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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017
356
AFRICA
Clinical profile, management and outcomes of patients
with pulmonary embolism: a retrospective tertiary centre
study in Angola
Ana Manuel, Adelina Aufico, Rui Africano, Tomáz Peralta, Abel Salas, Adelaide Silva, José Ricardo,
Pedro Sabola, Domingas Baião, Carlos Sotolongo, António Dias Neto, Telmo Martins, Vasco Sabino,
Joaquim van Dúnem, António Pedro Filipe Júnior
Abstract
Objective:
Pulmonary embolism (PE) is a potentially fatal
disease. In Angola, few data are available on its occurrence.
The aim of the study was to characterise the clinical profile,
management and outcomes of patients with PE.
Methods:
A retrospective observational study was conducted
at the Girassol Clinic in Luanda, Angola. The medical
records of patients admitted to the intensive care unit were
analysed from 2011 to 2015.
Results:
Fifty patients were included and the median age was
50.5
±
17.8 years. Dyspnoea and immobilisation for more
than 72 hours were the most frequently seen risk factors
at admission; 28% of the patients had massive PE, 36%
sub-massive PE, 28% were haemodynamically unstable at
admission and 30% had a very high risk of mortality. The
in-hospital mortality rate was 20%.
Conclusions:
The clinical characteristics of our patients were
similar to those described in the literature. The high preva-
lence of patients with very high risk at admisson highlights
the need to investigate the cause of worst cardiovascular
disease outcomes in Africans.
Keywords:
pulmonary embolism, pulmonary CT angiography,
anticoagulation, cardiovascular disease, Angola, Africa
Submitted 10/4/16, accepted 4/4/17
Published online 17/5/17
Cardiovasc J Afr
2017;
28
: 356–361
www.cvja.co.zaDOI: 10.5830/CVJA-2017-017
Pulmonary embolism (PE) is characterised by obstruction of
the pulmonary arteries by thrombus. It is a potentially fatal
disease in the absence of timely diagnosis and treatment. Venous
thromboembolism is the third most frequent cardiovascular
disease in some Western countries.
1,2
In Africa, the available data
relate to retrospective in-hospital and cohort studies, describing
the mortality rate between 9.2 and 64%.
3-6
The Virchow triad describes the main factors associated
with thrombus formation: blood stasis, hypercoagulable states
and endothelial injury. Despite sharing risk factors, deep-vein
thrombosis is three times more frequent than PE, and both
diseases can co-exist or occur alone.
1,7,8
In Angola, few data are available on the occurrence and
treatment of PE. Considering the need to improve knowledge
about cardiovascular diseases, this study presents the clinical
profile, management and outcomes of patients with PE.
Methods
A retrospective, single-centre, observational study was conducted
at the Girassol Clinic in Luanda, Angola. The study was
approved by the clinical studies ethics committee of the Girassol
clinic polyvalent intensive care unit (ICU). The manuscript is
in accordance with the Helsinki Declaration and with ethical
guidelines from our studies committee.
The medical records of patients admitted to our ICU were
analysed from September 2011 to September 2015. Clinical
suspicion was defined by the physician based on symptoms, signs
and risk factors. Patients with clinical suspicion were included in
the study if PE was confirmed by one of the following diagnostic
tests: pulmonary computed tomography (CT) angiography,
transthoracic echocardiography and Doppler ultrasound of the
limbs.
Demographic variables and the presence of symptoms and
clinical signs of PE were analysed (Fig. 1, Table 1). The presence
of risk factors and co-morbidities is described in Table 2. Patients
were also stratified according to PE risk scores (modified Wells
and Geneva revised scoring systems).
The following diagnostic tests were analysed regarding the
frequency of realisation and positivity rates:
•
Laboratory tests: D-dimer, troponins, B-type natriuretic
peptide (BNP), increased white blood cell count, increased
Cardiothoracic Center, Girassol Clinic, Luanda, Angola
Ana Manuel, MD,
mosalina@live.com.ptTomáz Peralta, MD
Abel Salas, MD
José Ricardo, MD
Pedro Sabola, MD
Domingas Baião, MD
Telmo Martins, MD
António Pedro Filipe Júnior, MD
Intensive Care Unit, Girassol Clinic, Luanda, Angola
Adelina Aufico, MD
Rui Africano, MD
Adelaide Silva, MD
Carlos Sotolongo, MD
António Dias Neto, MD, PhD
Imaging Department, Girassol Clinic, Luanda, Angola
Vasco Sabino, MD
Studies Office, Girassol Clinic, Luanda, Angola
Joaquim van Dúnem, MD, PhD