Clinical Phenotypes With Prognostic Implications in Pulmonary Embolism Patients With Syncope

Shuai Zhang; Xiaomao Xu; Yingqun Ji; Yuanhua Yang; Qun Yi; Hong Chen; Xiaoyun Hu; Zhihong Liu; Yimin Mao; Jie Zhang; Juhong Shi; Jieping Lei; Dingyi Wang; Zhu Zhang; Sinan Wu; Qian Gao; Xincao Tao; Wanmu Xie; Jun Wan; Yunxia Zhang; Meng Zhang; Xiang Shao; Zhonghe Zhang; Baomin Fang; Peiran Yang; Zhenguo Zhai; Chen Wang; China pUlmonary Thromboembolism REgistry Study (CURES) Investigators

doi:10.3389/fcvm.2022.836850

Clinical Phenotypes With Prognostic Implications in Pulmonary Embolism Patients With Syncope

Front Cardiovasc Med. 2022 Feb 15:9:836850. doi: 10.3389/fcvm.2022.836850. eCollection 2022.

Authors

Shuai Zhang^{1

2

3

4}, Xiaomao Xu⁵, Yingqun Ji⁶, Yuanhua Yang⁷, Qun Yi⁸, Hong Chen⁹, Xiaoyun Hu¹⁰, Zhihong Liu¹¹, Yimin Mao¹², Jie Zhang¹³, Juhong Shi¹⁴, Jieping Lei^{1

2

3

4

15}, Dingyi Wang^{1

2

3

4

15}, Zhu Zhang^{1

2

3

4}, Sinan Wu^{1

2

3

4

15}, Qian Gao^{1

2

3

4}, Xincao Tao^{1

2

3

4}, Wanmu Xie^{1

2

3

4}, Jun Wan^{1

2

3

4}, Yunxia Zhang^{1

2

3

4}, Meng Zhang¹⁶, Xiang Shao¹⁷, Zhonghe Zhang⁶, Baomin Fang⁵, Peiran Yang¹⁸, Zhenguo Zhai^{1

2

3

4}, Chen Wang^{1

2

3

4

19

20}; China pUlmonary Thromboembolism REgistry Study (CURES) Investigators

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
² National Center for Respiratory Medicine, Beijing, China.
³ Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
⁴ National Clinical Research Center for Respiratory Disease, Beijing, China.
⁵ Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China.
⁶ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
⁷ Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
⁸ Department of Pulmonary and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.
⁹ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
¹⁰ Department of Pulmonary and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.
¹¹ National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science, Beijing, China.
¹² Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
¹³ Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.
¹⁴ Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.
¹⁵ Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
¹⁶ Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
¹⁷ Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
¹⁸ Department of Pathophysiology, Peking Union Medical College, Beijing, China.
¹⁹ Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
²⁰ Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Abstract

Objectives: There are conflicting data concerning the prognostic significance of syncope in acute pulmonary embolism (PE). This study aimed to investigate the impact of syncope on clinical outcomes of acute PE, and determine the clinical phenotypes of PE patients with syncope and their correlation with prognosis.

Methods: In the ongoing, national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES) enrolling consecutive patients with acute PE, patients with and without syncope were investigated. Principal component analysis (PCA) was performed using nine variables relevant to syncope and PE, including age, sex, body mass index, history of cardiovascular disease, recent surgery or trauma, malignancy, pulse, systolic blood pressure, and respiratory rate. Patient classification was performed using cluster analysis based on the PCA-transformed data. The clinical presentation, disease severity and outcomes were compared among the phenotypes.

Results: In 7,438 patients with acute PE, 777 (10.4%) had syncope, with younger age, more females and higher body mass index. Patients with syncope had higher frequency of precordial pain, palpitation, and elevated cardiac biomarkers, as well as higher D-Dimer level. In the syncope group, more patients had right ventricular/left ventricular ratio > 0.9 in ultrasonic cardiogram and these patients had higher estimated pulmonary arterial systolic pressure compared with patients without syncope. As the initial antithrombotic treatment, more patients with syncope received systemic thrombolysis. Despite a higher prevalence of hemodynamic instability (OR 7.626, 95% CI 2.960-19.644, P < 0.001), syncope did not increase in-hospital death. Principal component analysis revealed that four independent components accounted for 60.3% of variance. PE patients with syncope were classified into four phenotypes, in which patients with high pulse and respiratory rate had markedly higher all-cause mortality during admission.

Conclusion: Syncope was associated with hemodynamic instability and more application of thrombolysis, without increasing in-hospital deaths. Different clinical phenotypes existed in PE patients with syncope, which might be caused by various mechanisms and thus correlated with clinical outcomes.

Keywords: cluster analysis; mortality; phenotype; pulmonary embolism; syncope.

Copyright © 2022 Zhang, Xu, Ji, Yang, Yi, Chen, Hu, Liu, Mao, Zhang, Shi, Lei, Wang, Zhang, Wu, Gao, Tao, Xie, Wan, Zhang, Zhang, Shao, Zhang, Fang, Yang, Zhai, Wang and the China pUlmonary Thromboembolism REgistry Study (CURES) Investigators.