ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Obesity in Acute PE - More Good Than Harm?
Session Title
TP88 - TP088 LUCY IN THE SKY WITH DIAMONDS - PULMONARY EMBOLISM, CTEPH, THROMBOSIS, AND COVID19: CLINICAL ADVANCES
Abstract
A3724 - Obesity in Acute PE - More Good Than Harm?
Author Block: O. A. O'Corragain1, D. Sacher1, T. Stiegler2, R. Khatri2, H. Zhao3, G. J. Criner1, P. Rali4; 1Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA, United States, 2Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 3Clinical Sciences, Temple University Hospital, Philadelphia, PA, United States, 4Pulmonary and Critical Care, Temple University, Philadelphia, PA, United States.
Rationale: Obesity has been associated with an increased risk of development of cardiovascular disease including acute pulmonary embolism (PE). The risk of venous thromboembolism (VTE) and recurrent VTE increases with increasing body mass index (BMI). Prognostic data in patients with obesity who develop acute PE however remains mixed, with a protective effect noted in some studies (the so called “obesity paradox”). The aims of this study were to assess the inpatient outcomes, including mortality, need for ICU admission and rates of reperfusion therapy in patients with obesity who develop acute PE. Methods:All patients who underwent assessment by the PE response team (PERT) between January 2017 and June 2019 at Temple University Hospital (Philadelphia, PA) were evaluated. Patients were stratified based on a body mass index (BMI) of < 30 kg/m2 or ≥30 kg/m2. Patient demographics, comorbidities, treatment and outcomes were assessed. Statistical analysis was performed using Wilcoxon analysis for continuous variables and Fisher's Exact test and Chi-Square test for categorical variables. Results: 335 patients were identified, 159 with a BMI <30 and 176 with a BMI ≥30. Patients with a BMI ≥30 were younger (55.2 vs 61.4, p = 0.003), and had lower rates of malignancy (12.5% vs 25.2%, p =0.003) and pre-existing cardiopulmonary disease (35.9% vs 49.6%, p=0.026). Patients with a BMI ≥30 higher rates of right ventricular dysfunction (RVD) on CT (p=0.004) with larger pulmonary artery diameter (30.08 vs 28.53, p=0.033), and higher right ventricular systolic pressure (RVSP) on echocardiography (47.18 vs 40.86, p=0.010). Patients with BMI ≥30 received more reperfusion therapy (31.8% vs 17.6%, p=0.008) driven by higher rates of CDT (21.2% vs 8.4%, p=0.006) and systemic thrombolysis (11.8% vs 3.9%, p=0.016) . There was no difference in length of stay, mortality, 30 day readmission or need for oxygen on discharge. Conclusions: Obese patients, despite lower rates of pre-existing cardiopulmonary disease, and younger age had higher rates of RVD in our cohort, and received higher rates of reperfusion therapies (interventional and non-interventional). Reperfusion therapies in patients with a BMI ≥ 30 may explain a lack of clinical decline, rather than obesity itself as a protective factor in patients with acute PE.
Author Block: O. A. O'Corragain1, D. Sacher1, T. Stiegler2, R. Khatri2, H. Zhao3, G. J. Criner1, P. Rali4; 1Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA, United States, 2Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 3Clinical Sciences, Temple University Hospital, Philadelphia, PA, United States, 4Pulmonary and Critical Care, Temple University, Philadelphia, PA, United States.
Rationale: Obesity has been associated with an increased risk of development of cardiovascular disease including acute pulmonary embolism (PE). The risk of venous thromboembolism (VTE) and recurrent VTE increases with increasing body mass index (BMI). Prognostic data in patients with obesity who develop acute PE however remains mixed, with a protective effect noted in some studies (the so called “obesity paradox”). The aims of this study were to assess the inpatient outcomes, including mortality, need for ICU admission and rates of reperfusion therapy in patients with obesity who develop acute PE. Methods:All patients who underwent assessment by the PE response team (PERT) between January 2017 and June 2019 at Temple University Hospital (Philadelphia, PA) were evaluated. Patients were stratified based on a body mass index (BMI) of < 30 kg/m2 or ≥30 kg/m2. Patient demographics, comorbidities, treatment and outcomes were assessed. Statistical analysis was performed using Wilcoxon analysis for continuous variables and Fisher's Exact test and Chi-Square test for categorical variables. Results: 335 patients were identified, 159 with a BMI <30 and 176 with a BMI ≥30. Patients with a BMI ≥30 were younger (55.2 vs 61.4, p = 0.003), and had lower rates of malignancy (12.5% vs 25.2%, p =0.003) and pre-existing cardiopulmonary disease (35.9% vs 49.6%, p=0.026). Patients with a BMI ≥30 higher rates of right ventricular dysfunction (RVD) on CT (p=0.004) with larger pulmonary artery diameter (30.08 vs 28.53, p=0.033), and higher right ventricular systolic pressure (RVSP) on echocardiography (47.18 vs 40.86, p=0.010). Patients with BMI ≥30 received more reperfusion therapy (31.8% vs 17.6%, p=0.008) driven by higher rates of CDT (21.2% vs 8.4%, p=0.006) and systemic thrombolysis (11.8% vs 3.9%, p=0.016) . There was no difference in length of stay, mortality, 30 day readmission or need for oxygen on discharge. Conclusions: Obese patients, despite lower rates of pre-existing cardiopulmonary disease, and younger age had higher rates of RVD in our cohort, and received higher rates of reperfusion therapies (interventional and non-interventional). Reperfusion therapies in patients with a BMI ≥ 30 may explain a lack of clinical decline, rather than obesity itself as a protective factor in patients with acute PE.
