Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To study the prognostic value of syncope in non-massive pulmonary embolism (PE). Material and methods. Patients (n=64; 35 men and 29 women; aged 52±13 years) with non-massive PE were examined. 13 (20%) patients had a high risk of death according to the ESC criteria, and 51 (80%) — an intermediate risk. PE diagnosis was verified by X-ray contrast angiography or computer angiography of the pulmonary artery. Patients were split into 2 groups: patients of group 1 (n=14) had syncope episodes during the last 24 hours (from 1 to 30), and group 2 (n=50) — did not have. Groups did not differ by age, sex and disease duration. Comparative analysis of clinical and instrumental data, hospital mortality was made. Results. The significant differences for most parameters in the studied groups were not found. Combination of syncope and right bundle branch block on ECG was observed more often in PE patients of high risk mortality: 50% vs 14.2% in groups 1 and 2, respectively (p=0.004). High risk of death was defined 3 times more often in group 1 than this in group 2: 42.8% vs 14% (p=0.017). Syncope at the onset of non-massive PE clinical manifestations associated with more often hypotension development — 42.8% vs 14% in groups 1 and 2, respectively (p=0.017). Patients of group 1 needed in thrombolytic therapy 3 times more often than patients of group 2: 50% vs 16%, respectively. Hospital mortality did not differ significantly — 0 and 2% in groups 1 and 2, respectively. Conclusion. Syncope in non-massive PE, especially in combination with right bundle branch block on ECG, may be considered as a possible criterion for high risk of complications and can be rationale for thrombolytic therapy in addition to standard therapy. Designed studies on prognostic significance of syncope in PE, depending on mass of pulmonary artery lesions and risk stratification are necessary.

About the Authors

E. A. Kurakina
Samara Regional Cardiology Clinic
Russian Federation

D. V. Duplyakov
Samara Regional Cardiology Clinic Samara State Medical University
Russian Federation

S. M. Khokhlunov
Samara Regional Cardiology Clinic Samara State Medical University
Russian Federation

G. S. Kozupitsa
Medical Centre "LITTLE"
Russian Federation


1. Khanevich M.D., Khrupkin V.I., Zubritskiy V.F . et al. Thromboembolism of the pulmonary circulation: Diagnosis, treatment, endovascular surgery , prevention. Moscow: MedEkspertPress; 2003. Russian (Ханевич М.Д., Хрупкин В.И., Зубрицкий В.Ф. и др. Тромбоэмболия малого круга кровообращения: Диагностика, лечение, эндоваскулярная хирургия, профилактика. М.: МедЭкспертПресс; 2003).

2. Bokarev I.N., Popova L.V., Kozlova T.V. Thrombosis and antithrombotic therapy in clinical practice. M.: Meditsinskoe Informatsionnoe Agentstvo; 2009. Russian (Бокарев И.Н., Попова Л.В., Козлова Т .В. Тромбозы и противотромботическая терапия в клинической практике. М.: Медицинское ин- формационное агентство; 2009).

3. Crawford MH. Current Diagnosis and T reatment: Cardiology . 3nd ed. New York, N.Y .: McGraw-Hill; 2003.

4. Wicki J, Perneger TV, Junod AF et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001;161: 92–97.

5. Iles S, Hodges A.M, Darley J.R et al. Clinical experience and pre-test probability scores in the diagnosis of pulmonary embolism. QJM 2002; 96(3): 211–215.

6. Guidelines on the diagnosis and management of acute pulmonary embolism The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008;29, 2276–2315.

7. Castelli R, Tarsia P , Tantardini C, et al. Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope. Vasc Med 2003;8(4):257–261.

8. Koutkia P , Wachtel T.J. Pulmonary embolism presenting as syncope: case report and review of the literature. Heart &Lung 1999;28(5):342–347.

9. Calvo-Romero JM, Perez-Miranda M, Bureo-Dacal P . Syncope in acute pulmonary embolism. Eur J Emerg Med 2004;11(4):208–209.

10. Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J AmColl Cardiol 1997; 30: 1165-1171.

11. Konstantinides S, Geibel A, Olschewski M. et al. Association Between Thrombolytic Treatment and the Prognosis of Hemodynamically Stable Patients With Major Pulmonary Embolism. Results of a Multicenter Registry Circulation 1997;96:882–888.

12. Piazza G, Goldhaber SZ. Acute Pulmonary Embolism Part I: Epidemiology and Diagnosis. Circulation 2006;114:e28–e32.

13. Piazza G, Goldhaber SZ. Management of Submassive Pulmonary Embolism. Circulation 2010;122:1124–1129.

14. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation 2005; 112: 28–32.

15. Stein PD, Terrin ML, Hales CA. et al. Clinical laboratory , roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991;100:598–603.

16. Simpson R.J, Podolak R, Mangano C.A et al. Vagal syncope during recurrent pulmonary embolism. JAMA 1983;249(3):390–393.

17. Charnaya M.A, Morozov Yu.A. Thrombosis in clinical practice. M. Geotar-Media; 2009. Russian (Чарная М.А, Морозов Ю.А. Тромбозы в клинической практике. М.: Г эотар-Медиа; 2009).

18. Moya A, Sutton R, Ammirati F et al. Guidelines for the diagnosis and management of syncope (2009). Eur Heart J 2009; 30: 2631–71.

19. Jimenez, D, Diaz G, Valle M., et al. Prognostic Value of Syncope in the Presentation of Pulmonary Embolism. Arch Bronconeumol 2005;41:385–388.

20. Morpurgo M, Zonzin P . Syncope in acute pulmonary embolism. Ital Heart J 2004; 5 (1): 3–5.

21. Lobo J L., Zorrilla V., Aizpuru F . et al. Clinical syndromes and clinical outcome in patients with pulmonary embolism. Findings from the RIETE Registry. Chest 2006;130;1817–1822

22. Eldadah Z.A, Najjar S.S, Ziegelstein RC. A Patient With Syncope, Only “Vagally” Related to the Heart. Chest 2000;117:1801–1803.

23. Wilner C, Garnier-Crussard JP , Huygue De Mahenge A. et al. Paroxysmal atrioventricular block, a cause of syncope in pulmonary embolism. Presse Med 1983;12:2987–2989.

24. Berghaus TM, Haeckel T , Behr W. et al. Central thromboembolism is a possible predictor of right heart dysfunction in normotensive patients with acute pulmonary embolism. Thromb Res 2010;126(3):201–205.

25. Tereshchenko S.N., editor . Pulmonary embolism: a guide. Moscow: Geotar-Media; 2010. Russian (Терещенко С.Н., редактор. Тромбоэмболия легочной артерии: руководство. Москва: Г еотар-Медиа; 2010).

26. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353: 1386–9.

27. Kumasaka N, Sakuma M, Shirato K. Clinical features and predictors of in-hospital mortality in patients with acute and chronic pulmonary thromboembolism. J Intern Med 2000;39(12):1038–1043.

28. Piazza G, Goldhaber SZ. Fibrinolysis for acute pulmonary embolism. Vasc Med 2010; 15(5): 419– 428.

29. Meneveau N, Ming L P , Serinde M.F et al. In-hospital and long-term outcome after sub-massive and massive pulmonary embolism submitted to thrombolytic therapy. Eur Heart J 2003;24(15):1447– 54.

30. Konstantinides S. Should thrombolytic therapy be used in patients with pulmonary embolism? Am J Cardiovasc Drugs 2004;4(2):69–74.

31. Daniels LB, Parker JA, Patel SR. et al. Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism. Am J Cardiol 1997;80:184–188.

For citation:

Kurakina E.A., Duplyakov D.V., Khokhlunov S.M., Kozupitsa G.S. SYNCOPE IN NON-MASSIVE PULMONARY EMBOLISM AS A PREDICTOR OF HIGH-RISK MORTALITY. Rational Pharmacotherapy in Cardiology. 2012;8(2):158-162. (In Russ.)

Views: 432

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)