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RESEARCH PRODUCT

The risk factor age in normotensive patients with pulmonary embolism: Effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients.

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Abstract Introduction Right ventricular dysfunction (RVD), submassive pulmonary embolism (PE), elevated systolic pulmonary artery pressure (sPAP), elevated cardiac troponin I (cTnI) and old age are well-known risk factors for poor outcome in acute normotensive PE. The aim of this analysis was to calculate age cut-off values to predict submassive PE, cardiac injury, RVD and elevated sPAP in normotensive PE patients. Methods Retrospective analysis of clinical, laboratory, radiological and echocardiographic data of normotensive PE patients (2006–2011) was performed. Receiver operating characteristic (ROC) curves and Youden indexes were used to test the effectiveness of using patients' ages at the PE event to predict a submassive PE, cardiac injury (elevated cTnI > 0.1 ng/ml), RVD and elevated sPAP (> 30 mm Hg) in normotensive PE patients and to calculate optimal cut-off values. Patients > 76 years were compared to those aged ≤ 76 years. Results 129 normotensive PE patients (59.7% women) met the inclusion criteria and were included in this analysis. The optimal cut-off value for patient ages to predict submassive PE, cardiac injury (elevated cTnI > 0.1 ng/ml), RVD and elevated sPAP (> 30 mm Hg) was 76.5, 81.5, 66.5 and 66.5 years, respectively, with moderate effectiveness (AUC 0.69, 0.58, 0.71 and 0.69, respectively). Patients > 76 years old had higher percentages of submassive PE (91.1% vs. 63.1%, P = 0.000680), RVD (91.1% vs. 58.3%, P = 0.000119), sPAP (42.64 ± 16.70 vs. 29.24 ± 17.56 mm Hg, P = 0.000044) and cTnI (0.22 ± 0.40 vs. 0.10 ± 0.25 ng/ml, P = 0.00488). Conclusions Age is an important prognostic factor in acute normotensive PE. In addition to cTn and RVD, age should be taken into account in determining the risk stratification for acute PE.