Dynamics of clinical and instrumental parameters and predictors of adverse long-term outcomes in patients with pulmonary embolism
H.K.D. Musa, G.A. Selivanov, V.A. Kokorin
Introduction. Long‑term outcomes after acute pulmonary embolism (PE) remain insufficiently studied. Early identification of patients at high risk for adverse events is an unresolved clinical problem.
Objective: To evaluate the dynamics of clinical, laboratory, and echocardiographic parameters in the patients at 3 months after acute PE and to identify independent predictors of adverse outcome (AO) – all‑cause death, recurrent venous thromboembolism (VTE), or chronic thromboembolic pulmonary hypertension (CTEPH) – within 12 months of follow‑up.
Materials and methods. This retrospective‑prospective observational study included 212 consecutive patients with confirmed acute PE (median age 64 years, 56.6% male). Clinical, laboratory, and echocardiographic assessments were performed at hospital discharge and after 3 months of follow‑up. Multivariable logistic regression analysis was used to identify independent predictors.
Results. An adverse outcome occurred in 47 patients (22.2%): death – 10.8%, recurrent VTE – 11.8%, CTEPH – 7.5%. In patients with a favorable outcome, the prevalence of weakness decreased from 66.9% to 33.8% at 3 months (p <0.001), whereas in the AO group weakness persisted in 75% (p < 0.001 for between‑group difference). Over the 3‑month period, the AO group showed a decrease in estimated glomerular filtration rate (Δ -9.5 ml/min/1.73 m², p = 0.007), no increase in haemoglobin (p = 0.044), an increase in right ventricular size (Δ +2.1 mm, p = 0.037), and no reduction in systolic pulmonary artery pressure (SPAP) (between‑group p <0.001). Independent predictors of adverse outcome were: persistence of weakness at 3 months (OR 3.63, 95% CI: 1.41–9.38, p = 0.008), an increase in right ventricular size per 1 mm (OR 1.15, 95% CI: 1.05–1.26, p = 0.004), and lack of SPAP reduction per 1 mmHg (OR 1.05, 95% CI: 1.01–1.10, p = 0.010). Weakness persisting at 3 months likely reflects reduced exercise tolerance. The identified predictors make it possible to identify a high‑risk group already at an early stage of outpatient follow‑up.
Conclusion. Patients with persistent weakness, absence of regression of pulmonary hypertension, and right ventricular enlargement require dynamic follow‑up.
For citation: Musa HKD, Selivanov GA, Kokorin VA. Dynamics of clinical and instrumental parameters and predictors of adverse long-term outcomes in patients with pulmonary embolism. Therapy (Moscow). 2026;12(5S):10–16.
https://doi.org/10.18565/therapy.2026.5-s5.10-16
Ключевые слова
pulmonary embolism
long‑term outcome
chronic thromboembolic pulmonary hypertension
right ventricle
weakness
echocardiography
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Об авторах / Для корреспонденции
Hamza K.D. Musa, MD, postgraduate student of the Department of hospital therapy with courses in endocrinology, hematology, and clinical and laboratory diagnostics of the Medical Institute, RUDN University; cardiologist at Polyclinic No. 4 of the Voskresensk Hospital, Voskresensk, Russian Federation, Libya.E-mail: Mezobaptista@gmail.com
ORCID: https://orcid.org/0009-0002-4877-6388. eLibrary SPIN: 6425-3342
Gleb A. Selivanov, 5th year student of the Medical Institute, RUDN University, Moscow, Russian Federation.
E-mail: 1032216380@rudn.ru
ORCID: https://orcid.org/0009-0002-6051-8779. Scopus ID: 60189406700. eLibrary SPIN: 8562-1978
Valentin A. Kokorin, MD, Dr. Sci. (Medicine), associate professor, head of the Department of hospital therapy with courses in endocrinology, hematology and clinical and laboratory diagnostics of the Medical Institute, RUDN University; professor of the Department of hospital therapy named after academician P.E. Lukomsky of the Institute of clinical medicine Pirogov Russian National Research Medical University, Moscow, Russian Federation.
E-mail: kokorin_va@rudn.ru
ORCID: https://orcid.org/0000-0001-8614-6542. Scopus ID: 60478883000. eLibrary SPIN: 9772-2288
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