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Raghubeer N, Lahri S, Hendrikse C. The value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism: A cross sectional analysis. Afr J Emerg Med 2024; 14:65-69. [PMID: 38425642 PMCID: PMC10899042 DOI: 10.1016/j.afjem.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Pulmonary embolism (PE) is a significant global cause of mortality, ranking third after myocardial infarction and stroke. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. Method This study was a cross sectional analysis based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019 (2 years). The ECGs were independently screened by two blinded emergency physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. Results Of the included 81 patients, 61 (75 %) were female. Of the 41 (51 %) patients with submassive PE and 8 (10 %) with massive PE, 7 (17 %) and 3 (38 %) suffered inpatient mortality (p = 0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95 % CI, 1.1 to 69.9; p = 0.044) and right axis deviation (OR, 5.6; 95 % CI, 1.4 to 22.4; p = 0.015) were significant predictors of inpatient mortality. Conclusion Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.
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Affiliation(s)
- Nishen Raghubeer
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | - Clint Hendrikse
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Xu X, Yuan J, Pan X, Du G, Zhang J. The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism. Stem Cells Int 2022; 2022:5012613. [PMID: 36213685 PMCID: PMC9534721 DOI: 10.1155/2022/5012613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to evaluate the value of bedside echocardiography (TTE) and lower extremity blood vessels in diagnosis and prognosis of acute pulmonary embolism (APE). Methods A retrospective study was performed on 53 patients with APE diagnosed by CT pulmonary angiography (CTPA) (systemic systolic blood pressure was >90 mmHg at time of consultation, and systemic systolic blood pressure decreased by <40 mmHg compared with basic value in those with hypertension). All patients underwent TTE examination before treatment. The high-risk factors, clinical manifestations, laboratory tests, and prognosis were retrospectively analyzed. Results The rate of PE-related deterioration (cardiopulmonary resuscitation, tracheal intubation, cardiogenic shock, and death) within 14 days of hospitalization in RVD was 28%, and mortality rate (sudden death) was 20%, compared with non-RVD (both 0%). TTE examination showed that RVD as a predictor of pulmonary embolism-related death had a sensitivity of 100%, a specificity of 58%, a positive predictive value of 20%, and a negative predictive value of 100%. Conclusions (1) TTE has increasingly shown obvious advantages in diagnosis of APE. It can detect direct or indirect signs of pulmonary embolism, confirm diagnosis or suspected diagnosis, and noninvasively and dynamically observe hemodynamic changes of heart in patients with acute PTE before and after treatment.. (2) The PE-related exacerbation rate (28%) or mortality (20%) of APE patients in normotensive with RVD was higher without RVD (0%). RVD is an independent predictor of poor prognosis in normotensive acute PTE. TTE tests allow people to identify people at risk of early death. The short-term prognosis of patients without RVD was better (14 days).
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Affiliation(s)
- Xinxin Xu
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Jing Yuan
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Xiaojie Pan
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Guibin Du
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Jiahui Zhang
- Department of Mammary Gland, Guangyang Maternal and Child Health Hospital, Langfang, Hebei, China
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Real world data on clinical profile, management and outcomes of venous thromboembolism from a tertiary care centre in India. Indian Heart J 2021; 73:336-341. [PMID: 34154752 PMCID: PMC8322750 DOI: 10.1016/j.ihj.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/21/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Venous thromboembolism (VTE) is a major cause of mortality and morbidity worldwide. This study describes a real-world scenario of VTE presenting to a tertiary care hospital in India. METHODS All patients presenting with acute VTE or associated complications from January 2017 to January 2020 were included in the study. RESULTS A total of 330 patient admissions related to VTE were included over 3 years, of which 303 had an acute episode of VTE. The median age was 50 years (IQR 38-64); 30% of patients were younger than 40 years of age. Only 24% of patients had provoked VTE with recent surgery (56%) and malignancy (16%) being the commonest risk factors. VTE manifested as isolated DVT (56%), isolated pulmonary embolism (PE; 19.1%), combined DVT/PE (22.4%), and upper limb DVT (2.3%). Patients with PE (n = 126) were classified as low-risk (15%), intermediate-risk (55%) and high-risk (29%). Reperfusion therapy was performed for 15.7% of patients with intermediate-risk and 75.6% with high-risk PE. In-hospital mortality for the entire cohort was 8.9%; 35% for high-risk PE and 11% for intermediate-risk PE. On multivariate analysis, the presence of active malignancy (OR = 5.8; 95% CI: 1.1-30.8, p = 0.038) and high-risk PE (OR = 4.8; 95% CI: 1.6-14.9, p = 0.006) were found to be independent predictors of mortality. CONCLUSION Our data provides real-world perspectives on the demographic sand management of patients presenting with acute VTE in a referral hospital setting. We observed relatively high mortality for intermediate-risk PE, necessitating better subclassification of this group to identify candidates for more aggressive approaches.
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Muralidharan TR, Ramesh S, Kumar BV, Ruia AV, Kumar M, Gopalakrishnan A, Johal GS, Hooda A, Malhotra R, Masoomi R, Ramadoss M, Subramanian V, Kalsingh MJ, Manokar P, Rathinasamy J, Sadhanandham S, Balasubramaniyan JV, Krishnamurthy P, Murthy JS, Thanikachalam S, Senguttuvan NB. Clinical profile and management of patients with acute pulmonary thromboembolism - a single centre, large observational study from India. Pulm Circ 2021; 11:2045894021992678. [PMID: 34104416 PMCID: PMC8164559 DOI: 10.1177/2045894021992678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 12/02/2022] Open
Abstract
Acute pulmonary thromboembolism is associated with high mortality, similar to
that of myocardial infarction and stroke. We studied the clinical presentation
and management of pulmonary thromboembolism in the Indian population. An
analysis of 140 patients who presented with acute pulmonary thromboembolism at a
large volume center in India from June 2015 through December 2018 was performed.
The mean age of our study population was 50 years with 59% being male.
Comorbidities including deep vein thrombosis, diabetes mellitus, hypertension,
and chronic obstructive pulmonary disease were present in 52.9%, 40%, 35.7% and
7.14% of patients, respectively. Out of 140 patients, 40 (28.6%) patients had
massive pulmonary thromboembolism, 36 (25.7%) sub-massive pulmonary
thromboembolism, and 64 (45.7%) had low-risk pulmonary thromboembolism. Overall,
in-hospital mortality was 25.7%. Multivariate regression analysis found chronic
kidney disease and pulmonary thromboembolism severity to be the only independent
risk factors. Thrombolysis was performed in 62.5% of patients with a massive
pulmonary thromboembolism and 63.9% of patients with a sub-massive pulmonary
thromboembolism. In the massive pulmonary thromboembolism group, patients
receiving thrombolytic therapy had lower mortality compared with patients who
did not receive therapy (p=0.022), whereas this difference was
not observed in patients in the sub-massive pulmonary thromboembolism group. We
conclude that patients with acute pulmonary thromboembolism in India presented
more than a decade earlier than our western counterparts, and it was associated
with poor clinical outcomes. Thrombolysis was associated with significantly
reduced in-hospital mortality in patients with massive pulmonary
thromboembolism.
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Affiliation(s)
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Aditya V Ruia
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Mohan Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | | | - Gurpreet S Johal
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Amit Hooda
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Rohit Malhotra
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Reza Masoomi
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Mahalakshmi Ramadoss
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Vinodhini Subramanian
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | | | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Jebaraj Rathinasamy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | | | - Jayanthy V Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Jayanthy S Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.,Adjunct Faculty, Department of Engineering & Design Indian Institute of Technology (IIT-M) Chennai, Tamil Nadu
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