Phlebologie 2014; 43(02): 69-76
DOI: 10.12687/phleb2178-2-2014
Original article
Schattauer GmbH

Effect of age on pulmonary embolism

Lungenarterienembolie und Lebensalter
K. Keller
1   Department of Medicine II, University Medical Center Mainz (Johannes Gutenberg-University Mainz, Germany)
2   Centrum for Thrombosis and Haemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz, Germany)
,
J. Beule
3   Department of Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Germany
,
M. Coldewey
1   Department of Medicine II, University Medical Center Mainz (Johannes Gutenberg-University Mainz, Germany)
2   Centrum for Thrombosis and Haemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz, Germany)
,
W. Dippold
3   Department of Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Germany
,
J. O. Balzer
4   Department of Radiology and Nuclear medicine, Katholisches Klinikum Mainz (KKM), Germany
5   Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main, Germany
› Author Affiliations
Further Information

Publication History

Received: 11 November 2013

Accepted: 27 January 2014

Publication Date:
04 January 2018 (online)

Summary

Background: Age is an important and independent risk factor for venous thromboembolism (VTE) and pulmonary embolism (PE). The objectives of this study were to investigate the effects of aging process on PE with regard to the severity of PE, symptoms, inhospital death, history of PE, ECG, echocardiographic, and laboratory findings.

Methods: 182 patients with confirmed PE were reviewed retrospectively and subdivided into 4 age groups (<60, 60–69, 70–79 and ≥ 80 years). Analysis of patients’ symptoms, history, echocardiographic, electrocardiographic and laboratory parameters was performed.

Results: Proportion of women increased with age (<60 years: 41.5 % vs. 80+ years: 73.1 %, P<0.05). Also percentage of right ventricular dysfunction (RVD) was highest in eldest age group (60–69 years: 42.4 % vs. 80+ years: 75 %, P<0.05). Systolic pulmonary artery pressure (sPAP) was significantly higher in the 80+ years age group. The sPAP was constant from the <60 years group (29.0 ± 17.4 mmHg) to the 60–69 years group (27.4 ± 19.3 mmHg), and increased from the 60–69 years and 70–79 years group (33.8 ± 17.5 mmHg) to the 80+ years groups (44.3 ± 14.3 mmHg) (<60 vs. 80+ and 60–69 vs. 80+ years: respectively P<0.001 and 70–79 vs. 80+ years: P<0.05).

Regression model for PE patients 80years showed an association between age 80+ and female gender (OR, 2.53; 95%CI: 1.07–5.99, p<0.05), right bundle branch block (OR, 3.07; 95%CI: 1.05–9.02, p<0.05), RVD (OR, 2.53; 95%CI: 1.07–6.00, p<0.05) and sPAP (OR, 1.05; 95%CI: 1.02–1.08, p<0.001). Pearson correlation matrix revealed a significant correlation between age and sPAP (r=0.30, P<0.001).

Conclusions: Right ventricular load at acute PE event, evident from RVD and elevated sPAP, increases with age. RVD is connected with higher mortality in PE patients. High sPAP at acute PE event is one of the well-known risk factors for the development of chronic thromboembolic pulmonary hypertension in long-term. Proportion of female PE patients increases with age.

Zusammenfassung

Hintergrund: Der Alterungsprozess des menschlichen Organismus ist ein wichtiger und unabhängiger Risikofaktor des venösen Thromboembolismus (VTE) und der Lungenarterienembolie (LE). Das Ziel der vorliegenden Analyse war, den Effekt des Alterungsprozesses auf die LE hinsichtlich Schweregradstadium, Symptome, Versterben im Krankenhaus, medizinische Vorgeschichte, EKG, Echokardiographie und Laborparameter zu untersuchen.

Methoden: 182 Patienten mit einer bestätigten LE wurden retrospektiv analysiert und die Patienten anhand des Alters in 4 Gruppen eingeteilt: <60, 60-69, 70-79 und ≥ 80Jahre. Die Gruppen wurden bezüglich Symptomen, Krankengeschichten, Echokardiographie-, EKG- und Laborergebnissen verglichen.

Ergebnisse: Der Frauenanteil in den Alters-gruppen nahm mit dem Alter zu (<60 Jahre: 41,5 % vs. 80+ Jahre: 73,1 %, P<0,05). Der Anteil einer rechtsventrikulären Dysfunktion (RVD) wuchs mit zunehmendem Alter an und betraf ¾ der ältesten LE-Patienten (60–69 Jahre: 42,4 % vs. 80+ Jahre: 75 %, P<0,05). Der systolische pulmonal-arterielle Druck (sPAP) war in der Gruppe 80+ Jahre signifikant höher als in den anderen Altersgruppen. Der sPAP war weitgehend konstant von der Altersgruppe <60 Jahre (29,0 ± 17,4 mmHg) zur Gruppe 60–69 Jahre (27,4 ± 19,3 mmHg), aber nahm von der Altersgruppe 60–69 Jahre über die Altergruppe 70–79 Jahre (33,8 ± 17,5 mmHg) zur Altergruppe 80+ Jahre deutlich zu (44,3 ± 14,3 mmHg) (<60 vs. 80+ und 60–69 vs. 80+ Jahre: jeweils P<0,001 and 70–79 vs. 80+ Jahre: P<0,05). Das Regressionsmodell für LE Patienten 80 Jahre zeigte eine Assoziation zwischen dem Alter 80+ und sowohl dem weiblichen Geschlecht (OR, 2.53; 95%CI: 1.07–5.99, p<0.05), als auch einem Rechtsschenkelblock (OR, 3.07; 95%CI: 1.05–9.02, p<0.05), einer RVD (OR, 2.53; 95%CI: 1.07–6.00, p<0.05) und dem sPAP (OR, 1.05; 95%CI: 1.02–1.08, p<0.001). Die Pearson-Korrelationsmatrix ließ eine signifikante Korrelation zwischen Alter und sPAP beobachten (r=0.30, P<0.001).

Schlussfolgerungen: Die Rechtsherzbelastung zum Zeitpunkt des akuten LE-Ereignisses, ersichtlich an der RVD und am erhöhten sPAP, wächst mit dem Alter an. Eine RVD geht mit einem erhöhten Mortalitätsrisiko einher. Es ist bekannt, dass ein deutlich erhöhter sPAP zum Zeitpunkt der akuten LE einen Risikofaktor für die Ausbildung einer persistierenden pulmonalen Hypertonie darstellt. Der Frauenanteil an den LE-Patienten steigt mit dem Alter an.

 
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