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Cardiac findings and long-term thromboembolic outcomes following pulmonary embolism in children: a combined retrospective-prospective inception cohort study

Published online by Cambridge University Press:  22 October 2012

Hayley S. Hancock ,
Michael Wang ,
Katja M. Gist ,
Elizabeth Gibson ,
Shelley D. Miyamoto ,
Peter M. Mourani ,
Marilyn J. Manco-Johnson  and
Neil A. Goldenberg
Hayley S. Hancock*
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Michael Wang
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Katja M. Gist
Affiliation:
Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Elizabeth Gibson
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Shelley D. Miyamoto
Affiliation:
Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Peter M. Mourani
Affiliation:
Division of Critical Care Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Marilyn J. Manco-Johnson
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Neil A. Goldenberg
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Department of Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America CPC Clinical Research, Aurora, Colorado, United States of America
*
Correspondence to: Dr H. S. Hancock, MD, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Box 158, Aurora, CO 80045, United States of America. Tel: +1 720 777 6918; Fax: +1 720 777 7258; E-mail: hancockh@med.umich.edu
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Abstract

In paediatric pulmonary embolism, cardiac findings and thromboembolic outcomes are poorly defined. We conducted a mixed retrospective-prospective cohort study of paediatric pulmonary embolism at the Children's Hospital Colorado between March, 2006 and January, 2011. A total of 58 consecutive children – age less than or equal to 21 years – with acute pulmonary embolism were enrolled. Data collection included clinical and laboratory characteristics, treatments, serial echocardiographic and electrocardiographic findings, and outcomes of pulmonary embolism non-resolution and recurrence. The median age was 16.5 years ranging from 0 to 21 years. The most prevalent clinical risk factors were oral contraceptive pill use (52% of female patients), presence of a non-infectious inflammatory condition (21%), and trauma (21%). Thrombophilias included heterozygous factor V Leiden in 21%; antiphospholipid antibody syndrome was established in 31% overall. Proximal pulmonary artery involvement was present in 34%. At presentation, nearly half of the patients had hypoxaemia and 37% had tachycardia. The classic electrocardiographic finding of S1Q3T3 was present in 12% acutely; tricuspid regurgitation greater than 3 metres per second, septal flattening, and right ventricular dilation were each present on acute echocardiogram in 25%. Nearly all patients received therapeutic anticoagulation, with initial systemic tissue plasminogen activator administered in 16% for occlusive iliofemoral deep venous thrombosis and/or massive pulmonary embolism. Pulmonary embolism resolution was observed in 82% by 6 months. Recurrent pulmonary embolism occurred in 9%. There were no pulmonary embolism-related deaths. Right ventricular dysfunction was rare in follow-up. These data indicate that acute heart strain is common, but chronic cardiac dysfunction is rare, following aggressive management of acute pulmonary embolism in children.

Keywords

Heart strainventricular dysfunctioncardiogrampulmonary hypertension
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 344 - 352
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Raffini, L, Huang, YS, Witmer, C, Feudtner, C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics 2009; 124: 1001–1008.CrossRefGoogle ScholarPubMed
2. Biss, TT, Brandao, LR, Kahr, WH, Chan, AK, Williams, S. Clinical features and outcome of pulmonary embolism in children. Br J Haematol 2008; 142: 808–818.CrossRefGoogle ScholarPubMed
3. Hsiao, SH, Yang, SH, Wang, WC, Lee, CY, Lin, SK, Liu, CP. Usefulness of regional myocardial performance index to diagnose pulmonary embolism in patients with echocardiographic signs of pulmonary hypertension. Am J Cardiol 2006; 98: 1652–1655.CrossRefGoogle ScholarPubMed
4. Hsiao, SH, Lee, CY, Chang, SM, Yang, SH, Lin, SK, Huang, WC. Pulmonary embolism and right heart function: insights from myocardial Doppler tissue imaging. J Am Soc Echocardiogr 2006; 19: 822–828.CrossRefGoogle ScholarPubMed
5. Rydman, R, Larsen, F, Caidahl, K, Alam, M. Right ventricular function in patients with pulmonary embolism: early and late findings using Doppler tissue imaging. J Am Soc Echocardiogr 2010; 23: 531–537.CrossRefGoogle ScholarPubMed
6. Kasper, W, Konstantinides, S, Geibel, A, Tiede, N, Krause, T, Just, H. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart 1997; 77: 346–349.CrossRefGoogle ScholarPubMed
7. Kline, JA, Steuerwald, MT, Marchick, MR, Hernandez-Nino, J, Rose, GA. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest 2009; 136: 1202–1210.CrossRefGoogle ScholarPubMed
8. Konstantinides, S. Pulmonary embolism: impact of right ventricular dysfunction. Curr Opin Cardiol 2005; 20: 496–501.CrossRefGoogle ScholarPubMed
9. Monagle, P, Chan, A, Massicotte, P, Chalmers, E, Michelson, AD. Antithrombotic therapy in children: the 7th ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest, 2004; 126: 645S–687S.CrossRefGoogle Scholar
10. Monagle, P, Chalmers, E, Chan, A, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 887S–968S.CrossRefGoogle ScholarPubMed
11. Calhoon, MJ, Ross, CN, Pounder, E, Cassidy, D, Manco-Johnson, MJ, Goldenberg, NA. High prevalence of thrombophilic traits in children with family history of thromboembolism. J Pediatr 2010; 157: 485–489.CrossRefGoogle ScholarPubMed
12. Goldenberg, NA, Durham, JD, Knapp-Clevenger, R, Manco-Johnson, MJ. A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood 2007; 110: 45–53.CrossRefGoogle ScholarPubMed
13. Goldenberg, NA, Branchford, B, Wang, M, Ray, C Jr, Durham, JD, Manco-Johnson, MJ. Percutaneous mechanical andpharmacomechanical thrombolysis for occlusive deep vein thrombosis of the proximal limb in adolescent subjects: findings from an institution-based prospective inception cohort study of pediatric venous thromboembolism. J Vasc Interv Radiol 2011; 22: 121–132.CrossRefGoogle ScholarPubMed
14. Miyakis, S, Lockshin, MD, Atsumi, T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295–306.CrossRefGoogle Scholar
15. Rajpurkar, M, Warrier, I, Chitlur, M, et al. Pulmonary embolism-experience at a single children's hospital. Thromb Res 2007; 119: 699–703.CrossRefGoogle Scholar
16. Pengo, V, Lensing, AW, Prins, MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 2257–2264.CrossRefGoogle ScholarPubMed
17. Piazza, G, Goldhaber, SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2011; 364: 351–360.CrossRefGoogle ScholarPubMed
18. Poli, D, Grifoni, E, Antonucci, E, et al. Incidence of recurrent venous thromboembolism and of chronic thromboembolic pulmonary hypertension in patients after a first episode of pulmonary embolism. J Thromb Thrombolysis 2010; 30: 294–299.CrossRefGoogle ScholarPubMed
19. Geibel, A, Zehender, M, Kasper, W, Olschewski, M, Klima, C, Konstantinides, SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J 2005; 25: 843–848.CrossRefGoogle ScholarPubMed
20. Goldhaber, SZ, Visani, L, De Rosa, M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386–1389.CrossRefGoogle ScholarPubMed
21. Kucher, N, Walpoth, N, Wustmann, K, Noveanu, M, Gertsch, M. QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism. Eur Heart J 2003; 24: 1113–1119.CrossRefGoogle ScholarPubMed
22. Kosuge, M, Kimura, K, Ishikawa, T, et al. Prognostic significance of inverted T waves in patients with acute pulmonary embolism. Circ J 2006; 70: 750–755.CrossRefGoogle ScholarPubMed
23. Vanni, S, Polidori, G, Vergara, R, et al. Prognostic value of ECG among patients with acute pulmonary embolism and normal blood pressure. Am J Med 2009; 122: 257–264.CrossRefGoogle ScholarPubMed