Clinical Manifestations and Diagnosis of Pulmonary Embolism in Routine Clinical Practice: Data from the Ryazan Regional Vascular Center

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Abstract

BACKGROUND: Data on the peculiarities of the clinical presentation and characteristics of pulmonary embolism (PE) and problems of its diagnosis in routine clinical practice (CP) are limited. Data obtained long ago are mostly described in terms of venous thromboembolism in general and practically do not include Russian patients with PE. The study was performed within the RusSIan REgistery of pulmoNAry embolism (SIRENA) register.

AIM: To study the peculiarities of the clinical and demographic profile and diagnosis of PE in modern CP in comparison with the results of other PE registers.

MATERIALS AND METHODS: In this registry-based study, medical records were analyzed to obtain information on the demographic profile, clinical presentation, and examination results of patients with PE (n = 107; age, 63 (52–74) years; men, 39.3%) who received inpatient treatment in one of the Ryazan Regional Vascular centers. The study period was 13 months (2018–2019).

RESULTS: The most common concomitant pathologies were arterial hypertension (70.1%), obesity (46.7%), and diabetes mellitus (17.8%). High- and moderate-risk factors were identified in 26.2% and 72.9% of the patients, respectively. Low-risk factors identified in 5.6% of the patients in different combinations did not have a single risk factor for PE development. Clinical manifestations included shortness of breath (93.5%), chest pain (43.0%), severe weakness (59.8%), tachycardia (29.0%), hypoxemia (27.1%), and unstable hemodynamics (18.7%). The most frequent electrocardiographic sign was a T-wave inversion in the right chest leads (52.3%). Right ventricle dysfunction was detected in 38.1% of the cases and elevation of troponin levels in 33.6%. According to the Pulmonary Embolism Severity Index scale, high- and very-high-risk cases accounted for 46.7% of the cases. According to the results of the integrated assessment of PE severity, 34.6% and 14.0% of the patients moved to the lower- and higher-risk classes, respectively. The proportion of moderate-risk cases increased from 23.4% to 62.6%, and the high- and very-high-risk cases reduced from 46.7% to 32.0%.

CONCLUSION: The modern clinical picture of PE is characterized by a higher prevalence of concomitant pathology and reduction of the rates of traditional risk factors. There remain difficulties in PE diagnosis, which are associated with the concomitant pathology, absence of traditional risk factors, and non-specificity of the clinical manifestations and results of additional examinations.

About the authors

Sergey S. Yakushin

Ryazan State Medical University

Email: prof.yakushin@gmail.com
ORCID iD: 0000-0002-1394-3791
SPIN-code: 7726-7198
ResearcherId: ID A-9290-2017

MD, Dr. Sci. (Med.), Professor

Russian Federation, Ryazan

Natal’ya N. Nikulina

Ryazan State Medical University

Email: natalia.nikulina@mail.ru
ORCID iD: 0000-0001-8593-3173
SPIN-code: 9486-1801
ResearcherId: A-8594-2017

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, Ryazan

Yuliya V. Terekhovskaya

Ryazan Regional Clinical Cardiology Dispensary

Author for correspondence.
Email: shera_11.11@mail.ru
ORCID iD: 0000-0002-9537-1618
SPIN-code: 4980-9875

врач кардиолог I кардиологического отделения

Russian Federation, Ryazan

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Supplementary files

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2. Fig. 1. Ratio of patients with high-, moderate-, and low-risk factors for venous thromboembolism and their combinations. Notes: The area of the colored circles (red, yellow, and green) reflects the number of cases with a certain level of risk factor (high, moderate, and low, respectively) for venous thromboembolism. The overlapping zone shows the number of cases with a simultaneous existence of different levels of risk factors: n1a, patients with isolated high risk factors; n1b, patients with high-, moderate-, and low-risk factors; n1c, patients with high- and low-risk factors; n2b, patients with moderate- and low-risk factors; and n3a, patients with isolated low-risk factors.

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3. Fig. 2. Structure of the cohort of patients hospitalized with pulmonary embolism based on the calculation of the hospital or 30-day death risk. Note: PESI, Pulmonary Embolism Severity Index [1].

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