ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study
Berhan Keskin1, Hacer Ceren Tokgöz1, Özgür Yaşar Akbal1, Aykun Hakgör2, Ali Karagöz1, Barkın Kültürsay1, Seda Tanyeri1, Seyhmuş Külahçıoğlu1, İbrahim Halil Tanboğa3, Nihal Özdemir1, Cihangir Kaymaz1
1Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
2Department of Cardiology, Medipol Mega University Hospital, Istanbul, Türkiye
3Department of Cardiology, Nişantaşı University, Hisar Hospital, Istanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2022.22798
Background: We aimed to determine the clinical, echocardiographic and hemodynamic correlates of syncope as a presenting symptom in pulmonary embolism and its impact on in-hospital and long-term outcomes.

Methods: Between July 2012 and October 2019, a total of 641 patients with PE (277 males, 364 females; median age: 65 years; range, 51 to 74 years) in whom the diagnostic work-up and risk-based management were performed according to the current pulmonary embolism guidelines were retrospectively analyzed. Clinical, laboratory and imaging data of the patients were obtained from hospital database system.

Results: Syncope was noted in 193 (30.2%) of patients on admission, and was associated with a significantly higher-risk status manifested by elevated troponin and D-dimer levels, a higher Pulmonary Embolism Severity Index scores, deterioration of right-to-left ventricular diameter ratio, right ventricular longitudinal contraction measures, the higher Qanadli score, and higher rates of thrombolytic therapies (p<0.001) and rheolytic? thrombectomy (p=0.037) therapies. In-hospital mortality (p=0.007) and minor bleeding (p<0.001) were significantly higher in syncope subgroup. Multivariate logistic regression analysis showed that higher Pulmonary Embolism Severity Index scores and right-to-left ventricular diameter ratio were independently associated with syncope, while aging and increased heart rate predicted in-hospital mortality. Malignancy and right-to-left ventricular diameter ratio at discharge, but not syncope, were independent predictors of cumulative mortality during follow-up.

Conclusion: Syncope as the presenting symptom is associated with a higher risk due to more severe obstructive pressure load and right ventricular dysfunction requiring more proactive strategies in patients with pulmonary embolism. However, with appropriate risk-based therapies, neither in-hospital mortality nor long-term mortality can be predicted by syncope.

Keywords : Acute pulmonary embolism, mortality, risk prediction, syncope
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