Prevalência e preditores de embolia pulmonar em pacientes com insuficiência cardíaca agudamente descompensada

background: the prevalence of pulmonary embolism (pe) has not been reported in patients hospitalized due to classical findings of decompensated heart failure (hf). objective: to describe the prevalence of pe and to assess the diagnostic accuracy of the wells and geneva scores in patients hospitalized due to hf. methods: patients hospitalized primarily due to hf underwent systematic ventilation-perfusion lung scan, and pe was defined by a result of high probability. aiming at interpreting, low clinical probability of pe was defined as prevalence < 5%, according to the literature. when calculating the sample size, 49 patients were required to provide a 95% confidence interval with ±10% accuracy, estimating an a priori prevalence of 15%. results: of 51 patients studied, six had a high probability of pe on lung scan, resulting in 12% prevalence (95% ci = 5% - 23%). the wells and geneva scores had an area under the roc curve of 0.53 (95% ci = 0.27 - 0.80; p = 0.80) and 0.43 (95% ci = 0.13 - 0.73; p = 0.56), respectively, indicating lack of accuracy for the diagnosis of pe. alternatively, variables related to hf showed a tendency towards association with pe, and an exploratory model formed by that type of variable showed diagnostic accuracy for pe (roc = 0.81; 95% ci = 0.66 - 0.96; p = 0.01). conclusion: (1) despite the lack of primary suspicion, patients admitted with hf have intermediate clinical probability of concomitant pe; (2) the scores usually used to estimate the clinical probability of pe do not apply to the population with hf, and future predictive models should consider variables related to that syndrome.