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Pargana J, Calé R, Martinho M, Santos J, Lourenço C, Castro Pereira JA, Araújo P, Morgado J, Pereira E, Judas T, Alegria S, Ferreira F, Delerue F, Pereira H. Prevalence and predictors of chronic thromboembolic pulmonary hypertension following severe forms of acute pulmonary embolism. Rev Port Cardiol 2023; 42:947-958. [PMID: 37652118 DOI: 10.1016/j.repc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The true prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) in the Portuguese population remains unknown. We aimed to assess the prevalence and predictors of CTEPH two years after a symptomatic high- (HR) or intermediate-high risk (IHR) PE. METHODS We conducted a retrospective cohort study of patients admitted with PE between 2014 and 2019 to a Portuguese referral center for pulmonary hypertension. RESULTS In this single-center registry of 969 patients admitted with PE (annual incidence of 46/100000 population), 194 had HR (5.4%) and IHR (14.7%) PE. After excluding patients who died or had no follow-up in the first three months, 129 patients were included in the analysis. The overall prevalence of suspected CTEPH by clinical assessment, Doppler echocardiography and V/Q lung scan was 6.2% (eight patients). CTEPH was confirmed by right heart catheterization in four of these (3.1%). Increased pulmonary artery systolic pressure (PASP) at admission (OR 1.12; 95% CI 1.04-1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95% CI 1.53-36.41; p=0.013) were predictors of CTEPH. PASP >60 mmHg at admission identified patients with CTEPH at follow-up with sensitivity and specificity of 83.3% and 76.3%, respectively. All patients diagnosed with CTEPH had at least two radiological findings suggestive of CTEPH at the index event. CONCLUSIONS In our cohort, the prevalence of CTEPH in survivors of severe forms of acute PE was 6.2%. PASP above 60 mmHg and supporting radiological findings on the index computed tomography scan are highly suggestive of acute-on-chronic CTEPH.
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Affiliation(s)
- Joana Pargana
- Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Lisbon University, Portugal
| | - Rita Calé
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
| | - Mariana Martinho
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - João Santos
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Cândida Lourenço
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | | | - Patrícia Araújo
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - João Morgado
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Ernesto Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisboa, Portugal
| | - Tiago Judas
- Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Filipa Ferreira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Francisca Delerue
- Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Lisbon University, Portugal; Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
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Li S, Liu Y, Liu M, Wang L, Li X. Comprehensive bioinformatics analysis reveals biomarkers of DNA methylation-related genes in varicose veins. Front Genet 2022; 13:1013803. [PMID: 36506327 PMCID: PMC9732536 DOI: 10.3389/fgene.2022.1013803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Patients with Varicose veins (VV) show no obvious symptoms in the early stages, and it is a common and frequent clinical condition. DNA methylation plays a key role in VV by regulating gene expression. However, the molecular mechanism underlying methylation regulation in VV remains unclear. Methods: The mRNA and methylation data of VV and normal samples were obtained from the Gene Expression Omnibus (GEO) database. Methylation-Regulated Genes (MRGs) between VV and normal samples were crossed with VV-associated genes (VVGs) obtained by weighted gene co-expression network analysis (WGCNA) to obtain VV-associated MRGs (VV-MRGs). Their ability to predict disease was assessed using receiver operating characteristic (ROC) curves. Biomarkers were then screened using a random forest model (RF), support vector machine model (SVM), and generalized linear model (GLM). Next, gene set enrichment analysis (GSEA) was performed to explore the functions of biomarkers. Furthermore, we also predicted their drug targets, and constructed a competing endogenous RNAs (ceRNA) network and a drug target network. Finally, we verified their mRNA expression using quantitative real-time polymerase chain reaction (qRT-PCR). Results: Total three VV-MRGs, namely Wnt1-inducible signaling pathway protein 2 (WISP2), Cysteine-rich intestinal protein 1 (CRIP1), and Odd-skipped related 1 (OSR1) were identified by VVGs and MRGs overlapping. The area under the curves (AUCs) of the ROC curves for these three VV-MRGs were greater than 0.8. RF was confirmed as the optimal diagnostic model, and WISP2, CRIP1, and OSR1 were regarded as biomarkers. GSEA showed that WISP2, CRIP1, and OSR1 were associated with oxidative phosphorylation, extracellular matrix (ECM), and respiratory system functions. Furthermore, we found that lncRNA MIR17HG can regulate OSR1 by binding to hsa-miR-21-5p and that PAX2 might treat VV by targeting OSR1. Finally, qRT-PCR results showed that the mRNA expression of the three genes was consistent with the results of the datasets. Conclusion: This study identified WISP2, CRIP1, and OSR1 as biomarkers of VV through comprehensive bioinformatics analysis, and preliminary explored the DNA methylation-related molecular mechanism in VV, which might be important for VV diagnosis and exploration of potential molecular mechanisms.
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Affiliation(s)
- Shengyu Li
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China,*Correspondence: Shengyu Li, ; Xiaofeng Li,
| | - Yuehan Liu
- Department of Functional Examination, Beijing Aerospace General Hospital, Beijing, China
| | - Mingming Liu
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Lizhao Wang
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Xiaofeng Li
- Department of Vascular Surgery, Tianjin First Central Hospital, Tianjin, China,*Correspondence: Shengyu Li, ; Xiaofeng Li,
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Campia U, Rizzo SM, Snyder JE, Pfefferman MA, Morrison RB, Piazza G, Goldhaber SZ. Impact of Atrial Fibrillation on In-Hospital Mortality and Stroke in Acute Aortic Syndromes. Am J Med 2021; 134:1419-1423. [PMID: 34242621 DOI: 10.1016/j.amjmed.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute aortic syndromes may present with a number of cardiovascular complications, including atrial fibrillation. We assessed the prevalence of atrial fibrillation in patients presenting with acute aortic syndromes and evaluated atrial fibrillation's association with in-hospital mortality and stroke. METHODS Consecutive patients with acute aortic syndromes admitted to a single tertiary care center from January 2015 to March 2020 were included. We identified patients with atrial fibrillation on the presenting electrocardiogram. RESULTS A total of 309 patients with acute aortic syndromes were included in our analyses: 148 (48%) presented with Stanford type A and 161 (52%) with Stanford type B acute aortic syndromes. Twenty-seven (8.7%) patients had atrial fibrillation on the presenting electrocardiogram: 12 (44%) with type A and 15 (56%) with type B acute aortic syndromes. Patients with atrial fibrillation were older, more likely to be white, had a higher frequency of history of cancer, peripheral artery disease, cerebrovascular disease, and heart failure with preserved ejection fraction, compared with those without atrial fibrillation. Acute aortic syndromes patients with atrial fibrillation had higher frequencies of in-hospital mortality compared with those without atrial fibrillation (40.7% vs 12.4%, P < .0001). However, stroke frequencies did not differ between the 2 groups. CONCLUSION In patients presenting with acute aortic syndromes and atrial fibrillation, we observed higher frequencies of in-hospital mortality, without differences in the frequencies of stroke.
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Affiliation(s)
- Umberto Campia
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Samantha M Rizzo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Julia E Snyder
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Mariana A Pfefferman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ruth B Morrison
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Bilateral Lung Artery Embolization Mimicking an Acute Myocardial Infarction. Case Rep Med 2021; 2021:6616139. [PMID: 34221022 PMCID: PMC8221849 DOI: 10.1155/2021/6616139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/27/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
Electrocardiographic abnormalities in patients with massive pulmonary embolism are common and unspecific. An 80-year-old woman was admitted to our department with severe respiratory insufficiency and hemodynamic instability. Abnormal high-sensitivity cardiac troponin I and ST-segmental elevation in II, III, aVF, and V3–V6 were present on admission. Segmental motion abnormalities of the left ventricular wall were not detectable in echocardiography. Instead, the presence of a right ventricular strain raised the suspicion of a lung artery embolization. The diagnosis was confirmed by a computed tomography of the chest, and a thrombolytic therapy with 100 mg recombinant tissue plasminogen activator (rt-PA) was administered. Though respiratory and hemodynamic stability were established, electromechanical disassociation suddenly occurred 30 hours later and the patient died. Electrocardiographic changes mimicking a myocardial infarction may occur after a massive pulmonary embolism and constitute a diagnostic challenge for clinicians being active in the field of emergency medicine and intensive care.
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Klimenko AA, Demidova NA, Shostak NA, Anischenko MO. Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-12-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
After suffering pulmonary embolism (PE), doctors are confronted with various consequences of the disease, from asymptomatic residual pulmonary thrombosis to the formation of chronic thromboembolic pulmonary hypertension (CTEPH). There is also a subgroup of patients who have undergone pulmonary embolism, who experience shortness of breath during physical exertion, absent before pulmonary embolism, or shortened dyspnea preceding PE, combined with residual thrombosis of pulmonary artery (PA) and normal average pressure in PA at rest during catheterization of the right heart (CRH). This condition is defined as chronic thromboembolic pulmonary disease or post thromboembolic syndrome. Pathogenetic aspects of this condition are not fully investigated. It is important to predict the development of postembolic syndrome and to develop algorithms for the diagnosis, treatment and rehabilitation of patients with symptoms and residual pulmonary thrombosis. In case of the development of pulmonary vasculopathy in some patients who have undergone pulmonary embolism, a severe life-threatening condition forms - CTEPH, characterized by an increase in pressure in the pulmonary artery, right heart failure due to the presence of organized blood clots that have entered the pulmonary vascular bed during PE. The volume of thrombotic masses does not always correlate with clinical symptoms, which indicates the importance of microvascular remodeling. If CTEPH is suspected, a diagnostic algorithm is required, including ventilation-perfusion scintigraphy, CT angiopulmonography and catheterization of the right heart. Treating a patient with CTEPH is a difficult task fora doctor. The timely referral of the patient to the center where they are involved in treatment, including surgery and CTEPH is extremely important. Timely performed thrombendarterectomy in some cases allows to completely cure the patient. In the case of inoperable CTEPH or residual pulmonary hypertension after thrombendarterectomy, balloon angioplasty of the PA is used as well as drug treatment with specific drugs that reduce the pressure in the PA (riociguat), endothelin receptor antagonists (bosentan, macitentan), prostanoids (inhalant illoprost) phosphodiesterase-5 inhibitor and combined therapy. In this article we considered some consequences directly related to PE: asymptomatic residual pulmonary thrombosis, chronic thromboembolic pulmonary disease, chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
| | | | - N. A. Shostak
- Pirogov Russian National Research Medical University
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Ramírez P, Otero R, Barberà JA. Pulmonary chronic thromboembolic disease. Arch Bronconeumol 2020; 56:314-321. [PMID: 35373741 DOI: 10.1016/j.arbr.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/21/2019] [Indexed: 06/14/2023]
Abstract
Persistent thrombotic lesions are common in patients with pulmonary embolism. These lesions occur on a clinical spectrum, ranging from an asymptomatic course with complete functional recovery to chronic thromboembolic pulmonary hypertension. The concept of chronic thromboembolic disease has emerged in recent years to describe a subgroup of patients with persistent thrombotic lesions who have symptoms on exertion and pulmonary vascular dysfunction, but no pulmonary hypertension at rest. The prevalence of this entity is unknown and the criteria for diagnosing it are not defined. The aim of this article is to analyze post-pulmonary embolism sequelae and review existing evidence on chronic thromboembolic disease, with special emphasis on its diagnosis and therapeutic approach.
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Affiliation(s)
- Purificación Ramírez
- Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Remedios Otero
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío-Instituto de Biomedicina de Sevilla (IBiS); CSIC; Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joan Albert Barberà
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Servicio de Neumología y Alergia Respiratoria, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Universidad de Barcelona, Barcelona, Spain.
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Yang Y, Liu B, Taylor J, Huang Z, Gupta S, Thumma S, Wu L, Wang S, Everett G. Prevalence and Clinical Impact of Atrial Fibrillation in Patients with Pulmonary Embolism. South Med J 2020; 113:93-97. [DOI: 10.14423/smj.0000000000001059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Helmersen D, Provencher S, Hirsch AM, Van Dam A, Dennie C, De Perrot M, Mielniczuk L, Hirani N, Chandy G, Swiston J, Lien D, Kim NH, Delcroix M, Mehta S. Diagnosis of chronic thromboembolic pulmonary hypertension: A Canadian Thoracic Society clinical practice guideline update. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2019.1631663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Doug Helmersen
- Pulmonary Hypertension Program, Division of Respiratory Medicine, Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université de Laval, Quebec, Quebec, Canada
| | - Andrew M. Hirsch
- Centre for Pulmonary Vascular Disease, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anne Van Dam
- Canadian Thoracic Society, Ottawa, Ontario, Canada
| | - Carole Dennie
- Thoracic and Cardiac Imaging Sections, The Ottawa Hospital Cardiac Radiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc De Perrot
- Division of Thoracic Surgery, Toronto General Hospital, Toronto Pulmonary Endarterectomy Program, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute Pulmonary Hypertension Clinic, Cardiology Division, University of Ottawa, Ottawa, Ontario, Canada
| | - Naushad Hirani
- Pulmonary Hypertension Program, Division of Respiratory Medicine, Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada
| | - George Chandy
- University of Ottawa Heart Institute Pulmonary Hypertension Clinic, Respirology Division, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - John Swiston
- Pulmonary Hypertension Program, Respirology Division, Vancouver General Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dale Lien
- University of Alberta Pulmonary Hypertension Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Nick H. Kim
- Pulmonary Vascular Medicine, University of California San Diego, California, U.S.A.
| | - Marion Delcroix
- Centre for Pulmonary Vascular Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sanjay Mehta
- Southwest Ontario Pulmonary Hypertension Clinic, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Esposito R, Santoro C, Sorrentino R, Alcidi G, De Roberto AM, Santoro A, Tufano A, Trimarco B, Galderisi M. The role of cardiovascular ultrasound in diagnosis and management of pulmonary embolism. Future Cardiol 2017; 13:465-477. [PMID: 28832194 DOI: 10.2217/fca-2017-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The diagnosis of acute pulmonary embolism (PE) is one of the most important problems in medical emergencies. Commonly accepted criterion for diagnosis of deep venous thrombosis is the lack of vein compressibility assessed by Compression UltraSonography. Echocardiography represents an easily available and reliable imaging technique in the clinical setting of hemodynamic instability and in the direct visualization of thromboembolic masses in the right heart chambers. Moreover, echocardiography is useful for prognostic stratification after acute PE as right ventricular dysfunction is the most important predictor of mortality in this context. This review aims to highlight usefulness, potentialities and perspectives of standard and advanced echocardiography in evaluating patients affected by PE.
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Affiliation(s)
- Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Gianmarco Alcidi
- Department of Clinical Medicine & Surgery, Federico II University Hospital, Naples, Italy
| | - Anna Maria De Roberto
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Antonella Tufano
- Department of Clinical Medicine & Surgery, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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