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Yadigaroğlu M, Güzel M, Erdem E, Görgün S, Aksu EA, Ocak M, Yadigaroğlu NÖ, Demir MT, Yücel M. IL-33/sST2 signaling pathway in pulmonary thromboembolism: A clinical observational study. Cytokine 2024; 182:156707. [PMID: 39084069 DOI: 10.1016/j.cyto.2024.156707] [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: 02/15/2024] [Revised: 06/28/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Pulmonary thromboembolism (PTE) is a cardiovascular emergency that can result in mortality. In the interleukin-33 (IL-33) /soluble suppression of tumorigenicity 2 (sST2) signaling pathway, increased sST2 is a cardiovascular risk factor. This study aimed to investigate the effectiveness of biomarkers in the IL-33/sST2 signaling pathway in determining PTE diagnosis, clinical severity, and mortality. METHOD This study was conducted as a single-center, prospective, observational study. Patients admitted to the emergency department and diagnosed with PTE constituted the patient group (n = 112), and healthy volunteers with similar sociodemographic characteristics constituted the control group (n = 62). Biomarkers in the IL-33/sST2 signaling pathway were evaluated for diagnosis, clinical severity, and prognosis. RESULTS IL-33 was lower in the patient group than in the control group (275.89 versus 403.35 pg/mL), while sST2 levels were higher in the patient group than in the control group (53.16 versus 11.78 ng/mL) (p < 0.001 and p = 0.001; respectively). The AUC of IL-33 to diagnose PTE was 0.656 (95 % CI: 0.580-0.726). The optimal IL-33 cut-off point to diagnose PTE was ≤304.11 pg/mL (56.2 % sensitivity, 79 % specificity). The AUC of sST2 to diagnose PTE was 0.818 (95 % CI: 0.752-0.872). The optimal sST2 cut-off point to diagnose PTE was >14.48 ng/mL (83 % sensitivity, 71 % specificity). IL-33 levels were lower in patients with mortality (169.85 versus 332.04 pg/mL) compared to patients without mortality, whereas sST2 levels were higher in patients with mortality (118.32 versus 28.07 ng/mL) compared to patients without mortality (p > 0.001 for both). The AUC of IL-33 to predict the mortality of PTE was 0.801 (95 % CI: 0.715-0.870). The optimal IL-33 cut-off point to predict the mortality of PTE was ≤212.05 pg/mL (75 % sensitivity, 79.5 % specificity). The AUC of sST2 to predict the mortality of PTE was 0.824 (95 % CI: 0.740-0.889). The optimal sST2 cut-off point to predict the mortality of PTE was >81 ng/mL (95.8 % sensitivity, 78.4 % specificity). CONCLUSION In the IL-33/ST2 signaling pathway, decreased IL-33 and increased sST2 are valuable biomarkers for diagnosis and prediction of mortality in patients with PTE.
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Affiliation(s)
- Metin Yadigaroğlu
- Samsun University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey.
| | - Murat Güzel
- Samsun University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey.
| | - Elif Erdem
- Şırnak State Hospital, Department of Emergency Medicine, Şırnak, Turkey.
| | - Selim Görgün
- Samsun Education and Research Hospital, Department of Microbiology and Clinical Microbiology, Samsun, Turkey.
| | - Esra Arslan Aksu
- Samsun University, Faculty of Medicine, Department of Chest Diseases, Samsun, Turkey.
| | - Metin Ocak
- Samsun University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey.
| | | | - Mehmet Tevfik Demir
- Samsun Education and Research Hospital, Department of Emergency Medicine, Samsun, Turkey.
| | - Murat Yücel
- Samsun University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey.
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Thomas SE, Weinberg I, Schainfeld RM, Rosenfield K, Parmar GM. Diagnosis of Pulmonary Embolism: A Review of Evidence-Based Approaches. J Clin Med 2024; 13:3722. [PMID: 38999289 PMCID: PMC11242034 DOI: 10.3390/jcm13133722] [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: 05/13/2024] [Revised: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Venous thromboembolism, commonly presented as pulmonary embolism and deep-vein thrombosis, is a paramount and potentially fatal condition with variable clinical presentation. Diagnosis is key to providing appropriate treatment in a safe and timely fashion. Clinical judgment and assessment using clinical scoring systems should guide diagnostic testing, including laboratory and imaging modalities, for optimal results and to avoid unnecessary testing.
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Affiliation(s)
- Sneha E Thomas
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ido Weinberg
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Robert M Schainfeld
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kenneth Rosenfield
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gaurav M Parmar
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
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Adler AC. Ultrasound Rounds: Intraoperative Point-of-Care Ultrasound Identifies Intracardiac Thrombus and Pulmonary Embolism Allowing for Alteration in Surgical Management. A A Pract 2024; 18:e01796. [PMID: 38842207 DOI: 10.1213/xaa.0000000000001796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Most of the cases demonstrating describing acute findings using point-of-care ultrasound (POCUS) have been described in emergency medicine and critical care medicine. While the use of POCUS has become more prevalent in anesthesia practice, documentation of acute findings resulting in alteration in management based on real-time ultrasound findings during pediatric anesthesia remains limited. This case highlights the use of POCUS during cardiopulmonary collapse occurring during correction of neuromuscular scoliosis. POCUS excluded the presumed diagnosis of venous air embolism and identified an intracardiac thrombus leading to the diagnosis and treatment of pulmonary embolism.
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Affiliation(s)
- Adam C Adler
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Khandait H, Harkut P, Khandait V, Bang V. Acute pulmonary embolism: Diagnosis and management. Indian Heart J 2023; 75:335-342. [PMID: 37207830 PMCID: PMC10568061 DOI: 10.1016/j.ihj.2023.05.007] [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: 12/01/2022] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
Acute pulmonary embolism (PE) can present with non-specific signs and symptoms and thus the diagnosis and management might not be as straightforward. This review outlines the new PE management guidelines in the Indian context. The exact prevalence in the Indian population is not well defined; despite recent studies suggesting an increasing trend in the Asian population. A delay in treatment can be fatal, especially in massive PE. The nuances associated with stratification and management have led to heterogeneity in acute PE management. The purpose of the review is. 1: To highlight the principles of stratification, diagnosis and management of acute PE with a special attention towards the Indian population. 2: To aid patient selection for newer catheter based therapies. To conclude, formulation of pulmonary embolism guidelines in the Indian setting is required underlying the role of further research in this area.
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Affiliation(s)
| | | | | | - Vijay Bang
- Grant Medical College and Sir JJ Group of Hospitals, Maharashtra, India
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5
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Hassine M, Kallala MY, Mahjoub M, Boussaada M, Bouchahda N, Gamra H. [Pulmonary embolism: the Pulmonary Embolism Severity Index (PESI) score and mortality predictors]. Pan Afr Med J 2023; 45:48. [PMID: 37575526 PMCID: PMC10422038 DOI: 10.11604/pamj.2023.45.48.39031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/25/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction pulmonary embolism is a real public health problem because of its high morbidity and mortality rate. The purpose of this study is to evaluate the impact of PESI score on the prognosis of pulmonary embolism. Methods we conducted a retrospective study of 146 cases of formally confirmed embolism. Pulmonary embolism severity index (PESI) score was calculated for the entire study population. The patients were divided into 2 groups: a low-risk group (LR) comprising patients in risk classes I and II: 83 patients; a high-risk group (HR) comprising patients in risk classes III, IV and V: 63 patients; the primary endpoint of the study (MACE) was the occurrence of shock, the need for mechanical ventilation, and the occurrence of in-hospital death. Results total in-hospital mortality was 15.1%, significantly higher in the HR group (25.4% versus 7.2%, p=0.001). In logistic regression analysis, being in the HR group (OR=5.1; 95% CI: [1,637 - 16,093]; p=0.005)) and having renal impairment (OR=4.5; 95% CI: [1.457 - 14.075]; p=0.009) were the independent factors for the occurrence of MACE. After a mean follow-up of 18 ± 8 months, there were more deaths in the HR group (68.4% versus 33%, p=0.004). Conclusion the results of our study show that the PESI score is correlated with the severity of PE. This should encourage the widespread use of this risk score.
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Affiliation(s)
- Majed Hassine
- Cardiology A Department, Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16), University of Monastir, Monastir, Tunisia
| | - Mohamed Yassine Kallala
- Cardiology A Department, Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16), University of Monastir, Monastir, Tunisia
| | - Marouen Mahjoub
- Cardiology A Department, Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16), University of Monastir, Monastir, Tunisia
| | - Mehdi Boussaada
- Cardiology A Department, Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16), University of Monastir, Monastir, Tunisia
| | - Nidhal Bouchahda
- Cardiology A Department, Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16), University of Monastir, Monastir, Tunisia
| | - Habib Gamra
- Cardiology A Department, Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16), University of Monastir, Monastir, Tunisia
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Jenab Y, Hosseini K, Esmaeili Z, Tofighi S, Ariannejad H, Sotoudeh H. Prediction of in-hospital adverse clinical outcomes in patients with pulmonary thromboembolism, machine learning based models. Front Cardiovasc Med 2023; 10:1087702. [PMID: 36998977 PMCID: PMC10043172 DOI: 10.3389/fcvm.2023.1087702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundPulmonary thromboembolism (PE) is the third leading cause of cardiovascular events. The conventional modeling methods and severity risk scores lack multiple laboratories, paraclinical and imaging data. Data science and machine learning (ML) based prediction models may help better predict outcomes.Materials and methodsIn this retrospective registry-based design, all consecutive hospitalized patients diagnosed with pulmonary thromboembolism (based on pulmonary CT angiography) from 2011 to 2019 were recruited. ML based algorithms [Gradient Boosting (GB) and Deep Learning (DL)] were applied and compared with logistic regression (LR) to predict hemodynamic instability and/or all-cause mortality.ResultsA total number of 1,017 patients were finally enrolled in the study, including 465 women and 552 men. Overall incidence of study main endpoint was 9.6%, (7.2% in men and 12.4% in women; p-value = 0.05). The overall performance of the GB model is better than the other two models (AUC: 0.94 for GB vs. 0.88 and 0.90 for DL and LR models respectively). Based on GB model, lower O2 saturation and right ventricle dilation and dysfunction were among the strongest adverse event predictors.ConclusionML-based models have notable prediction ability in PE patients. These algorithms may help physicians to detect high-risk patients earlier and take appropriate preventive measures.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaeili
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Tofighi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence: Saeed Tofighi
| | - Hamid Ariannejad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Houman Sotoudeh
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
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Zhang J, Ali A, Liu Y, Peng L, Pu J, Yi Q, Zhou H. Derivation and Validation of a Prognostic Model for Mortality in Chinese Patients with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2022; 28:10760296221129597. [PMID: 36484273 PMCID: PMC9742928 DOI: 10.1177/10760296221129597] [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] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION We aim to explore the risk factors for in-hospital mortality and to derive a prognostic model for patients with APE in China. MATERIALS AND METHODS Inpatients with APE were enrolled from West China Hospital between January 2016 and December 2019. Logistic regression analyses were used to explore risk factors for in-hospital mortality and develop a prognostic model. RESULTS A total of 813 subjects with APE were included in this study, of whom 542 were in the training set and 271 were in the test set. Multivariable regression analyses indicated that age, male, heart rate, systolic blood pressure, elevated NT-proBNP or troponin T, malignancy, chronic renal insufficiency, and respiratory failure were independent risk factors for in-hospital mortality. For the training set, the area under the curve (AUC) of the ROC curve was 0.899, with a sensitivity and specificity of 89.7% and 77.7%, respectively. The model had higher prediction accuracy than the PESI and sPESI. CONCLUSIONS The prediction model has proven excellent discrimination and calibration, which may be a useful tool to help physicians make decisions regarding the best treatment strategy.
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Affiliation(s)
- Jiarui Zhang
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Adila Ali
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China,Sichuan Cancer Hospital and Institution, Sichuan Cancer Center,
Cancer Hospital Affiliate to School of Medicine, UESTC, Chengdu, Sichuan Province,
China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China,Haixia Zhou, MD, PhD, Qun Yi, MD, PhD,
Department of Respiratory and Critical Care Medicine, West China Hospital,
Sichuan University, Guo-xue-xiang 37#, Wuhou district, Chengdu 610041, Sichuan
Province, China.
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Bobadilla L, Scatularo CE, Antoniolli M, Lerech E, Cigalini IM, Zaidel EJ. IMPACT OF REPERFUSION ON CLINICAL OUTCOMES IN PATIENTS WITH INTERMEDIATE-HIGH RISK PULMONARY EMBOLISM. Curr Probl Cardiol 2022; 47:101308. [DOI: 10.1016/j.cpcardiol.2022.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
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9
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Left Ventricle Outflow Tract Velocity-Time Index and Right Ventricle to Left Ventricle Ratio as Predictors for in Hospital Outcome in Intermediate-Risk Pulmonary Embolism. Diagnostics (Basel) 2022; 12:diagnostics12051226. [PMID: 35626382 PMCID: PMC9139934 DOI: 10.3390/diagnostics12051226] [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: 04/18/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022] Open
Abstract
Accurate estimation of risk with both imaging and biochemical parameters in intermediate risk pulmonary embolism (PE) remains challenging. The aim of the study was to evaluate echocardiographic parameters that reflect right and left heart hemodynamic as predictors of adverse events in intermediate risk PE. This was a retrospective observational study on patients with computed tomography pulmonary angiography diagnosis of PE admitted at Cardiology department of the Clinical Emergency Hospital of Oradea, Romania between January 2018—December 2021. Echocardiographic parameters obtained at admission were studied as predictors of in hospital adverse events. The following adverse outcomes were registered: death, resuscitated cardiac arrest, hemodynamic deterioration and need of rescue thrombolysis. An adverse outcome was present in 50 patients (12.62%). PE related death was registered in 17 patients (4.3%), resuscitated cardiac arrest occurred in 6 patients (1.51%). Another 20 patients (5.05%) required escalation of therapy with thrombolysis and 7 (1.76%) patients developed haemodynamic instability. Echocardiographic independent predictors for in hospital adverse outcome were RV/LV ≥ 1 (HR = 3.599, 95% CI 1.378−9.400, p = 0.009) and VTI ≤ 15 mm (HR = 11.711, 95% CI 4.336−31.633, p < 0.001). The receiver operator curve renders an area under curve for LVOT VTI ≤ 15 mm of 0.792 (95% CI 0.719−0.864, p < 0.001) and for a RV/LV ≥ 1 of 0.746 (95% CI 0.671−0.821, p < 0.001). A combined criterion (LVOT VTI ≤ 15 and RV/LV ≥ 1) showed a positive predictive value of 75% and a negative predictive value of 95% regarding in hospital adverse outcomes. Low LVOT VTI and increased RV/LV are useful for identifying normotensive patients with PE at risk for short term adverse outcomes. Combining an LVOT VTI ≤ 15 cm with a RV/LV ≥ 1 can identify with increased accuracy PE patients with impending risk of clinical deterioration.
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Barrionuevo B, Scatularo CE, Antoniolli M, Lerech E, Morcos L, Bernal MI, Cigalini IM, Zaidel EJ. Predictors of use of direct oral anticoagulants in acute pulmonary embolism. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2022; 92:454-460. [PMID: 36413692 PMCID: PMC9681506 DOI: 10.24875/acm.22000038] [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: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In the last decade, direct oral anticoagulants (DOACs) have been incorporated as an anticoagulation tool in patients with acute pulmonary thromboembolism (PTE). Although they have a better pharmacological profile than vitamin K antagonists (VKA), the use of these drugs is not massive. The objective of this study was to evaluate the use of DOACs in patients with acute PE and to detect determinants of its use. METHODOLOGY Prespecified analysis of the CONAREC XX registry that included patients with acute PE in 64 centers in Argentina. An analysis was performed to detect predictors of DOAC prescription at discharge. RESULTS 579 patients who received anticoagulation at hospital discharge were analyzed: 60% received VKA, 21% heparin and 19% DOAC (of them, 49% Rivaroxaban, 34% Apixaban, and 17% Dabigatran). Patients receiving DOACs had less severe PE, lower risk of bleeding, and fewer in-hospital complications. At 30-day follow-up, there were no differences in all-cause mortality or bleeding. Health coverage by social insurance (OR 7.45, CI 95% 1.74-31.9, p < 0.01) or by private coverage (OR 10.5, CI 95% 2.4-45.9, p < 0.01) were independent predictors of DOAC prescription at discharge, and history of heart failure (OR 0.19, 95% CI 0.04-0.84, p = 0.028) and oncological disease (OR 0.49, 95% CI 0.27-0.89; p = 0.02) were predictors not prescribe them. CONCLUSIONS One in five survivors of acute PE received DOACs at hospital discharge in Argentina, and this was determined by clinical and economic variables.
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Affiliation(s)
| | - Cristhian E. Scatularo
- Servicio de Cardiología, Sanatorio de la Trinidad de Palermo, Ciudad Autónoma de Buenos Aires
| | - Melisa Antoniolli
- Servicio de Cardiología, Sanatorio Finochietto, Ciudad Autónoma de Buenos Aires
| | - Ezequiel Lerech
- Servicio de Cardiología, Hospital Durand, Ciudad Autónoma de Buenos Aires
| | - Ludmila Morcos
- Servicio de Cardiología, Hospital Italiano de Mendoza, Mendoza
| | - Maico I. Bernal
- Servicio de Cardiología, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires
| | - Ignacio M. Cigalini
- Servicio de Cardiología Intervencionista y Tratamientos Endovasculares, Hospital Privado de Rosario, Rosario
| | - Ezequiel J. Zaidel
- Servicio de Cardiología, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires. Argentina
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ÖSKEN A, ÇAM N. The predictive value of systemic immune inflammation index on long-term outcomes among acute pulmonary embolism patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.931405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism. Aging Clin Exp Res 2021; 33:2223-2230. [PMID: 33999379 DOI: 10.1007/s40520-021-01882-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND An increase in short-term mortality can be found among older patients with hemodynamically stable acute pulmonary embolism (APE) who have signs of right ventricular (RV) dysfunction. AIMS This study was designed to assess whether any difference exists among clinical, laboratory, electrocardiography and echocardiography parameters between older and younger patients diagnosed with APE. METHODS The study sample included a total of 635 patients with confirmed APE who were divided into two groups of older (65 years and older) and younger (younger than 65 years) individuals. Comparisons were performed between these groups in terms of clinical, predisposing factors and laboratory, electrocardiographic and echocardiographic parameters. RESULTS Analyses of 295 (46.4%) older and 340 (53.6%) younger patients diagnosed with APE were performed. Female sex, Pulmonary Embolism Severity Index score and baseline creatinine levels were higher in the older group. Also, the frequency of atrial fibrillation, RV outflow tract parasternal long-axis proximal diameter, RV end-diastolic diameter (RV-EDD) basal (apical four-chamber) and RV systolic pressure were significantly greater in older patients with APE. A total of 30 (4.7%) deaths were observed during the in-hospital period [21 (7.1%) older vs 9 (2.6%) younger patients; p < 0.01]. In the multivariate logistic regression analysis, age, white blood cell count (WBC), left ventricular ejection fraction (LVEF), RV-EDD basal and tricuspid annular plane systolic excursion (TAPSE) of less than 16 mm were found to be independently associated with in-hospital mortality. CONCLUSION Older patients might experience greater rates of RV dilatation, RV dysfunction and atrial fibrillation during APE. In addition to age; elevated WBC, low LVEF, increased RV-EDD basal and TAPSE of less than 16 mm were independent predictors of mortality among study population.
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Garcia-Zamora S, Sigal A, Cardinali-Re B, Iglesias RM. CONAREC: 40 years of a very special society. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:477-478. [PMID: 33715979 DOI: 10.1016/j.rec.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - Alan Sigal
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina
| | - Braian Cardinali-Re
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina
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Piazza G. Trailblazing in pulmonary embolism research: the importance of extending beyond randomized controlled trials. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:237-239. [PMID: 33974690 DOI: 10.1093/ehjacc/zuab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
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Tandon R, Singh A, Mohan B. Risk Stratification in Acute Normotensive Pulmonary Embolism– Role of Echocardiography Imaging and Biomarkers. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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