Francisco Galeano‐Valle

Background Soluble P‐selectin (sP‐selectin) has been proposed as a potential biomarker for venous thromboembolism (VTE) diagnosis with interesting results. However, its role in predicting early mortality in pulmonary embolism (PE) remains unexplored. Methods This observational, prospective, single‐center study enrolled consecutive patients aged 18 or older with confirmed acute symptomatic PE and no prior anticoagulation. The study aims to assess the prognostic capacity of sP‐selectin measured at the time of PE diagnosis for short‐term mortality and major bleeding. Results A total of 196 patients, with a mean age of 69.1 years (SD 17), were included, of whom 52.6% were male. Within 30 days, 9.7% of patients ( n = 19) died, and 5.1% ( n = 10) suffered major bleeding. PE risk stratification revealed 4.6% ( n = 9) with high‐risk PE, 34.7% ( n = 68) with intermediate‐high‐risk PE, 38.3% ( n = 75) with intermediate‐low‐risk PE, and 22.5% ( n = 44) with low‐risk PE according to the European Society of Cardiology score. Mean plasma sP‐selectin levels were comparable between survivors and non‐survivors (489.7 ng/mL ±63 vs. 497.3 ng/mL ±51; p = .9). The ROC curve for 30‐day all‐cause mortality and major bleeding yielded an AUC of 0.49 (95% CI 0.36–0.63) and 0.46 (95% CI 0.24–0.68), respectively. Multivariate and survival analyses were precluded due to lack of significance. Conclusions sP‐selectin was not useful for predicting short‐term mortality or major bleeding in patients with acute symptomatic pulmonary embolism. Further studies are required to clarify the role of sP‐selectin in VTE, particularly in prognosticating PE outcomes.

Introduction: Patients with heart failure (HF) are known to have an increased risk of pulmonary embolism (PE), but there is limited evidence regarding the prognostic implications of HF in patients with acute PE and the relationship between PE prognosis and left ventricular ejection fraction (LVEF). The primary objective of this study was the development of a composite outcome (mortality, major bleeding, and recurrence) within the first 30 days. The secondary objective was to identify the role of LVEF in predicting the development of early complications in patients with both HF and reduced LVEF. Material and Methods: A prospective study was conducted at two tertiary hospitals between January 2012 and December 2022 to assess differences among patients diagnosed with acute PE based on the presence or absence of a history of HF. Cox regression models were employed to assess the impact of HF and reduced LVEF on the composite outcome at 30 days. Results: Out of 1991 patients with acute symptomatic PE, 7.13% had a history of HF. Patients with HF were older and had more comorbidities. The HF group exhibited higher mortality (11.27% vs. 4.33%, p < 0.001) and a higher incidence of major bleeding (9.86% vs. 4.54%, p = 0.005). In the multivariate analysis, HF was an independent risk factor for the development of the composite outcome (HR 1.93; 95% CI 1.35–2.76). Reduced LVEF was independently associated with a higher risk of major bleeding (HR 3.44; 95% CI 1.34–8.81). Conclusion: In patients with acute pulmonary embolism, heart failure is independently associated with a higher risk of early complications. Additionally, heart failure with reduced LVEF is an independent risk factor for major bleeding.