TY - JOUR
T1 - Prevalence of pulmonary embolism among patients with recent onset of dyspnea on exertion. A cross-sectional study
AU - Prandoni, Paolo
AU - Lensing, Anthonie W A
AU - Prins, Martin H
AU - Ciammaichella, Maurizio
AU - Pirillo, Silvana
AU - Pace, Federica
AU - Zalunardo, Beniamino
AU - Bottino, Fabrizio
AU - Ageno, Walter
AU - Muiesan, Maria L
AU - Forlin, Marco
AU - Depietri, Luca
AU - Bova, Carlo
AU - Costantini, Nicoletta
AU - Caviglioli, Cosimo
AU - Migliaccio, Ludovica
AU - Noventa, Franco
AU - Levi, Marcel
AU - Davidson, Bruce L
AU - Palareti, Gualtiero
N1 - Published by Elsevier Inc.
PY - 2023/1
Y1 - 2023/1
N2 - Background: Exertional dyspnea is a frequently encountered complaint in clinical practice. However, the prevalence of pulmonary embolism (PE) among patients with dyspnea on exertion has not been reported. Objective: The objective of this study was to assess the prevalence of objectively confirmed PE among consecutive patients visiting an emergency department because of recent onset of exertional dyspnea. Methods: Patients aged ≤75 years with recent (<1 month) marked exertional dyspnea had a systematic workup for PE, irrespective of concomitant signs or symptoms of venous thromboembolism and alternative explanations for dyspnea. PE was excluded on the basis of a low pretest clinical probability and normal age-adjusted D-dimer. All other patients had computed tomography pulmonary angiography. An interim analysis after inclusion of 400 patients would stop recruitment if the 95% confidence interval (CI) of the PE prevalence had a lower limit exceeding 20%. Results: The study was prematurely terminated after the inclusion of 417 patients. In 134 patients (32.1%), PE was excluded based on low clinical probability and normal D-dimer. PE was found in 134 (47.3%) of the remaining 283 patients, for an overall prevalence of 32.1% (95% CI, 27.8-36.8). PE was present in 40 of 204 (19.6%) patients without other findings suspicious for PE and in 94 of 213 patients (44.1%) with such findings. PE involved a main pulmonary artery in 37% and multiple lobes in 87% of the patients. Conclusion: The angiographic demonstration of PE is common in patients presenting with recent onset of marked exertional dyspnea, including 20% without other findings suggesting pulmonary embolism.
AB - Background: Exertional dyspnea is a frequently encountered complaint in clinical practice. However, the prevalence of pulmonary embolism (PE) among patients with dyspnea on exertion has not been reported. Objective: The objective of this study was to assess the prevalence of objectively confirmed PE among consecutive patients visiting an emergency department because of recent onset of exertional dyspnea. Methods: Patients aged ≤75 years with recent (<1 month) marked exertional dyspnea had a systematic workup for PE, irrespective of concomitant signs or symptoms of venous thromboembolism and alternative explanations for dyspnea. PE was excluded on the basis of a low pretest clinical probability and normal age-adjusted D-dimer. All other patients had computed tomography pulmonary angiography. An interim analysis after inclusion of 400 patients would stop recruitment if the 95% confidence interval (CI) of the PE prevalence had a lower limit exceeding 20%. Results: The study was prematurely terminated after the inclusion of 417 patients. In 134 patients (32.1%), PE was excluded based on low clinical probability and normal D-dimer. PE was found in 134 (47.3%) of the remaining 283 patients, for an overall prevalence of 32.1% (95% CI, 27.8-36.8). PE was present in 40 of 204 (19.6%) patients without other findings suspicious for PE and in 94 of 213 patients (44.1%) with such findings. PE involved a main pulmonary artery in 37% and multiple lobes in 87% of the patients. Conclusion: The angiographic demonstration of PE is common in patients presenting with recent onset of marked exertional dyspnea, including 20% without other findings suggesting pulmonary embolism.
KW - Cross-Sectional Studies
KW - Dyspnea/epidemiology
KW - Fibrin Fibrinogen Degradation Products
KW - Humans
KW - Physical Exertion
KW - Prevalence
KW - Pulmonary Embolism/diagnostic imaging
U2 - 10.1016/j.jtha.2022.09.007
DO - 10.1016/j.jtha.2022.09.007
M3 - Article
C2 - 36695397
SN - 1538-7933
VL - 21
SP - 68
EP - 75
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 1
ER -