |
| spellingShingle | Wanis H Ibrahim Shaikha D Al-Shokri Musa S Hussein Antoun Kamel Lana M Abu Afifeh Gowri Karuppasamy Jessiya V Parambil Farras M Elasad Mohamed S Abdelghani Ahmed Abdallah Mohammed E Faris Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics Libyan Journal of Medicine Pulmonary embolism saddle pulmonary embolism hemodynamics echocardiography |
| title | Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics |
| title_full | Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics |
| title_fullStr | Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics |
| title_full_unstemmed | Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics |
| title_short | Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics |
| title_sort | saddle versus non saddle pulmonary embolism differences in the clinical echocardiographic and outcome characteristics |
| topic | Pulmonary embolism saddle pulmonary embolism hemodynamics echocardiography |
| url | https://www.tandfonline.com/doi/10.1080/19932820.2022.2044597 |
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