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Keller K, Schmitt VH, Hahad O, Espinola-Klein C, Münzel T, Lurz P, Konstantinides S, Hobohm L. Categorization of Patients With Pulmonary Embolism by Charlson Comorbidity Index. Am J Med 2024; 137:727-735. [PMID: 38663792 DOI: 10.1016/j.amjmed.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Short-term outcomes of pulmonary embolism are closely related to right ventricular dysfunction and patient's hemodynamic status, but also to individual comorbidity profile. However, the impact of patients' comorbidities on survival during pulmonary embolism might be underrated. Although the Charlson Comorbidity Index (CCI) is the most extensively studied comorbidity index for detecting comorbidity burden, studies analyzing the impact of CCI on pulmonary embolism patients' survival are limited. METHODS We used the German nationwide inpatient sample to analyze all hospitalized patients with pulmonary embolism in Germany 2005-2020 and calculated CCI for each patient, compared the CCI classes (very low: CCI = 0 points, mild: CCI = 1-2 points, moderate: CCI = 3-4, high severity: CCI >4 points) and impact of CCI class on outcomes. RESULTS Overall, 1,373,145 hospitalizations of patients with acute pulmonary embolism (53.0% females, 55.9% aged ≥70 years) were recorded in Germany between 2005 and 2020; the CCI class stratified them. Among these, 100,156 (7.3%) were categorized as very low; 221,545 (16.1%) as mild; 394,965 (28.8%) as moderate; and 656,479 (47.8%) as patients with a high comorbidity burden according to CCI class. In-hospital case fatality increased depending on the CCI class: 3.6% in very low, 6.5% in mild, 12.1% in moderate, and 22.1% in high CCI class (P < .001). CCI class was associated with increased in-hospital case fatality (odds ratio 2.014; 95% confidence interval, 2.000-2.027; P < .001). CONCLUSION Our study results may help practitioners to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case fatality in patients with pulmonary embolism.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Germany.
| | - Volker H Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Philipp Lurz
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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Li R, Shen S, Jiang J, Liu Y. Prognostic Value of Neutrophil/Lymphocyte Ratio for Pulmonary Embolism: A Meta-Analysis and External Validation. Ann Vasc Surg 2024; 105:48-59. [PMID: 38582200 DOI: 10.1016/j.avsg.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Prognostic value of neutrophil/lymphocyte ratio (NLR) for pulmonary embolism (PE) has been reported in several retrospective studies. The purpose of this investigation was to perform a pooled analysis and external validation of predictive value of NLR. METHODS PubMed, Embase, and Cochrane databases were searched from inception to November 5, 2022. A random effects model was used. Grade was used to evaluate the certainty of evidence. External validation was conducted in clinical cohorts before and after a propensity scoring matching (PSM). Covariates include basic clinical characteristics, such as age, gender, etc. The value of NLR in prediction model was also evaluated. RESULTS A total of 15 studies comprising 5,874 patients were included. Pooled risk ratio of NLR was 2.33 (95% confidence interval [CI]: 1.97-2.75), with an area under the curve of 0.78 (95% CI: 0.74-0.81), a sensitivity of 0.75 (95% CI: 0.71-0.79), a specificity of 0.67 (95% CI: 0.61-0.73), and a median cut-off value of 5.7. Grade of Recommendations Assessment Development and Evaluation (GRADE) certainty analysis showed the quality of the evidence was moderate. Before (n = 336) and after (n = 152) propensity scoring matching, risk ratio of NLR was 2.69 (95% CI: 1.04-6.97) and 6.58 (95% CI: 1.99-17.75). A prediction model consisting of NLR, age, D-dimer, and simplified PE severity index had an area under the curve of 0.809 (95% CI: 0.738-0.88), a sensitivity of 0.638 (95% CI: 0.511-0.745), and a specificity of 0.851 (95% CI: 0.709-0.917). Net reclassification index (12%, P = 0.035) and integrated discrimination improvement (17%, P = 0.022) indicated an improvement caused by NLR. CONCLUSIONS Prognostic value of NLR for PE was confirmed by meta-analysis and validated in an independent cohort, deserving further clinical application.
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Affiliation(s)
- Ruihua Li
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shuohao Shen
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Yang Liu
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Singh G, Bamba H, Inban P, Chandrasekaran SH, Priyatha V, John J, Prajjwal P. The prognostic significance of pro-BNP and heart failure in acute pulmonary embolism: A systematic review. Dis Mon 2024:101783. [PMID: 38955637 DOI: 10.1016/j.disamonth.2024.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Pulmonary embolism (PE) is the third most common type of cardiovascular disease and carries a high mortality rate of 30% if left untreated. Although it is commonly known that individuals who suffer heart failure (HF) are more likely to experience a pulmonary embolism, little is known concerning the prognostic relationship between acute PE and HF. This study aims to evaluate the prognostic usefulness of heart failure and pro-BNP in pulmonary embolism cases. A scientific literature search, including PubMed, Medline, and Cochrane reviews, was used to assess and evaluate the most pertinent research that has been published. The findings showed that increased N-terminal brain natriuretic peptide (NT-proBNP) levels could potentially identify pulmonary embolism patients with worse immediate prognoses and were highly predictive of all-cause death. Important prognostic information can be obtained from NT-proBNP and Heart-type Fatty Acid Binding Proteins (H-FABP) when examining individuals with PE. The heart, distal tubular cells of the renal system, and skeletal muscle are where H-FABP is primarily found, with myocardial cells having the highest concentration. Recent studies have indicated that these biomarkers may also help assess the severity of PE and its long-term risk.
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Affiliation(s)
- Gurmehar Singh
- Government Medical College and Hospital, Chandigarh, India
| | - Hyma Bamba
- Government Medical College and Hospital, Chandigarh, India
| | - Pugazhendi Inban
- Internal Medicine, St. Mary's General Hospital and Saint Clare's Health, NY, USA.
| | | | | | - Jobby John
- Dr. Somervell Memorial CSI Medical College and Hospital Karakonam, Trivandrum, India
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Keller K, Schmitt VH, Hahad O, Hobohm L. Outcome of Pulmonary Embolism with and without Ischemic Stroke. J Clin Med 2024; 13:2730. [PMID: 38792272 PMCID: PMC11122224 DOI: 10.3390/jcm13102730] [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: 03/26/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Ischemic stroke is the second, and pulmonary embolism (PE) is the third most common cardiovascular cause of death after myocardial infarction. Data regarding risk factors for ischemic stroke in patients with acute PE are limited. Methods: Patients were selected by screening the German nationwide in-patient sample for PE (ICD-code I26) and were stratified by ischemic stroke (ICD code I63) and compared. Results: The nationwide in-patient sample comprised 346,586 hospitalized PE patients (53.3% females) in Germany from 2011 to 2014; among these, 6704 (1.9%) patients had additionally an ischemic stroke. PE patients with ischemic stroke had a higher in-hospital mortality rate than those without (28.9% vs. 14.5%, p < 0.001). Ischemic stroke was independently associated with in-hospital death (OR 2.424, 95%CI 2.278-2.579, p < 0.001). Deep venous thrombosis and/or thrombophlebitis (DVT) combined with heart septal defect (OR 24.714 [95%CI 20.693-29.517], p < 0.001) as well as atrial fibrillation/flutter (OR 2.060 [95%CI 1.943-2.183], p < 0.001) were independent risk factors for stroke in PE patients. Systemic thrombolysis was associated with a better survival in PE patients with ischemic thrombolysis who underwent cardio-pulmonary resuscitation (CPR, OR 0.55 [95%CI 0.36-0.84], p = 0.006). Conclusions: Ischemic stroke did negatively affect the survival of PE. Combination of DVT and heart septal defect and atrial fibrillation/flutter were strong and independent risk factors for ischemic stroke in PE patients. In PE patients with ischemic stroke, who had to underwent CPR, systemic thrombolysis was associated with improved survival.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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Welker C, Huang J, Elmadhoun O, Esmaeilzadeh S, Mookadam F, Ramakrishna H. Morbidity Following Pulmonary Embolism Hospitalization- Contributing Factors and Outcomes. J Cardiothorac Vasc Anesth 2024; 38:1239-1243. [PMID: 38402062 DOI: 10.1053/j.jvca.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Carson Welker
- Division of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey Huang
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Omar Elmadhoun
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Sarvie Esmaeilzadeh
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Farouk Mookadam
- Emeritus member, Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Pugliese ME, Battaglia R, Ursino M, Lucca LF, Quintieri M, Vatrano M, Tonin P, Cerasa A. Prevalence and Risk Factors of Deep Venous Thrombosis in Intensive Inpatient Neurorehabilitation Unit. Healthcare (Basel) 2024; 12:936. [PMID: 38727493 PMCID: PMC11082945 DOI: 10.3390/healthcare12090936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Venous thromboembolism (VTE) (deep vein thrombosis and its complication, pulmonary embolism) is a major cause of morbidity and mortality in hospitalized patients and about 7% of these cases are due to immobility secondary to a neurological impairment. Acquired brain injury (ABI) has also been recognized as one of the main risk factors for VTE. Numerous epidemiological studies have been conducted to assess the risk factors for VTE in institutionalized polytrauma patients, although there is a lack of information about neurorehabilitation wards. Since VTE is often undiagnosed, this prospective study aimed to determine the prevalence and clinical characteristics of lower-limb deep venous thrombosis (DVT) in ABI patients at neurorehabilitation admission. METHODS ABI patients were screened for DVT on admission to the intensive rehabilitation unit (IRU) with compression ultrasonography and basal D-dimer assay and were daily clinically monitored until discharge. A total of 127 consecutive ABI patients (mean age: 60.1 ± 17.6 years; 63% male; time from event: 30.9 ± 22.1 days; rehabilitation time in IRU: 84.6 ± 58.4 days) were enrolled. RESULTS On admission to the IRU, the DVT prevalence was about 8.6%. The mean D-dimer level in patients with DVT was significantly higher than in patients without DVT (6 ± 0.9 vs. 1.97 ± 1.61, p-value = 0.0001). ABI patients with DVT did not show any significant clinical characteristics with respect to ABI without DVT, although a prevalence of hemorrhagic strokes and patients originating from the Intensive Care Unit and Neurosurgery ward was revealed. During the rehabilitation period, patients with DVT showed a significant difference in pharmacological DVT prophylaxis (high prevalence of nadroparin with 27.3% vs. 1.7%, p-value = 0.04) and a prevalence of transfers in critical awards (36% versus 9.5% of patients without DVT, p-value = 0.05). The mortality rate was similar in the two groups. CONCLUSIONS Our research offers a more comprehensive view of the clinical development of DVT patients and confirms the prevalence rate of DVT in ABI patients as determined upon IRU admission. According to our findings, screening these individuals regularly at the time of rehabilitation admission may help identify asymptomatic DVT quickly and initiate the proper treatment to avoid potentially fatal consequences. However, to avoid time-consuming general ultrasonography observation, a more precise selection of patients entering the rehabilitation ward is required.
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Affiliation(s)
- Maria Elena Pugliese
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Riccardo Battaglia
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Maria Ursino
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Lucia Francesca Lucca
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Maria Quintieri
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Martina Vatrano
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Paolo Tonin
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
| | - Antonio Cerasa
- Intensive Rehabilitation Unit, S’Anna Institute, 88900 Crotone, Italy; (R.B.); (M.U.); (L.F.L.); (M.Q.); (M.V.); (P.T.)
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
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Wei S, Lu C, Li S, Zhang Q, Cheng R, Pan S, Wu Q, Zhao X, Tian X, Zeng X, Liu Y. Efficacy and safety of mesenchymal stem cell-derived microvesicles in mouse inflammatory arthritis. Int Immunopharmacol 2024; 131:111845. [PMID: 38531171 DOI: 10.1016/j.intimp.2024.111845] [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: 10/29/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To determine the effective and safe intravenous doses of mesenchymal stem cells (MSCs)-derived microvesicles (MVs) and to elucidate the possible causes of death in mice receiving high-dose MVs. METHODS MVs were isolated from human MSCs by gradient centrifugation. Mice with collagen-induced arthritis were treated with different doses of intravenous MVs or MSCs. Arthritis severity, white blood cell count, and serum C-reactive protein levels were measured. To assess the safety profile of MSCs and MVs, mice were treated with different doses of MSCs and MVs, and LD50 was calculated. Mouse lungs and heart were assessed by live fluorescence imaging, histopathological measurements, and immunohistochemistry to explore the possible causes of death. Serum concentrations of cTnT, cTnI, and CK-MB were determined by ELISA. With the H9C2 cardiomyocyte cell line, cellular uptake of MVs was observed using confocal microscopy and cell toxicity was assessed by CCK-8 and flow cytometry. RESULTS Intravenous treatment with MSCs and MVs alleviated inflammatory arthritis, while high doses of MSCs and MVs were lethal. Mice receiving a maximum dose of MSCs (0.1 mL of MSCs at 109/mL) died immediately, while mice receiving a maximum dose of MVs (0.1 mL of MVs at 1012/mL) exhibited tears, drooling, tachycardia, shortness of breath, unbalanced rollover, bouncing, circular crawling, mania, and death. Some mice died after exhibiting convulsions and other symptoms. All mice died shortly after injecting the maximum dose of MSCs. Histologically, mice receiving high doses of MSCs frequently developed pulmonary embolism, while those receiving high doses of MVs died of myocardial infarction. Consistently, the serum levels of cTnT, cTnI, and CK-MB were significantly increased in the MVs-treated group (P < 0.05). The LD50 of intravenous MVs was 1.60 × 1012/kg. Further, MVs could enter the cell. High doses of MVs induced cell apoptosis, though low concentrations of MVs induced cell proliferation. CONCLUSIONS Appropriate dosages of MVs and MSCs are effective treatments for inflammatory arthritis while MVs and MSCs overdose is unsafe by causing cardiopulmonary complications.
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Affiliation(s)
- Shixiong Wei
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, NO. 1 Shuai Fu Yuan, Wang Fu Jing street, Beijing 100730, China; Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - Chenyang Lu
- Division of Rheumatology, Department of Internal Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
| | - Sujia Li
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - Qiuping Zhang
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - Ruijuan Cheng
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - ShuYue Pan
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - QiuHong Wu
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - Xueting Zhao
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, NO. 1 Shuai Fu Yuan, Wang Fu Jing street, Beijing 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, NO. 1 Shuai Fu Yuan, Wang Fu Jing street, Beijing 100730, China.
| | - Yi Liu
- Department of Rheumatology & Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue xiang Wuhou District, Chengdu City, Sichuan Province 610041, China.
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Donadini MP, Mumoli N, Fenu P, Pomero F, Re R, Palmiero G, Spadafora L, Mazzi V, Grittini A, Bertù L, Aujesky D, Dentali F, Ageno W, Squizzato A. The Clinical Impact of the Pulmonary Embolism Severity Index on the Length of Hospital Stay of Patients with Pulmonary Embolism: A Randomized Controlled Trial. Diagnostics (Basel) 2024; 14:776. [PMID: 38611689 PMCID: PMC11011567 DOI: 10.3390/diagnostics14070776] [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: 02/28/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The Pulmonary Embolism Severity Index (PESI) is an extensively validated prognostic score, but impact analyses of the PESI on management strategies, outcomes and health care costs are lacking. Our aim was to assess whether the adoption of the PESI for patients admitted to an internal medicine ward has the potential to safely reduce the length of hospital stay (LOS). METHODS We carried out a multicenter randomized controlled trial, enrolling consecutive adult outpatients diagnosed with acute PE and admitted to an internal medicine ward. Within 48 h after diagnosis, the treating physicians were randomized, for every patient, to calculate and report the PESI in the clinical record form on top of the standard of care (experimental arm) or to continue routine clinical practice (standard of care). The ClinicalTrials.gov identifier is NCT03002467. RESULTS This study was prematurely stopped due to slow recruitment. A total of 118 patients were enrolled at six internal medicine units from 2016 to 2019. The treating physicians were randomized to the use of the PESI for 59 patients or to the standard of care for 59 patients. No difference in the median LOS was found between the experimental arm (8, IQR 6-12) and the standard-of-care arm (8, IQR 6-12) (p = 0.63). A pre-specified secondary analysis showed that the LOS was significantly shorter among the patients who were treated with DOACs (median of 8 days, IQR 5-11) compared to VKAs or heparin (median of 9 days, IQR 7-12) (p = 0.04). CONCLUSIONS The formal calculation of the PESI in the patients already admitted to internal medicine units did not impact the length of hospital stay.
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Affiliation(s)
- Marco Paolo Donadini
- Thrombosis and Haemostasis Center, Ospedale di Circolo, ASST Sette Laghi, 21100 Varese, Italy; (M.P.D.); (F.D.); (W.A.)
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy; (L.B.); (A.S.)
| | - Nicola Mumoli
- Department of Internal Medicine, Magenta Hospital, 20013 Magenta, Italy;
- Presidio Ospedaliero di Livorno, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Patrizia Fenu
- Presidio Ospedaliero di Cecina, Azienda USL Toscana Nord Ovest, 57023 Cecina, Italy;
| | - Fulvio Pomero
- Internal Medicine Unit, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy; (F.P.); (L.S.)
| | - Roberta Re
- Medicina Interna, Ospedale S. Andrea, ASL Vercelli, 13100 Vercelli, Italy;
| | - Gerardo Palmiero
- Ospedale Versilia, Azienda USL Toscana Nord Ovest, 55049 Viareggio, Italy;
| | - Laura Spadafora
- Internal Medicine Unit, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy; (F.P.); (L.S.)
| | - Valeria Mazzi
- Presidio Ospedaliero di Livorno, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | | | - Lorenza Bertù
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy; (L.B.); (A.S.)
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Francesco Dentali
- Thrombosis and Haemostasis Center, Ospedale di Circolo, ASST Sette Laghi, 21100 Varese, Italy; (M.P.D.); (F.D.); (W.A.)
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy; (L.B.); (A.S.)
| | - Walter Ageno
- Thrombosis and Haemostasis Center, Ospedale di Circolo, ASST Sette Laghi, 21100 Varese, Italy; (M.P.D.); (F.D.); (W.A.)
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy; (L.B.); (A.S.)
| | - Alessandro Squizzato
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy; (L.B.); (A.S.)
- Internal Medicine Unit, ‘Sant’Anna’ Hospital, ASST Lariana, 22042 San Fermo della Battagli, Italy
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Silva D, Muders T, Wodack K, Putensen C, Leonhardt S, Siepmann R, Hentze B, Reinartz S. Pulmonary CT perfusion robustly measures cardiac output in the context of multilevel pulmonary occlusion: a porcine study. Eur Radiol Exp 2024; 8:51. [PMID: 38517595 PMCID: PMC10959917 DOI: 10.1186/s41747-024-00431-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/09/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND To validate pulmonary computed tomography (CT) perfusion in a porcine model by invasive monitoring of cardiac output (CO) using thermodilution method. METHODS Animals were studied at a single center, using a Swan-Ganz catheter for invasive CO monitoring as a reference. Fifteen pigs were included. Contrast-enhanced CT perfusion of the descending aorta and right and left pulmonary artery was performed. For variation purposes, a balloon catheter was inserted to block the contralateral pulmonary vascular bed; additionally, two increased CO settings were created by intravenous administration of catecholamines. Finally, stepwise capillary occlusion was performed by intrapulmonary arterial injection of 75-μm microspheres in four stages. A semiautomatic selection of AFs and a recirculation-aware tracer-kinetics model to extract the first-pass of AFs, estimating blood flow with the Stewart-Hamilton method, was implemented. Linear mixed models (LMM) were developed to calibrate blood flow calculations accounting with individual- and cohort-level effects. RESULTS Nine of 15 pigs had complete datasets. Strong correlations were observed between calibrated pulmonary (0.73, 95% confidence interval [CI] 0.6-0.82) and aortic blood flow measurements (0.82, 95% CI, 0.73-0.88) and the reference as well as agreements (± 2.24 L/min and ± 1.86 L/min, respectively) comparable to the state of the art, on a relatively wide range of right ventricle-CO measurements. CONCLUSIONS CT perfusion validly measures CO using LMMs at both individual and cohort levels, as demonstrated by referencing the invasive CO. RELEVANCE STATEMENT Possible clinical applications of CT perfusion for measuring CO could be in acute pulmonary thromboembolism or to assess right ventricular function to show impairment or mismatch to the left ventricle. KEY POINTS • CT perfusion measures flow in vessels. • CT perfusion measures cumulative cardiac output in the aorta and pulmonary vessels. • CT perfusion validly measures CO using LMMs at both individual and cohort levels, as demonstrated by using the invasive CO as a reference standard.
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Affiliation(s)
- Diogo Silva
- Medical Information Technology (MedIT), RWTH Aachen University, Aachen, Germany
| | - Thomas Muders
- Department of Anaesthesiology and Intensive Care Medicine, University Bonn, Bonn, Germany
| | - Karin Wodack
- Department of Anaesthesiology and Intensive Care Medicine, University Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University Bonn, Bonn, Germany
| | - Steffen Leonhardt
- Medical Information Technology (MedIT), RWTH Aachen University, Aachen, Germany
| | - Robert Siepmann
- Department of Diagnostic and Interventional Radiology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Benjamin Hentze
- Medical Information Technology (MedIT), RWTH Aachen University, Aachen, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Bonn, Bonn, Germany
| | - Sebastian Reinartz
- Department of Diagnostic and Interventional Radiology, Uniklinik RWTH Aachen, Aachen, Germany.
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10
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Zuin M, Piazza G, Rigatelli G, Bilato C, Bongarzoni A, Henkin S, Zonzin P, Casazza F, Roncon L. Prognostic Role of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure Ratio for the Identification of Early Clinical Deterioration in Intermediate-High-Risk Pulmonary Embolism Patients. Am J Cardiol 2024; 214:40-46. [PMID: 38218392 DOI: 10.1016/j.amjcard.2023.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate-high-risk patients with pulmonary embolism (PE). A post hoc analysis of intermediate-high-risk patients with PE enrolled in the Italian Pulmonary Embolism Registry (ClinicalTrials.gov: NCT01604538) was performed. All patients underwent transthoracic echocardiography at admission. The primary and secondary outcomes were clinical deterioration within 48 hours from admission and 30-day all-cause mortality, respectively. In 422 intermediate-high-risk patients with PE (mean age 71.2 ± 5.3 years, 238 men), 37 (8.7%) experienced clinical deterioration within 48 hours of admission. The 30-day mortality rate was 6.6% (n = 28). The receiver operating characteristic analysis established 0.33 as the optimal cut-off value for the TAPSE/PASP in predicting 48-hour clinical deterioration (area under the curve 0.79 ± 0.1). The sensitivity, specificity, positive predictive value, and negative predictive value were 81%, 88.5%, 40.5%, and 97.9%, respectively. The multivariate Cox regression analysis showed that a TAPSE/PASP ≤0.33 was an independent predictor of 48-hour clinical deterioration (hazard ratio 2.06, 95% confidence interval 1.98 to 2.11, p <0.0001) and 30-day mortality (hazard ratio 2.28, 95% confidence interval 2.25 to 2.33, p <0.001). TAPSE/PASP shows promise as a noninvasive prognostic predictor to identify intermediate-high-risk patients with PE at a higher risk of early clinical deterioration and short-term mortality.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Gregory Piazza
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Amedeo Bongarzoni
- Department of Cardiology, ASST Santi Paolo e Carlo, University of Milan, Milano, Italy
| | | | - Pietro Zonzin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Franco Casazza
- Department of Cardiology, San Carlo Borromeo Hospital, Milano, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy; Cardiology Clinic, Casa di Cura Città di Rovigo, Rovigo, Italy
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11
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Kenneweg F, Hobohm L, Bang C, Gupta SK, Xiao K, Thum S, Ten Cate V, Rapp S, Hasenfuß G, Wild P, Konstantinides S, Wachter R, Lankeit M, Thum T. Circulating miR-let7a levels predict future diagnosis of chronic thromboembolic pulmonary hypertension. Sci Rep 2024; 14:4514. [PMID: 38402278 PMCID: PMC10894210 DOI: 10.1038/s41598-024-55223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
Distinct patterns of circulating microRNAs (miRNAs) were found to be involved in misguided thrombus resolution. Thus, we aimed to investigate dysregulated miRNA signatures during the acute phase of pulmonary embolism (PE) and test their diagnostic and predictive value for future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Microarray screening and subsequent validation in a large patient cohort (n = 177) identified three dysregulated miRNAs as potential biomarkers: circulating miR-29a and miR-720 were significantly upregulated and miR-let7a was significantly downregulated in plasma of patients with PE. In a second validation study equal expression patterns for miR-29a and miR-let7a regarding an acute event of recurrent venous thromboembolism (VTE) or deaths were found. MiR-let7a concentrations significantly correlated with echocardiographic and laboratory parameters indicating right ventricular (RV) dysfunction. Additionally, circulating miR-let7a levels were associated with diagnosis of CTEPH during follow-up. Regarding CTEPH diagnosis, ROC analysis illustrated an AUC of 0.767 (95% CI 0.54-0.99) for miR-let7a. Using logistic regression analysis, a calculated patient-cohort optimized miR-let7a cut-off value derived from ROC analysis of ≥ 11.92 was associated with a 12.8-fold increased risk for CTEPH. Therefore, miR-let7a might serve as a novel biomarker to identify patients with haemodynamic impairment and as a novel predictor for patients at risk for CTEPH.
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Affiliation(s)
- Franziska Kenneweg
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Claudia Bang
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Shashi K Gupta
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Ke Xiao
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Sabrina Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Vincent Ten Cate
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - Steffen Rapp
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Cardiovascular Research Centre (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Gerd Hasenfuß
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Philipp Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
- German Cardiovascular Research Centre (DZHK), Partner Site Rhine Main, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Rolf Wachter
- Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité-University Medicine Berlin, Berlin, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.
- REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany.
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12
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Lai Y, Chen M, Chen M, Li C, Chen X, Lai Y, Zheng Z, Chen R. Gender differences in the incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: A meta-analysis. Medicine (Baltimore) 2024; 103:e35150. [PMID: 38241593 PMCID: PMC10798717 DOI: 10.1097/md.0000000000035150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/18/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND To explore the role of gender in the incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. METHODS Two researchers search the PubMed Database, Embase Database and Cochrane Library Database from their establishment to October 2022, using Endnote software for document management and RevMan5.3 software for the meta-analysis of the included literature. A total of 11 studies are selected, including 5788 acute pulmonary embolism events and 391 patients (179 males and 212 females) with chronic thromboembolic pulmonary hypertension (CTEPH) under the stated conditions. The results show that there is no statistically significant difference in the incidence of CTEPH between males and females after PE (P = .28), with combined OR of 0.89 and 95% CI 0.72-1.10. RESULTS AND CONCLUSIONS Gender is found to be absent as a factor in the incidence of CTEPH after acute pulmonary embolism. This may indicate that gender is not a risk factor for CTEPH and that female patients are not necessarily more likely to have a higher incidence than male patients. As such, accurate judgments should be made on the possible complications of all patients after acute pulmonary embolism, which will be conducive to early detection and intervention in the treatment of CTEPH.
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Affiliation(s)
- Yuanqiang Lai
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Minshan Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Mingdi Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Chunhe Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojuan Chen
- Medical College of Jiaying University, Meizhou, China
| | - Yuanzhi Lai
- Department of Clinical Medicine, The First Clinical School of Southern Medical University, Guangzhou, China
| | - Zhenzhen Zheng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Riken Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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13
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Palm V, Heye T, Molwitz I, von Stackelberg O, Kauczor HU, Schreyer AG. Sustainability and Climate Protection in Radiology - An Overview. ROFO-FORTSCHR RONTG 2023; 195:981-988. [PMID: 37348529 DOI: 10.1055/a-2093-4177] [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: 06/24/2023]
Abstract
BACKGROUND Sustainability is becoming increasingly important in radiology. Besides climate protection - economic, ecological, and social aspects are integral elements of sustainability. An overview of the scientific background of the sustainability and environmental impact of radiology as well as possibilities for future concepts for more sustainable diagnostic and interventional radiology are presented below.The three elements of sustainability:1. EcologyWith an annually increasing number of tomographic images, Germany is in one of the leading positions worldwide in a per capita comparison. The energy consumption of an MRI system is comparable to 26 four-person households annually. CT and MRI together make a significant contribution to the overall energy consumption of a hospital. In particular, the energy consumption in the idle or inactive state is responsible for a relevant proportion.2. EconomyA critical assessment of the indications for radiological imaging is important not only because of radiation protection, but also in terms of sustainability and "value-based radiology". As part of the "Choosing Wisely" initiative, a total of 600 recommendations for avoiding unnecessary examinations were compiled from various medical societies, including specific indications in radiological diagnostics.3. Social SustainabilityThe alignment of radiology to the needs of patients and referring physicians is a core aspect of the social component of sustainability. Likewise, ensuring employee loyalty by supporting and maintaining motivation, well-being, and job satisfaction is an essential aspect of social sustainability. In addition, sustainable concepts are of relevance in teaching and research, such as the educational curriculum for residents in radiology, RADUCATION or the recommendations of the International Committee of Medical Journal Editors. KEY POINTS · Sustainability comprises three pillars: economy, ecology and the social component.. · Radiologies have a high optimization potential due to a significant demand of these resources.. · A dialogue between medicine, politics and industry is necessary for a sustainable radiology.. · The discourse, knowledge transfer and public communication of recommendations are part of the sustainability network of the German Roentgen Society (DRG).. CITATION FORMAT · Palm V, Heye T, Molwitz I et al. Sustainability and Climate Protection in Radiology - An Overview. Fortschr Röntgenstr 2023; 195: 981 - 988.
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Affiliation(s)
- Viktoria Palm
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany
| | - Tobias Heye
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oyunbileg von Stackelberg
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany
| | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
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14
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Katzenschlager S, Obermaier M, Kuhner M, Spöttl W, Dietrich M, Weigand MA, Weilbacher F, Popp E. [Focus emergency medicine 2022/2023-Summary of selected studies in emergency medicine]. DIE ANAESTHESIOLOGIE 2023; 72:809-820. [PMID: 37725144 DOI: 10.1007/s00101-023-01330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- S Katzenschlager
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - M Obermaier
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kuhner
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - W Spöttl
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Dietrich
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - F Weilbacher
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - E Popp
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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15
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Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med 2023; 72:72-84. [PMID: 37499553 DOI: 10.1016/j.ajem.2023.07.011] [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: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) and pulmonary hypertension (PH) are potentially fatal disease states. Early diagnosis and goal-directed management improve outcomes and survival. Both conditions share several echocardiographic findings of right ventricular dysfunction. This can inadvertently lead to incorrect diagnosis, inappropriate and potentially harmful management, and delay in time-sensitive therapies. Fortunately, bedside echocardiography imparts a few critical distinctions. OBJECTIVE This narrative review describes eight physiologically interdependent echocardiographic parameters that help distinguish acute PE and chronic PH. The manuscript details each finding along with associated pathophysiology and summarization of the literature evaluating diagnostic utility. This guide then provides pearls and pitfalls with high-quality media for the bedside evaluation. DISCUSSION The echocardiographic parameters suggesting acute or chronic right ventricular dysfunction (best used in combination) are: 1. Right heart thrombus (acute PE) 2. Right ventricular free wall thickness (acute ≤ 5 mm, chronic > 5 mm) 3. Tricuspid regurgitation pressure gradient (acute ≤ 46 mmHg, chronic > 46 mmHg, corresponding to tricuspid regurgitation maximal velocity ≤ 3.4 m/sec and > 3.4 m/sec, respectively) 4. Pulmonary artery acceleration time (acute ≤ 60-80 msec, chronic < 105 msec) 5. 60/60 sign (acute) 6. Pulmonary artery early-systolic notching (proximally-located, higher-risk PE) 7. McConnell's sign (acute) 8. Right atrial enlargement (equal to left atrial size suggests acute, greater than left atrial size suggests chronic). CONCLUSIONS Emergency physicians must appreciate the echocardiographic findings and associated pathophysiology that help distinguish acute and chronic right ventricular dysfunction. In the proper clinical context, these findings can point towards PE or PH, thereby leading to earlier goal-directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Robert James Adrian
- Department of Emergency Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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16
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Feng H, Li C, Feng H. Numerical simulation and in vitro experimental study of thrombus capture efficiency of a new retrievable vena cava filter. Comput Methods Biomech Biomed Engin 2023; 26:2034-2046. [PMID: 36625716 DOI: 10.1080/10255842.2022.2163849] [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: 10/21/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023]
Abstract
The vena cava filter is a filtering device to prevent pulmonary embolism caused by thrombosis from lower limbs and pelvis. A new retrievable vena cava filter was evaluated in this paper. To evaluate the hemodynamic performance and thrombus capture efficiency after transplantation, numerical simulation of computational fluid dynamics was performed. In this paper, the two-phase flow model of computational fluid dynamics software was used to analyze the outlet blood flow velocity, inlet-outlet pressure difference, filter wall shear stress, the ratio of area with wall shear stress, and the thrombus capture efficiency with the thrombus diameter of 5 mm, 10 mm, 15 mm and the thrombus content of 10%, 20%, 30%, respectively. Additionally, in vitro experimental test was performed to compare its thrombus capture efficiency with Denali and Aegisy Filters. The Denali Filter showed the least interference with the blood flow, followed by the new filter and the Aegisy Filter. The results indicated that the new filter had a higher capture rate in capturing 5mm small-diameter thrombus. This research certain theoretical significance and reference value for the research and development of the new vena cava filters as well as the evaluation of the thrombus capture efficiency of the filters.
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Affiliation(s)
- Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Changsheng Li
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Haoxiang Feng
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P.R. China
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17
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Canepa M, De Marzo V, Ameri P, Ferrari R, Tavazzi L, Rapezzi C, Porto I, Maggioni AP. Temporal trends in evidence supporting therapeutic interventions in heart failure and other European Society of Cardiology guidelines. ESC Heart Fail 2023; 10:3019-3027. [PMID: 37550897 PMCID: PMC10567640 DOI: 10.1002/ehf2.14459] [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: 12/07/2022] [Revised: 05/20/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS This study aimed to determine whether any change occurred over time in level of evidence (LoE) of therapeutic interventions supporting heart failure (HF) and other European Society of Cardiology guideline recommendations. METHODS AND RESULTS We selected topics with at least three documents released between 2008 and April 2022. Classes of recommendations (CoR) and supporting LoE related to therapeutic interventions within each document were collected and compared over time. A total of 1822 recommendations from 18 documents on 6 topics [median number per document = 112, 867 (48%) CoR I] were included in the analysis. There was a trend towards a reduction over time in the percentage of CoR I in HF (46-36-34%), non-ST elevation myocardial infarction (NSTEMI; 78-58-54%), and pulmonary embolism (PE; 65-50-39%) guidelines, with a decrease in the total number of recommendations for HF only. Percentage of CoR I was stable over time around 40% for valvular heart disease (VHD) and atrial fibrillation (AF), and around 60% for cardiovascular prevention (CVP), with an increase in the total number of recommendations for VHD and CVP and a decrease for AF. Among CoR I, 319 (37%) were supported by LoE A, with a decrease over time for HF (56-46-42%), an increase for NSTEMI (29-38-48%) and AF (28-31-36%), a bimodal distribution for PE and CVP, and a lack for VHD. CONCLUSIONS LoE supporting therapeutic recommendations in contemporary European guidelines is generally low. Physicians should be aware of these limitations, and scientific societies promote a greater understanding of their significance and drive future research directions.
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Affiliation(s)
- Marco Canepa
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | | | - Pietro Ameri
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Roberto Ferrari
- Scientific DepartmentMTA GroupLuganoSwitzerland
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Claudio Rapezzi
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Italo Porto
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Aldo Pietro Maggioni
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
- Centro Studi ANMCO, Heart Care FoundationFlorenceItaly
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18
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Jarman AF, Mumma BE, White R, Dooley E, Yang NT, Taylor SL, Newgard C, Morris C, Cloutier J, Maughan BC. Sex differences in guideline-consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18-49. Acad Emerg Med 2023; 30:896-905. [PMID: 36911917 PMCID: PMC10497718 DOI: 10.1111/acem.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is a frequent diagnostic consideration in emergency department (ED) patients, yet diagnosis is challenging because symptoms of PE are nonspecific. Guidelines recommend the use of clinical decision tools to increase efficiency and avoid harms from overtesting, including D-dimer screening in patients not at high risk for PE. Women undergo testing for PE more often than men yet have a lower yield from testing. Our study objective was to determine whether patient sex influenced the odds of received guideline-consistent care. METHODS We performed a retrospective cohort study at two large U.S. academic EDs from January 1, 2016, to December 31, 2018. Nonpregnant patients aged 18-49 years were included if they presented with chest pain, shortness of breath, hemoptysis, or syncope and underwent testing for PE with D-dimer or imaging. Demographic and clinical data were exported from the electronic medical record (EMR). Pretest risk scores were calculated using manually abstracted EMR data. Diagnostic testing was then compared with recommended testing based on pretest risk. The primary outcome was receipt of guideline-consistent care, which required an elevated screening D-dimer prior to imaging in all non-high-risk patients. RESULTS We studied 1991 discrete patient encounters; 37% (735) of patients were male and 63% (1256) were female. Baseline characteristics, including revised Geneva scores, were similar between sexes. Female patients were more likely to receive guideline-consistent care (70% [874/1256] female vs. 63% [463/735] male, p < 0.01) and less likely to be diagnosed with PE (3.1% [39/1256] female vs. 5.3% [39/735] male, p < 0.05). The most common guideline deviation in both sexes was obtaining imaging without a screening D-dimer in a non-high-risk patient (75% [287/382] female vs. 75% [205/272] male). CONCLUSIONS In this cohort, females were more likely than males to receive care consistent with current guidelines and less likely to be diagnosed with PE.
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Affiliation(s)
- Angela F Jarman
- Department of Emergency Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Richard White
- Department of Internal Medicine, Division of Rheumatology, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Emily Dooley
- University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Nuen Tsang Yang
- Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Sandra L. Taylor
- Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Craig Newgard
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Cynthia Morris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Jared Cloutier
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Brandon C Maughan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
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19
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Ma J, Li C, Zhai Z, Zhen Y, Wang D, Liu M, Liu X, Duan J. Distribution of thrombus predicts severe reperfusion pulmonary edema after pulmonary endarterectomy. Asian J Surg 2023; 46:3766-3772. [PMID: 36997419 DOI: 10.1016/j.asjsur.2023.03.061] [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: 09/29/2022] [Revised: 12/28/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES Patients underwent pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to investigate the effect of thrombus distribution on the occurrence of severe reperfusion pulmonary edema (RPE) and identify specific parameters for predicting severe RPE. METHODS Patients with CTEPH who underwent PEA surgery were retrospectively analyzed. The thrombus in pulmonary arteries were evaluated through computed tomography pulmonary angiography. Based on presence of prolonged artificial ventilation, extracorporeal membrane oxygenation required, or perioperative death due to RPE, the patients were divided into the severe RPE and without severe RPE groups. MAIN RESULTS Among the 77 patients (29 women), 16 (20.8%) patients developed severe RPE. The right major pulmonary artery (RPA) (0.64[0.58, 0.73] vs 0.58[0.49, 0.64]; p = 0.008) and pulmonary artery trunk (PAT) thrombus ratios (0.48[0.44, 0.61] vs 0.42[0.39, 0.50]; p = 0.009) (the PAT ratio is expressed as the sum of the right middle lobe clot burden and right lower lobe clot burden divided by the total clot burden multiplied by 100) of the severe RPE group was significantly higher than that of the without severe RPE group. Receiver operator characteristics curve identified a PAT ratio of 43.4% as the threshold with areas under the curve = 0.71(95%CI 0.582; 0.841) for the development of severe RPE (sensitivity 0.875, specificity 0.541). The logistic regression analysis demonstrated that age, period from symptom onset to PEA, NT-pro BNP, preoperative mPAP, preoperative PVR, RPA ratio, and PAT ratio were associated with the development of severe RPE. Multivariable logistic regression analysis revealed PAT ratio (odds ratio = 10.2; 95% confidence interval 1.87, 55.53, P = 0.007) and period from symptom onset to PEA (OR = 1.01; 95% CI = 1.00-1.02, P = 0.015) as independent risk factors for the development of severe RPE. CONCLUSIONS The thrombus distribution could be a key factor in the severity of RPE. PAT ratio and medical history could predict the development of severe RPE.
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Affiliation(s)
- Junyu Ma
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Chen Li
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Dingyi Wang
- Department of Clinical research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Center for Respiratory Medicine; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; National Clinical Research Center for Respiratory Diseases, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China
| | - Jun Duan
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, 100029, China.
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20
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Weekes AJ, Davison J, Lupez K, Raper JD, Thomas AM, Cox CA, Esener D, Boyd JS, Nomura JT, Murphy K, Ockerse PM, Leech S, Johnson J, Abrams E, Kelly C, O'Connell NS. Quality of life 1 month after acute pulmonary embolism in emergency department patients. Acad Emerg Med 2023; 30:819-831. [PMID: 36786661 DOI: 10.1111/acem.14692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The Pulmonary Embolism Quality-of-Life (PEmb-QoL) questionnaire assesses quality of life (QoL) after pulmonary embolism (PE). We aimed to determine whether any clinical or pathophysiologic features of PE were associated with worse PEmb-QoL scores 1 month after PE. METHODS In this prospective multicenter registry, we conducted PEmb-QoL questionnaires. We determined differences in QoL domain scores for four primary variables: clinical deterioration (death, cardiac arrest, respiratory failure, hypotension requiring fluid bolus, catecholamine support, or new dysrhythmia), right ventricular dysfunction (RVD), PE risk stratification, and subsequent rehospitalization. For overall QoL score, we fit a multivariable regression model that included these four primary variables as independent variables. RESULTS Of 788 PE patients participating in QoL assessments, 156 (19.8%) had a clinical deterioration event, 236 (30.7%) had RVD of which 38 (16.1%) had escalated interventions. For those without and with clinical deterioration, social limitations had mean (±SD) scores of 2.07 (±1.27) and 2.36 (±1.47), respectively (p = 0.027). For intensity of complaints, mean (±SD) scores for patients without RVD (4.32 ± 2.69) were significantly higher than for those with RVD with or without reperfusion interventions (3.82 ± 1.81 and 3.83 ± 2.11, respectively; p = 0.043). There were no domain score differences between PE risk stratification groups. All domain scores were worse for patients with rehospitalization versus without. By multivariable analysis, worse total PEmb-QoL scores with effect sizes were subsequent rehospitalization 11.29 (6.68-15.89), chronic obstructive pulmonary disease (COPD) 8.17 (3.91-12.43), and longer index hospital length of stay 0.06 (0.03-0.08). CONCLUSIONS Acute clinical deterioration, RVD, and PE severity were not predictors of QoL at 1 month post-PE. Independent predictors of worsened QoL were rehospitalization, COPD, and index hospital length of stay.
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Affiliation(s)
- Anthony J Weekes
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Jillian Davison
- Department of Emergency Medicine, Orlando Health, Orlando, Florida, USA
| | - Kathryn Lupez
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
- Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jaron D Raper
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alyssa M Thomas
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
- Emergency Department, Houston Methodist Baytown Hospital, Houston, Texas, USA
| | - Carly A Cox
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
- Emergency Medicine of Idaho, Meridian, Idaho, USA
| | - Dasia Esener
- Department of Emergency Medicine, Kaiser Permanente, San Diego, California, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason T Nomura
- Department of Emergency Medicine, Christiana Care, Newark, Delaware, USA
| | - Kathleen Murphy
- Department of Emergency Medicine, Christiana Care, Newark, Delaware, USA
| | - Patrick M Ockerse
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Stephen Leech
- Department of Emergency Medicine, Orlando Health, Orlando, Florida, USA
| | - Jakea Johnson
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Abrams
- Department of Emergency Medicine, Kaiser Permanente, San Diego, California, USA
| | - Christopher Kelly
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Nathaniel S O'Connell
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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21
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Khasin M, Gur I, Evgrafov EV, Toledano K, Zalts R. Clinical presentations of acute pulmonary embolism: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34224. [PMID: 37443506 PMCID: PMC10344497 DOI: 10.1097/md.0000000000034224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
We aimed to investigate whether the unusual clinical presentation of pulmonary embolism (PE) varies by the type of provocation. In this retrospective cohort study, we examined the electronic health records (EHR) records of all patients diagnosed with PE (upon presentation or during hospitalization) presented to our tertiary hospital during 2014 to 2019. Inclusion criteria were the diagnosis of acute PE and age above 18 years. Excluded were all patients to whom complete EHR were not available. The primary outcome was the main presenting symptom, categorized by a multidisciplinary consensus expert committee as either typical or atypical of PE. Comorbidities, vital signs, medications and laboratory results on presentations were recorded. 591 patients were included in the final analysis. Dyspnea was significantly less common and hemoptysis and chest pain more common in the unprovoked PE group (35%, 5%, and 25%, respectively) compared with nonmalignant (42.6%, 0%, and 16.3%) and malignancy-associated (47.7%, 0.9%, and 8.2%) PE (Pv = 0.02, 0.002 and 0.001, respectively). No recorded symptoms were the third most common presentation overall, accounting for a significantly (Pv < 0.001) higher proportion of PE patients with malignancy (19%) whereas atypical presentation was the hallmark of patients with nonmalignant provokation (19.7%) (Pv = 0.005). Accounting for multiple potential confounders, the risk of atypical or asymptomatic presentation was higher with lower heart rates (RR = 0.974 95%C.I. [0.957-0.990]) and higher pulse oximetry saturation (RR = 1.114 95%CI [1.034-1.201]). The clinical presentation of PE varies with different types of provoking factors, with atypical presentation most common in nonmalignant provocation and asymptomatic presentation most prevalent in patients with underlying malignancy. Further studies are needed to determine the effect of said variance on long term clinical outcomes.
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Affiliation(s)
- Moshe Khasin
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Ivan Gur
- Rambam Medical Center, Haifa, Israel
| | - Elite Vainer Evgrafov
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Kohava Toledano
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Ronen Zalts
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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22
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Konstantinides S. Modern Lung Scintigraphy Techniques for Optimizing the Diagnosis of Pulmonary Embolism: Great Expectations Still Awaiting to Be Met. Thromb Haemost 2023; 123:663-665. [PMID: 36934721 DOI: 10.1055/a-2057-8672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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23
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Sistla P, Kheder K, Iourinets J, Arora P, Desai PV, Brailovsky Y, Darki A. Catheter-Directed Thrombolysis or Catheter-Based Thrombectomy in Acute Pulmonary Embolism: Horses for Courses. Interv Cardiol Clin 2023; 12:309-321. [PMID: 37290836 DOI: 10.1016/j.iccl.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Venous thromboembolism is a common disorder encompassing both pulmonary embolism (PE) and deep vein thrombosis (DVT). In the United States, up to 2 million people are diagnosed with DVT and 600,000 with PE annually. The purpose of this review is to discuss the indications and evidence for catheter-directed thrombolysis versus catheter-based thrombectomy.
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Affiliation(s)
- Phanicharan Sistla
- Department of Interventional Cardiology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Kevin Kheder
- Department of Interventional Cardiology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Julia Iourinets
- Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Punit Arora
- Department of Internal Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Parth V Desai
- Department of Interventional Cardiology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Yevgeniy Brailovsky
- Department of Advanced Heart Failure and Transplantation, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Amir Darki
- Department of Interventional Cardiology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA; Cardiology, Loyola University Medical Center, Pulmonary Embolism Response Team.
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24
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Eckelt J, Hobohm L, Merten MC, Pagel CF, Eggers AS, Lerchbaumer MH, Stangl K, Hasenfuß G, Konstantinides S, Schmidtmann I, Lankeit M, Ebner M. Long-term mortality in patients with pulmonary embolism: results in a single-center registry. Res Pract Thromb Haemost 2023; 7:100280. [PMID: 37601025 PMCID: PMC10439384 DOI: 10.1016/j.rpth.2023.100280] [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: 11/15/2022] [Revised: 04/03/2023] [Accepted: 05/31/2023] [Indexed: 08/22/2023] Open
Abstract
Background While numerous studies have investigated short-term outcomes after pulmonary embolism (PE), long-term mortality remains insufficiently studied. Objectives To investigate long-term outcomes in an unselected cohort of patients with PE. Methods A total of 896 consecutive patients with PE enrolled in a single-center registry between May 2005 and December 2017 were followed up for up to 14 years. The observed mortality rate was compared with the expected rate in the general population. Results The total follow-up time was 3908 patient-years (median, 3.1 years). The 1- and 5-year mortality rates were 19.7% (95% CI, 17.2%-22.4%) and 37.1% (95% CI, 33.6%-40.5%), respectively. The most frequent causes of death were cancer (28.5%), PE (19.4%), infections (13.9%), and cardiovascular events (11.6%). Late mortality (after >30 days) was more frequent than expected in the general population, a finding that was consistent in patients without cancer (the 5-year standardized mortality ratios were 2.77 [95% CI, 2.41-3.16] and 1.80 [95% CI, 1.50-2.14], respectively). Active cancer was the strongest risk factor for death between 30 days and 3 years (hazard ratio [HR], 6.51; 95% CI, 4.67-9.08) but was not associated with later mortality. Death after >3 years was predicted by age (HR, 1.86; 95% CI, 1.51-2.29 per decade), chronic heart failure (HR, 1.66; 95% CI, 1.02-2.70), and anemia (HR, 1.62; 95% CI, 1.09-2.41). Conclusion The risk of mortality in patients with PE remained elevated compared with that in the general population throughout the follow-up period. The main driver of long-term mortality during the first 3 years was cancer. After that, mortality was predicted by age, chronic heart failure, and anemia.
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Affiliation(s)
- Johannes Eckelt
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Marie C. Merten
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Charlotta F. Pagel
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Ann-Sophie Eggers
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Markus H. Lerchbaumer
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Radiology, Campus Charité Mitte (CCM), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Stangl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Mareike Lankeit
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | - Matthias Ebner
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
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25
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Choudry H, Ata F, Ibrahim W, Rana MOR, Ahmad S, Mehmood A, Gill BA, Suheb MK. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series. Open Med (Wars) 2023; 18:20230724. [PMID: 37273918 PMCID: PMC10238810 DOI: 10.1515/med-2023-0724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Saddle pulmonary embolism (SPE) is a rare type of pulmonary embolism that can lead to hemodynamic compromise causing sudden deaths. Due to a dearth of large prospective studies in this area, little is known regarding the epidemiology, and prognosis and factors affecting the latter for COVID-19-associated SPE. We aimed to describe COVID-19-associated SPE and quantify and compare mortality and factors affecting mortality among the cases. We included a total of 25 publications with a total of 35 cases. The average age was 45 ± 16.3 years with 11 females and 24 males. Dyspnoea (82.5%), orthopnoea (43.5%), and cough (43.5%) were the most common symptoms, and obstructive shock was present in five (21.7%) patients. The average reported oxygen (O2) saturation was 85.8% ± 11.9 mm Hg. Hypertension (26.1%), diabetes (21.7%), and deep vein thrombosis (21.7%) were the most commonly reported comorbidities. Right heart strain was recognized in seven (30%) patients on electroencephalogram (S1QIIITIII) and 12 (52.2%) patients on echocardiogram. Anticoagulation, thrombolysis, and percutaneous intervention were tried in 21 (91.3%), 13 (56.5%), and 6 (26.1%) cases, respectively. Despite the aggressive management, 2 of 25 (8.7%) patients died in our smaller case report cohort. We conclude that despite aggressive management modalities, the mortality of SPE remains high in COVID-19.
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Affiliation(s)
- Hassan Choudry
- Department of Respiratory Medicine, University Hospital of Leicester, LeicesterLE1, UK
| | - Fateen Ata
- Department of Endocrinology, Hamad General Hospital, Hammad Medical Corporation, PO BOX 3050, Doha, Qatar
| | - Wanis Ibrahim
- Department of Internal Medicine and Pulmonology, Hammad Medical Corporation, Doha, Qatar
| | - Mohammad Omer Rehman Rana
- Department of Adult Cardiology, Chaudhary Pervaiz Ilahi Institute of Cardiology, Wazirabad, Pakistan
| | - Shoaib Ahmad
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Asim Mehmood
- Respiratory Department, Derriford Hospital, University Hospitals Plymouth, Plymouth, UK
| | - Basir Afzaal Gill
- Intensive Care Unit, Department of Anaesthesia, Jinnah Hospital, Lahore, Pakistan
| | - Mahammed Khan Suheb
- Critical Care Department, St. Luke’s Aurora Hospital, Milwaukee, Wisconsin, USA
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26
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Eggers AS, Hafian A, Lerchbaumer MH, Hasenfuß G, Stangl K, Pieske B, Lankeit M, Ebner M. Acute Infections and Inflammatory Biomarkers in Patients with Acute Pulmonary Embolism. J Clin Med 2023; 12:jcm12103546. [PMID: 37240652 DOI: 10.3390/jcm12103546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Although infections are frequent in patients with pulmonary embolism (PE), its effect on adverse outcome risk remains unclear. We investigated the incidence and prognostic impact of infections requiring antibiotic treatment and of inflammatory biomarkers (C-reactive protein [CRP] and procalcitonin [PCT]) on in-hospital adverse outcomes (all-cause mortality or hemodynamic insufficiency) in 749 consecutive PE patients enrolled in a single-centre registry. Adverse outcomes occurred in 65 patients. Clinically relevant infections were observed in 46.3% of patients and there was an increased adverse outcome risk with an odds ratio (OR) of 3.12 (95% confidence interval [CI] 1.70-5.74), comparable to an increase in one risk class of the European Society of Cardiology (ESC) risk stratification algorithm (OR 3.45 [95% CI 2.24-5.30]). CRP > 124 mg/dL and PCT > 0.25 µg/L predicted patient outcome independent of other risk factors and were associated with respective ORs for an adverse outcome of 4.87 (95% CI 2.55-9.33) and 5.91 (95% CI 2.74-12.76). In conclusion, clinically relevant infections requiring antibiotic treatment were observed in almost half of patients with acute PE and carried a similar prognostic effect to an increase in one risk class of the ESC risk stratification algorithm. Furthermore, elevated levels of CRP and PCT seemed to be independent predictors of adverse outcome.
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Affiliation(s)
- Ann-Sophie Eggers
- Department of Cardiology, Angiology and Intensive Care Medicine, Charité Campus Virchow-Klinikum Mittelallee, German Heart Center of the Charité-University Medicine Berlin, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Alaa Hafian
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Goettingen, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Campus Charité Mitte (CCM), Charité-University Medicine Berlin, 10117 Berlin, Germany
| | - Gerd Hasenfuß
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, 37075 Goettingen, Germany
| | - Karl Stangl
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Charité Campus Mitte, German Heart Center of the Charité-University Medicine Berlin, 10117 Berlin, Germany
| | | | - Mareike Lankeit
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Goettingen, Germany
| | - Matthias Ebner
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Charité Campus Mitte, German Heart Center of the Charité-University Medicine Berlin, 10117 Berlin, Germany
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Shang Z, Wanyan P, Zhang B, Wang M, Wang X. Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis. Front Cardiovasc Med 2023; 10:1153432. [PMID: 37252120 PMCID: PMC10213678 DOI: 10.3389/fcvm.2023.1153432] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Spinal cord injury (SCI) is a highly disabling disease with huge public health burden. The complications associated with it, especially deep vein thrombosis (DVT), further aggravate the disability. Objective To explore the incidence and risk factors of DVT after SCI, in order to provide guidance for disease prevention in the future. Methods A search was performed on PubMed, Web of Science, Embase, and Cochrane database up to November 9, 2022. Literature screening, information extraction and quality evaluation were performed by two researchers. The data was later combined by metaprop and metan commands in STATA 16.0. Results A total of 101 articles were included, including 223,221 patients. Meta-analysis showed that the overall incidence of DVT was 9.3% (95% CI: 8.2%-10.6%), and the incidence of DVT in patients with acute and chronic SCI was 10.9% (95% CI: 8.7%-13.2%) and 5.3% (95% CI: 2.2%-9.7%), respectively. The incidence of DVT decreased gradually with the accumulation of publication years and sample size. However, the annual incidence of DVT has increased since 2017. There are 24 kinds of risk factors that may contribute to the formation of DVT, involving multiple aspects of the baseline characteristics of the patient, biochemical indicators, severity of SCI, and comorbidities. Conclusions The incidence of DVT after SCI is high and has been gradually increasing in recent years. Moreover, there are numerous risk factors associated with DVT. Comprehensive preventive measures need to be taken as early as possible in the future. Systematic Review Registration www.crd.york.ac.uk/prospero, identifier CRD42022377466.
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Affiliation(s)
- Zhizhong Shang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Pingping Wanyan
- Department of Pathology and Pathophysiology, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Nephrology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Baolin Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Mingchuan Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xin Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- Chengren Institute of Traditional Chinese Medicine, Lanzhou, China
- Department of Spine, Changzheng Hospital, Naval Medical University, Shanghai, China
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Zuin M, Bilato C, Bongarzoni A, Zonzin P, Casazza F, Roncon L. Prognostic role of different temporal patterns of dyspnoea onset in patients with acute pulmonary embolism. J Cardiovasc Med (Hagerstown) 2023:01244665-990000000-00112. [PMID: 37129920 DOI: 10.2459/jcm.0000000000001477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIMS Dyspnoea is a well known symptom of acute pulmonary embolism (PE). We assess the prognostic role of different patterns of dyspnoea onset regarding in-hospital mortality, clinical deterioration and the composite of the outcomes in PE patients, according to their haemodynamic status at admission. METHODS Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, patients were stratified, according to their haemodynamic status, as high- (haemodynamically unstable) and non-high-risk (haemodynamically stable) patients. RESULTS Overall, 1623 consecutive patients (mean age 70.2 ± 15.2 years, 696 males), with confirmed acute PE, were evaluated for the features of dyspnoea. Among these, 1353 (83.3%) experienced dyspnoea at admission. No significant differences were observed regarding in-hospital mortality and the composite outcome of in-hospital mortality and clinical deterioration between patients with and without dyspnoea. However, in non-high-risk patients, clinical deterioration was more frequently observed when dyspnoea was present compared with absence of dyspnoea (P = 0.002). Multivariate Cox regression analyses showed that non-high-risk patients had an increased risk of clinical deterioration when experiencing dyspnoea within 24 h [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.49-1.65, P < 0.0001] and between 25 h and 7 days before admission (HR: 1.66, 95% CI: 1.58-1.77, P < 0.0001), independently of age, sex, right ventricular dysfunction, positive cardiac troponin and thrombolysis. CONCLUSIONS Non-high-risk PE patients experiencing dyspnoea within 7 days before hospitalization had a higher risk of clinical deterioration compared with those without and, therefore, they may require more aggressive management.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza
| | - Amedeo Bongarzoni
- Department of Cardiology, ASST Santi Paolo e Carlo, University of Milan, Milan
| | - Pietro Zonzin
- Department of Cardiology, Rovigo General Hospital, Rovigo
| | - Franco Casazza
- Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo
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Keller K, Kohring C, Farmakis IT, Valerio L, Barco S, Bätzing J, Akmatov MK, Konstantinides S, Münzel T, Hobohm L, Holstiege J. Impact of venous thromboembolism on incidence of arterial thromboembolism - An analysis of German outpatient claims data. Thromb Res 2023; 226:9-17. [PMID: 37079980 DOI: 10.1016/j.thromres.2023.04.008] [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: 01/07/2023] [Revised: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) and arterial thromboembolism (ATE) are considered as two separate disease-entities. In recent years, studies have reported clear associations between VTE and atherosclerosis. We aimed to evaluate the long-term risk of ATE in VTE patients in comparison to controls without VTE. METHODS Nationwide outpatient claims data of all inhabitants with statutory health insurance in Germany were used for secondary data analysis between the years 2011 and 2020. Patients treated in 2013 were stratified by VTE event, and groups were 1:2-matched by age and sex. The hazard for an ATE event in a 5-year follow-up period between patients with and without VTE was calculated with multivariable Cox regression adjusted for age, sex, cardiovascular risk factors, and comorbidities. RESULTS Of 69,699,277 individuals treated in the year 2013 by German physicians in outpatient care, in total 686,382 individuals (age 59.8 ± 17.5 years, 65.4 % females) were included comprising 228,794 patients with VTE and 457,588 controls without VTE. VTE patients more often had cardiovascular risk factors (81.6 % vs. 62.2 %) and traditional VTE risk factors. The occurrence of ATE events during follow-up was 1.8 %-points higher in VTE patients in comparison to the controls (9.7 % vs. 7.9 %). VTE events were independently associated with increased occurrence of ATE events within follow-up (HRadjusted 1.19 [99%CI 1.16-1.23], p < 0.0001). CONCLUSIONS Patients with a VTE event have an increased long-term risk for subsequent arterial cardiovascular events. Large prospective cohorts are needed to identify patient subgroups with a very high ATE risk after VTE.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Claudia Kohring
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Luca Valerio
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Manas K Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
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30
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Qin S, Liu H, Cao X, Zhang R. Clinical application value of echocardiography in evaluating left ventricular diastolic function in patients with acute pulmonary embolism. Perfusion 2023; 38:477-483. [PMID: 35484778 DOI: 10.1177/02676591211058287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the clinical value of echocardiography in the assessment of left ventricular diastolic function in patients with acute pulmonary embolism (APE). METHODS APE patients in our hospital from June 2019 to June 2021 were selected as the observation group. They were divided into low-risk group (19 cases), medium-risk group (16 cases) and high-risk group (15 cases). The non-APE people in our hospital during the same period were selected as the control group. All subjects underwent echocardiography to observe the performance of APE patients under echocardiography. The peak velocity ratio S-wave/D-wave (S/D), early diastolic annular velocity/advanced diastolic annular velocity (Ea/Aa), early filling/early diastolic annular velocity (E/Ea), and early filling/early diastolic annular velocity (E/Ea) were compared with Ar and Vp, respectively; receiver operator characteristic (ROC) curve was used to evaluate the value of echocardiography in evaluating left ventricular diastolic function in patients with APE. RESULTS Echocardiography show different manifestations of APE patients. Compared with the control group, S/D, Ea/Aa, and Vp in the observation group were significantly decreased and E/Ea and Ar in the observation group were significantly increased (p < 0.05). With the increase of risk stratification, S/D, Ea/Aa, and Vp gradually decreased, E/Ea and Ar gradually increased, and the difference was statistically significant (p < 0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, area under curve (AUC), and 95% CI were 89.52%, 65.57%, 72.86%, 80.82%, 75.38%, 0.730, and 0.629-0.831, respectively. CONCLUSION Echocardiography can effectively evaluate left ventricular diastolic function in patients with APE, and there are significant differences in left ventricular diastolic function in different risk stratification, which has important reference value for clinical diagnosis and treatment of APE.
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Affiliation(s)
- Shiyang Qin
- Department of Ultrasound, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Huiling Liu
- Department of Ultrasound, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Xuesong Cao
- Department of Ultrasound, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Rui Zhang
- Department of physical examination, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
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31
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Xiaoxiao G, Li L, Shijin G, Yueben W, Junhai Z. Investigation and analysis of status of mechanical prevention of venous thrombosis in ICU. Nurs Open 2023; 10:2648-2655. [PMID: 36517918 PMCID: PMC10006585 DOI: 10.1002/nop2.1525] [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: 03/09/2022] [Revised: 10/20/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS The presented paper aims at understanding the current situation of mechanical prevention of venous thrombosis in ICU. DESIGN A questionnaire survey. METHODS A self-developed Questionnaire on the Current Situation of VTE Mechanical Prevention in ICU was distributed. RESULTS A total of 125 valid questionnaires were collected. The results shows that only 11.2% ICUs had the ratio of mechanical prevention equipment to the bed number ≥0.8:1; there was significant differences among ICU nurses in different levels of hospitals in mastering the indications, contraindications and use process of venous thromboembolism mechanical prevention; 42 ICUs (33.6%) used disposable leg covers for patients before the use of mechanical prevention equipment. The face-to-face teaching model was the main method adopted in the education and training of mechanical prevention.
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Affiliation(s)
- Guan Xiaoxiao
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Li Li
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Gong Shijin
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Wang Yueben
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Zhen Junhai
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
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32
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Peng R, Yin W, Wang F, Cong X, Lu B, Hua L, Chen X. Neutrophil levels upon admission for the assessment of acute pulmonary embolism with intermediate- and high-risk: an indicator of thrombosis and inflammation. Thromb J 2023; 21:28. [PMID: 36918857 PMCID: PMC10015714 DOI: 10.1186/s12959-023-00471-w] [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: 11/06/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Risk prediction rules are important to establish appropriate treatment and management strategy for patients with different risk classification of pulmonary embolism (PE). Neutrophils are considered to be related to PE as an essential marker of inflammation. However, few studies have reported the association between neutrophil levels and risk classification of acute PE (APE). The aim of this study was to investigate the role of neutrophil levels upon admission in the assessment of risk classification of APE. METHODS A total of 299 consecutive APE patients and 90 patients without APE confirmed by computed tomographic pulmonary angiography were retrospectively screened. APE patients were stratified into two subgroups according to clinical guidelines: low- (n = 233) and intermediate- and high-risk (n = 60) APE. RESULTS The neutrophil levels in intermediate- and high-risk APE patients were significantly higher compared to low-risk APE or non-APE patients (P < 0.001). In multivariable logistic regression analysis, neutrophil levels were significantly and independently associated with intermediate- and high-risk APE (odds ratio = 1.239, 95% confidence interval [CI] 1.055-1.455, P = 0.009). Neutrophil levels were positively correlated with the pulmonary embolism severity index score (r = 0.357, P < 0.001), high sensitive C-reactive protein, D-dimer and pulmonary artery obstruction index (PAOI), in the overall population of APE patients. Receiver-operating characteristic curve analysis revealed that neutrophils had a better diagnostic value for intermediate- and high-risk APE (area under the curve [AUC] = 0.760, 95% CI 0.695-0.826; P < 0.001) compared to PAOI (AUC = 0.719) and D-dimer (AUC = 0.645). CONCLUSIONS High neutrophil levels upon admission were significantly and independently associated with intermediate- and high-risk APE, which could be regarded as an indicator of inflammation and thrombosis in APE simultaneously. The potent diagnostic role of neutrophil levels and their competitive advantage over PAOI and D-dimer for the assessment of APE risk classification are suggested.
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Affiliation(s)
- Rui Peng
- Center of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihua Yin
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Wang
- Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangfeng Cong
- Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Hua
- Key Laboratory of Pulmonary Vascular Medicine & State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xi Chen
- Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Assessment of sST2 Behaviors to Evaluate Severity/Clinical Impact of Acute Pulmonary Embolism. Int J Mol Sci 2023; 24:ijms24054591. [PMID: 36902022 PMCID: PMC10002919 DOI: 10.3390/ijms24054591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
Pulmonary embolism (PE) is a potentially life-threatening disorder. Beyond its usefulness in the prognostic stratification of heart failure, sST2 can represent a biomarker with high utility in several acute conditions. Our study was aimed to investigate whether sST2 can be used as a clinical marker of severity and prognostic outcome in acute PE. We enrolled 72 patients with documented PE and 38 healthy subjects; we measured the plasma concentrations of sST2 to evaluate the prognostic and severity performance of different levels of sST2 according to its association with the pulmonary embolism severity index (PESI) score and several parameters of respiratory function. PE patients had significantly higher levels of sST2 compared with healthy subjects (87.74 ± 17.1 vs. 17.1 ± 0.4 ng/mL, p < 0.001); we found higher PESI scores and serum lactate values in the group of patients with sST2 > 35 ng/mL compared with patients with sST2 < 35 ng/mL (138.7 ± 14.9 vs. 103.7 ± 15.1 and 2.43 ± 0.69 vs. 1.025 ± 0.05 mmol/L, respectively; p < 0.05). Patients with sST2 > 35 ng/mL showed higher radiological severity of PE compared with patients with sST2 < 35 ng/mL. Moreover, sST2 was the strongest parameter with a discriminative capacity for the development of acute respiratory failure and a PESI score >106 with respect to C reactive protein (CRP), creatinine, d-dimer, and serum lactate. We clearly demonstrated that sST2 significantly increased in PE and that its elevation was associated with disease severity. Therefore, sST2 may be used as a clinical marker in the evaluation of PE severity. However, further studies with larger patient populations are required to confirm these findings.
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Zuin M, Rigatelli G, Bongarzoni A, Enea I, Bilato C, Zonzin P, Casazza F, Roncon L. Mean arterial pressure predicts 48 h clinical deterioration in intermediate-high risk patients with acute pulmonary embolism. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:80-86. [PMID: 36580441 DOI: 10.1093/ehjacc/zuac169] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/17/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022]
Abstract
AIMS We assess the prognostic role of mean arterial pressure (MAP) for 48 h clinical deterioration in intermediate-high risk pulmonary embolism (PE) patients after admission. METHODS AND RESULTS A post hoc analysis of intermediate-high-risk PE and intermediate-low-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. Clinical deterioration within 48 h was defined as patient worsening from a stable to an unstable haemodynamic condition, need of catecholamine infusion, endotracheal intubation, or cardiopulmonary resuscitation. Of 450 intermediate-high risk PE patients (mean age 71.4 ± 13.8 years, 298 males), 40 (8.8%) experienced clinical deterioration within 48 h from admission. Receiver operating characteristic analysis established the optimal cut-off value for MAP, as a predictor of 48 h clinical deterioration, ≤81.5 mmHg [area under curve (AUC) of 0.77 ± 0.3] with sensitivity, specificity, positive predictive value, and negative predictive value were 77.5, 95.0, 63.2, and 97.7%, respectively. Multivariate Cox regression analysis showed that independent risk factors for 48 h clinical deterioration were age [hazard ratio (HR): 1.26, 95% confidence interval (CI): 1.19-1.28, P < 0.0001], history of heart failure (HR: 1.76, 95% CI: 1.72-1.81, P < 0.0001), simplified Pulmonary Embolism Severity Index (HR: 1.52, 95% CI: 1.49-1.58, P = 0.001), systemic thrombolysis (HR: 0.54, 95% CI: 0.30-0.65, P < 0.0001), and a MAP of ≤81.5 mmHg at admission (HR: 3.25, 95% CI: 1.89-5.21, P < 0.0001). The deteriorating group had a significantly higher risk of 30-day mortality (HR: 2.61, 95% CI: 2.54-2.66, P < 0.0001) compared with the non-deteriorating group. CONCLUSION The mean arterial pressure appears to be a useful, bedside, and non-invasive prognostic tool potentially capable of promptly identifying intermediate-high risk PE patients at higher risk of 48 h clinical deterioration.
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Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy.,Department of Translational Medicine, University of Ferrara, Via Luigi Borsari, 46, 44124 Ferrara, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Ospedali Riuniti Padova Sud, Monselice, via Albere 30, 35043 Padova, Italy
| | - Amedeo Bongarzoni
- Department of Cardiology, ASST Santi Paolo e Carlo, University of Milan, via Rudinì, 20142 Milano, Italy
| | - Iolanda Enea
- Emergency Department, S. Anna and S. Sebastiano Hospital, via Palasciano, 81100 Caserta, Italy
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Pietro Zonzin
- Department of Cardiology, Santa Maria della Misericordia Hospital, via Tre Martiri 140, 45100 Rovigo, Italy
| | - Franco Casazza
- Department of Cardiology, San Carlo Borromeo Hospital, via Pio II 3, 20153 Milano, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, via Tre Martiri 140, 45100 Rovigo, Italy
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Keller K, Schmitt VH, Sagoschen I, Münzel T, Espinola-Klein C, Hobohm L. CRB-65 for Risk Stratification and Prediction of Prognosis in Pulmonary Embolism. J Clin Med 2023; 12:jcm12041264. [PMID: 36835800 PMCID: PMC9961795 DOI: 10.3390/jcm12041264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is accompanied by high morbidity and mortality. The search for simple and easily assessable risk stratification scores with favourable effectiveness is still ongoing, and prognostic performance of the CRB-65 score in PE might promising. METHODS The German nationwide inpatient sample was used for this study. All patient cases of patients with PE in Germany 2005-2020 were included and stratified for CRB-65 risk class: low-risk group (CRB-65-score 0 points) vs. high-risk group (CRB-65-score ≥1 points). RESULTS Overall, 1,373,145 patient cases of patients with PE (76.6% aged ≥65 years, 47.0% females) were included. Among these, 1,051,244 patient cases (76.6%) were classified as high-risk according to CRB-65 score (≥1 points). The majority of high-risk patients according to CRB-65 score were females (55.8%). Additionally, high-risk patients according to CRB-65 score showed an aggravated comorbidity profile with increased Charlson comorbidity index (5.0 [IQR 4.0-7.0] vs. 2.0 [0.0-3.0], p < 0.001). In-hospital case fatality (19.0% vs. 3.4%, p < 0.001) and MACCE (22.4% vs. 5.1%, p < 0.001) occurred distinctly more often in PE patients of the high-risk group according to CRB-65 score (≥1 points) compared to the low-risk group (= 0 points). The CRB-65 high-risk class was independently associated with in-hospital death (OR 5.53 [95%CI 5.40-5.65], p < 0.001) as well as MACCE (OR 4.31 [95%CI 4.23-4.40], p < 0.001). CONCLUSIONS Risk stratification with CRB-65 score was helpful for identifying PE patients being at higher risk of adverse in-hospital events. The high-risk class according to CRB-65 score (≥1 points) was independently associated with a 5.5-fold increased occurrence of in-hospital death.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Ingo Sagoschen
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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Xiong W, Zhao Y, Cheng Y, Du H, Sun J, Wang Y, Xu M, Guo X. Comparison of VTE risk scores in guidelines for VTE diagnosis in nonsurgical hospitalized patients with suspected VTE. Thromb J 2023; 21:8. [PMID: 36658654 PMCID: PMC9850809 DOI: 10.1186/s12959-023-00450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The assessment of VTE likelihood with VTE risk scores is essential prior to imaging examinations during VTE diagnostic procedure. Little is known with respect to the disparity of predictive power for VTE diagnosis among VTE risk scores in guidelines for nonsurgical hospitalized patients with clinically suspected VTE. METHODS A retrospective study was performed to compare the predictive power for VTE diagnosis among the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores in the leading authoritative guidelines in nonsurgical hospitalized patients with suspected VTE. RESULTS Among 3168 nonsurgical hospitalized patients with suspected VTE, VTE was finally excluded in 2733(86.3%) ones, whereas confirmed in 435(13.7%) ones. The sensitivity and specificity resulted from the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores were (90.3%, 49.8%), (88.7%, 53.6%), (73.8%, 50.2%), (97.7%,16.9%), (80.9%, 44.0%), and (78.2%, 47.0%), respectively. The YI were 0.401, 0.423, 0.240, 0.146, 0.249, and 0.252 for the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores, respectively. The C-index were 0.694(0.626-0.762), 0.697(0.623-0.772), 0.602(0.535-0.669), 0.569(0.486-0.652), 0.607(0.533-0.681), and 0.609(0.538-0.680) for the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores, respectively. Consistency was significant in the pairwise comparison of Wells vs Geneva(Kappa 0.753, P = 0.565), YEARS vs Padua(Kappa 0.816, P = 0.565), YEARS vs IMPROVE(Kappa 0.771, P = 0.645), and Padua vs IMPROVE(Kappa 0.789, P = 0.812), whereas it did not present in the other pairs. The YI was improved to 0.304, 0.272, and 0.264 for the PERC(AUC 0.631[0.547-0.714], P = 0.006), Padua(AUC 0.613[0.527-0.700], P = 0.017), and IMPROVE(AUC 0.614[0.530-0.698], P = 0.016), with a revised cutoff of 5 or less, 6 or more, and 4 or more denoting the VTE-likely, respectively. CONCLUSIONS For nonsurgical hospitalized patients with suspected VTE, the Geneva and Wells scores perform best, the PERC scores performs worst despite its significantly high sensitivity, whereas the others perform intermediately, albeit the absolute predictive power of all isolated scores are mediocre. The predictive power of the PERC, Padua, and IMPROVE scores are improved with revised cutoffs.
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Affiliation(s)
- Wei Xiong
- grid.412987.10000 0004 0630 1330Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092 China
| | - Yunfeng Zhao
- grid.459502.fDepartment of Pulmonary and Critical Care Medicine, Pudong New District, Punan Hospital, Shanghai, China
| | - Yi Cheng
- grid.412987.10000 0004 0630 1330Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092 China
| | - He Du
- grid.412532.3Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinyuan Sun
- grid.412987.10000 0004 0630 1330Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092 China
| | - Yanmin Wang
- grid.412987.10000 0004 0630 1330Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092 China
| | - Mei Xu
- Department of General Practice, North Bund Community Health Service Center, Hongkou District, Shanghai, China
| | - Xuejun Guo
- grid.412987.10000 0004 0630 1330Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092 China
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Impact of clinical profile at admission on the outcomes in patients hospitalized for acute pulmonary embolism: data from the IPER Registry. J Thromb Thrombolysis 2023; 55:166-174. [PMID: 36350468 DOI: 10.1007/s11239-022-02726-1] [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] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
Acute pulmonary embolism (PE) is characterized by a large heterogeneity of clinical presentation and disease course. We investigate whether different symptom PE phenotypes in hemodynamically stable PE could be associated with 30-day mortality risk. Hemodynamically stable patients from the multicentre, prospective Italian Pulmonary Embolism Registry (IPER) (September 2006-August 2010) presenting the most common four clinical phenotypes (< 24 h onset dyspnoea, chest pain, pleuritic pain and phlebitis) at admission were included and compared to those who were asymptomatic at admission. Overall, 1365 (mean age 68.7 ± 15.3 years, 609 males) were evaluated. Recent onset dyspnoea (< 24 h), chest pain, pleuritic pain and phlebitis were observed in 28.4%, 19.7%, 12.9% and 25.2%, respectively while asymptomatic patients represented the remaining 13.6% of cases. PE presenting with recent dyspnoea onset and chest pain had a lower 30-day overall survival (log-rank p = 0.01 and p < 0.001, respectively). By contrast, there were no significant differences when comparing patients with pleuritic pain or phlebitis (log-rank p = 0.2). Similar findings were confirmed at the Cox multivariate regression analysis which indicated a higher mortality risk in patients with chest pain [HR 3.21, 95% CI 2.16-4.78, p < 0.001] or recent dyspnoea [HR 2.12, 95% CI 1.22-3.87, p = 0.002] independent of age, heart rate, presence of right ventricular dysfunction, positive cardiac troponin and administration of systemic thrombolysis. Hemodynamically stable PE patients presenting with chest pain or recent onset dyspnoea had a lower 30-day survival compared to those asymptomatic or presenting pleuritic or phlebitis pain.Trial registry ClinicalTrials.gov; No: NCT01604538).
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Keller K, Schmitt VH, Ostad MA, Münzel T, Hobohm L, Espinola‐Klein C. Mansoor's Self-Report Tool for Cardiovascular Risk Assessment predicts adverse in-hospital events in patients with pulmonary embolism. THE CLINICAL RESPIRATORY JOURNAL 2022; 17:80-89. [PMID: 36544042 PMCID: PMC9892697 DOI: 10.1111/crj.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is a life-threatening acute disease accompanied by high morbidity and mortality. Regarding hospitalizations of patients with PE, risk stratification of these patients is crucial. Thus, risk stratification tools like risk scores are of key interest. METHODS The nationwide German inpatient sample of the years 2005-2018 was used for this present analysis. Hospitalized PE patients were stratified according to Mansoor's Self-Report Tool for Cardiovascular Risk Assessment class, and the performance of this score was evaluated to predict adverse in-hospital events. RESULTS Overall, 1 174 196 hospitalizations of PE patients (53.5% females; 56.4% ≥70 years) were registered in Germany between 2005 and 2018. According to the Mansoor's self-report tool for cardiovascular risk assessment, 346 126 (29.5%) PE patients were classified as high risk. Higher Mansoor's Self-Report Tool for Cardiovascular Risk Assessment class was predictive for in-hospital death (OR 1.129 [95%CI 1.117-1.141], P < 0.001), shock (OR 1.117 [95%CI 1.095-1.140], P < 0.001), cardiopulmonary resuscitation (OR 1.109 [95%CI 1.092-1.126], P < 0.001), right ventricular dysfunction (OR 1.039 [95%CI 1.030-1.048], P < 0.001), intracerebral bleeding (OR 1.316 [95%CI 1.275-1.358], P < 0.001), and gastro-intestinal bleeding (OR 1.316 [95%CI 1.275-1.358], P < 0.001). Systemic thrombolysis was not associated with lower in-hospital mortality in high-risk class (OR 5.139 [95%CI 4.961-5.323], P < 0.001). CONCLUSIONS Prognostic performance of the Mansoor's Self-Report Tool for Cardiovascular Risk Assessment for risk stratification of PE patients was poor and not able to identify those PE patients, who might benefit from systemic thrombolysis. However, the Mansoor's Self-Report Tool for Cardiovascular Risk Assessment was moderately helpful to identify PE patients at higher risk for bleeding events.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany,Center for Thrombosis and Hemostasis (CTH)University Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany,Medical Clinic VII, Department of Sports MedicineUniversity Hospital HeidelbergHeidelbergGermany
| | - Volker H. Schmitt
- Department of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine MainMainzGermany
| | - Mir A. Ostad
- Department of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
| | - Thomas Münzel
- Department of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine MainMainzGermany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany,Center for Thrombosis and Hemostasis (CTH)University Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
| | - Christine Espinola‐Klein
- Department of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany,Center for Thrombosis and Hemostasis (CTH)University Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
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El-Azrak M, Boutaybi M, Mouedder F, EL Ouafi N, Ismaili N. Massive pulmonary embolism with ST-segment elevation mimicking an isolated right ventricular myocardial infarction in a patient with COVID-19 pneumonia: Case report. Ann Med Surg (Lond) 2022; 84:104943. [PMCID: PMC9671607 DOI: 10.1016/j.amsu.2022.104943] [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: 09/05/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Pulmonary embolism (PE) is a great simulator; It mimics step by step its main differential diagnosis which is myocardial infarction. Its clinical and electrical manifestations are unspecific. Rarely, an ST-segment elevation can occur making the diagnosis more difficult. Recognizing such an uncommon electrocardiographic (ECG) pattern is of an important relevance to lead to a prompt and suitable therapeutic management. In our paper, we discuss a 68 years-old man case who presents with dyspnea and chest pain with ST-segment elevation in V1, aVR, DIII, and right-sided leads suggestive of isolated right ventricular infarction, admitted in a stable hemodynamical status which rapidly deteriorated. Echocardiographic assessment has shown signs of acute pulmonary heart disease with the presence of the specific McConnell's sign. A computed tomography pulmonary angiogram was performed revealing massive bilateral PE that benefited from thrombolytic therapy with alteplase with a remarkable following and regression of the ST-segment elevation. To our knowledge, this is the first case report of massive PE presenting with these ECG findings in the context of COVID 19 pneumonia, of which practitioners should be aware to better orient diagnosis and therapeutic management.
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Pan Q, Gao H, Wang Y, Chen Q. Comparison of Efficacy and Safety between Thrombolysis Plus Anticoagulation vs. Anticoagulation Alone for the Treatment of Acute Submassive Pulmonary Embolism: A Systematic Review and Meta-analysis. Curr Vasc Pharmacol 2022; 20:491-500. [PMID: 35959626 DOI: 10.2174/1570161120666220811155353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/19/2022] [Accepted: 05/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of this study is to compare the efficacy and safety of thrombolysis plus anticoagulant therapy vs. anticoagulant therapy alone in acute submassive pulmonary embolism (PE). MATERIALS AND METHODS The PubMed, Embase, and Cochrane Library databases were searched for randomized clinical trials comparing thrombolytic therapy and anticoagulation vs. anticoagulation alone in acute submassive PE patients from 1 Jan 1980 to 20 Jan 2021, with no drug or dose restrictions. Data on upgraded treatment of clinical deterioration, all-cause mortality, PE recurrence and bleeding events were extracted and analyzed using Revman 5.3 software. RESULTS A total of 10 randomized controlled trials involving 1871 patients were included in the study after screening. In terms of efficacy, thrombolysis combined with anticoagulant therapy reduced the need for upgrading treatment (3.6 vs. 10.9%, risk ratio (RR) 0.36, 95% confidence interval (CI) 0.24- 0.54, p<0.00001) and PE recurrence (0.8 vs. 2.9%, RR 0.33, 95% CI 0.16-0.69, p=0.003) in patients with acute submassive PE. Compared with anticoagulant therapy alone, the concomitant use of thrombolysis was associated with lower all-cause mortality (1.3 vs. 3.0%, RR 0.47, 95% CI 0.26-0.87, p=0.02), but it increased minor bleeding rate (31.4 vs. 8.4%, RR 3.71, 95% CI 2.82-4.88, p<0.0001) and major bleeding rate (8.8 vs. 2.6%, RR 3.35, 95%CI 2.03-5.54, p<0.0001). CONCLUSION The use of thrombolysis plus anticoagulant therapy in acute submassive PE was negatively associated with patients requiring escalation of treatment, PE recurrence, and all-cause mortality, but it was positively associated with bleeding.
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Affiliation(s)
- Qingyun Pan
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Han Gao
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yingju Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Quanfang Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
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Khurana KV, Ranjan A. ST-Segment Elevation in Conditions of Non-cardiovascular Origin Mimicking an Acute Myocardial Infarction: A Narrative Review. Cureus 2022; 14:e30868. [DOI: 10.7759/cureus.30868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/30/2022] [Indexed: 11/07/2022] Open
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Sagcan G, Konukoglu D, Uzun H, Arseven O, Okumus G, Cuhadaroglu C. Importance of oxidative stress in the evaluation of acute pulmonary embolism severity. BMC Pulm Med 2022; 22:382. [PMID: 36253755 PMCID: PMC9575210 DOI: 10.1186/s12890-022-02076-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background Pulmonary embolism (PE) is a common and potentially life-threatening disorder. Our study was aimed to investigate whether oxidative stress markers can be used as clinical markers in the evaluation of acute PE (APE) severity. Methods 47 patients with objectively documented diagnosis of APE were recorded. Of these patients, 14 had low-risk PE, 16 had moderate-risk PE, and 17 had high-risk PE. 21 healthy subjects were also enrolled in this study. Ischemia-modified albumin (IMA), prooxidants-antioxidants balance (PAB), advanced protein oxidation products (AOPPs), and ferric reducing antioxidant power (FRAP) were measured as oxidative stress parameters to evaluate the role of oxidative stress. Results In the low-risk and moderate-risk APE groups, AOPPs and PAB levels were significantly higher and FRAP levels were significantly lower than those in the control group. AOPPs and IMA levels in the patients with high-risk PE were significantly higher than those in both the low-risk and moderate-risk APE patients. There was a significant correlation between levels of AOPPs and the levels of both IMA (r: 0.462, p < 0.001) and PAB (r:0.378, p < 0.005). Serum FRAP levels were negatively correlated with PAB (r:− 0.683, p < 0.001) and AOPPs levels (r:− 0,384, p < 0.001). There was also a significant positive correlation between the serum IMA and PAB levels. Conclusions We clearly demonstrated that reactive oxygen species formation is significantly enhanced in APE. IMA and AOPPs may be used as clinical markers in the evaluation of APE severity in clinical practice. However, further studies with larger patient populations and longer follow-up periods are required to confirm the mechanisms underlying these findings.
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Affiliation(s)
- Gülseren Sagcan
- Department of Respiratory Medicine, Acibadem Medical Faculty, Acibadem University, Istanbul, Turkey.
| | - Dildar Konukoglu
- Department of Medical Biochemistry, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, İstanbul Atlas University, Istanbul, Turkey
| | - Orhan Arseven
- Department of Respiratory Medicine, İstanbul Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Gulfer Okumus
- Department of Respiratory Medicine, İstanbul Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Caglar Cuhadaroglu
- Department of Respiratory Medicine, Acibadem Medical Faculty, Acibadem University, Istanbul, Turkey
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Saviñon-Flores AI, Saviñon-Flores F, Trejo G, Méndez E, Ţălu Ş, González-Fuentes MA, Méndez-Albores A. A review of cardiac troponin I detection by surface enhanced Raman spectroscopy: Under the spotlight of point-of-care testing. Front Chem 2022; 10:1017305. [PMID: 36311415 PMCID: PMC9608872 DOI: 10.3389/fchem.2022.1017305] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiac troponin I (cTnI) is a biomarker widely related to acute myocardial infarction (AMI), one of the leading causes of death around the world. Point-of-care testing (POCT) of cTnI not only demands a short turnaround time for its detection but the highest accuracy levels to set expeditious and adequate clinical decisions. The analytical technique Surface-enhanced Raman spectroscopy (SERS) possesses several properties that tailor to the POCT format, such as its flexibility to couple with rapid assay platforms like microfluidics and paper-based immunoassays. Here, we analyze the strategies used for the detection of cTnI by SERS considering POCT requirements. From the detection ranges reported in the reviewed literature, we suggest the diseases other than AMI that could be diagnosed with this technique. For this, a section with information about cardiac and non-cardiac diseases with cTnI release, including their release kinetics or cut-off values are presented. Likewise, POCT features, the use of SERS as a POCT technique, and the biochemistry of cTnI are discussed. The information provided in this review allowed the identification of strengths and lacks of the available SERS-based point-of-care tests for cTnI and the disclosing of requirements for future assays design.
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Affiliation(s)
- Anel I. Saviñon-Flores
- Centro de Química-ICUAP- Posgrado en Ciencias Ambientales, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - G. Trejo
- Laboratory of Composite Materials and Functional Coatings, Center for Research and Technological Development in Electrochemistry (CIDETEQ), Querétaro, Mexico
| | - Erika Méndez
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ştefan Ţălu
- Technical University of Cluj-Napoca, The Directorate of Research, Development and Innovation Management (DMCDI), Cluj-Napoca, Romania
| | - Miguel A. González-Fuentes
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- *Correspondence: Miguel A. González-Fuentes, ; Alia Méndez-Albores,
| | - Alia Méndez-Albores
- Centro de Química-ICUAP- Posgrado en Ciencias Ambientales, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- *Correspondence: Miguel A. González-Fuentes, ; Alia Méndez-Albores,
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Alosaimi HM, Alqahtani S, Balkhi B, Alqahtani M, Alzamil F, Alhossan A, Alqahtany FS, Alharbi AA, Alqahtani NA, Albackr H, Elgohary G, Algahtani FH. A retrospective study of real-world effectiveness and safety of rivaroxaban in patients with non-valvular atrial fibrillation and venous thromboembolism in Saudi Arabia. PeerJ 2022; 10:e13974. [PMID: 36105646 PMCID: PMC9466595 DOI: 10.7717/peerj.13974] [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: 02/28/2022] [Accepted: 08/09/2022] [Indexed: 01/19/2023] Open
Abstract
Background Real-world evidence on factor Xa inhibitor (rivaroxaban) prescribing patterns, safety, and efficacy in patients with non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE) is rare. Herein, we sought to examine the above outcomes in the largest academic center in the Kingdom of Saudi Arabia (KSA). Methods This is a retrospective observational study designed to examine the prescribing pattern, safety and real-world effectiveness of the factor Xa inhibitor rivaroxaban in patients with NVAF and VTE. Data on rivaroxaban prescriptions were collected and analyzed. Bleeding outcomes were defined as per the International Society on Thrombosis and Hemostasis (ISTH) definition. Results A total of 2,316 patients taking rivaroxaban recruited through several departments of King Saud University Medical City (KSUMC). The mean age was 61 years (±17.8) with 55% above the age of 60 and 58% were females. Deep vein thrombosis and pulmonary embolism (VTE) was the most prevalent reason for prescribing rivaroxaban, followed by NVAF. A total daily dosage of 15 mg was given to 23% of the patients. The incidence rate of recurrent thrombosis and recurrent stroke was 0.2%. Furthermore, rivaroxaban had a 0.04 percent incidence rate of myocardial infarction. Half of the patients with recurrent thrombosis and stroke were taking 15 mg per day. The incidence rate of major bleeding was 1.1%. More over half of the patients who experienced significant bleeding were taking rivaroxaban at a dosage of 20 mg per day. According to the HAS-BLED Score (>2 score), 48 percent of patients who experienced significant bleeding had a high risk of bleeding. Non-major bleeding occurred in 0.6% of cases. Similarly, 40% of patients with non-major bleeding were taking rivaroxaban at a dosage of 20 mg per day. According to the HAS-BLED Score, just 6.6% of these individuals had a high risk of bleeding. 93.4% of the patients, on the other hand, were at intermediate risk. Conclusion The prescription of rivaroxaban in this real-life cohort study differs from the prescribing label and the outcomes of a phase 3 randomised clinical trial. However, for individuals with VTE and NVAF, the 20 mg dose looked to be more efficacious than the pivotal trial outcomes. Furthermore, among patients with VTE and NVAF, rivaroxaban was linked to a decreased incidence of safety events such as recurrent thrombosis, recurrent stroke, MI, major bleeding, and non-major haemorrhage in a real-world environment.
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Affiliation(s)
- Hind M. Alosaimi
- Clinical Pharmacy Department, College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia,Pharmacy Services, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Saeed Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mishari Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alzamil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fatmah S. Alqahtany
- Hematopathology Unit, Department of Pathology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Alharbi
- College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nawaf Abdullah Alqahtani
- College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hanan Albackr
- Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ghada Elgohary
- Department of Adult Hematology/Oncology, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,Clinical Hematology and Bone Marrow Transplantation Unit, Division of Internal Medicine, Ain Shams University, Cairo, Egypt
| | - Farjah H. Algahtani
- Division of Oncology/Hematology, Department of Medicine, College of Medicine, King Saud University, Kind Saud University Medical City, Riyadh, Saudi Arabia
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Hillegass E, Lukaszewicz K, Puthoff M. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022. Phys Ther 2022; 102:6585463. [PMID: 35567347 DOI: 10.1093/ptj/pzac057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key action statements (KAS), including guidance on upper extremity DVT, pulmonary embolism, and special populations. This document will guide physical therapist practice in the prevention of and screening for VTE and in the management of patients who are at risk for or who have been diagnosed with VTE. Through a systematic review of published studies and a structured appraisal process, KAS were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms based on the KAS were developed that can assist with clinical decision-making. Physical therapists, along with other members of the health care team, should implement these KAS to decrease the incidence of VTE, improve the diagnosis and acute management of VTE, and reduce the long-term complications of VTE.
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Affiliation(s)
- Ellen Hillegass
- Department of Physical Therapy, Mercer University, Atlanta, Georgia, USA
| | | | - Michael Puthoff
- Physical Therapy Department, St Ambrose University, Davenport, Iowa, USA
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Thachil R, Nagraj S, Kharawala A, Sokol SI. Pulmonary Embolism in Women: A Systematic Review of the Current Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9080234. [PMID: 35893223 PMCID: PMC9330775 DOI: 10.3390/jcdd9080234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023] Open
Abstract
Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women.
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Affiliation(s)
- Rosy Thachil
- Correspondence: ; Tel.: +718-918-5937; Fax: +(571)-376-6710
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Tracking an Elusive Killer: State of the Art of Molecular-Genetic Knowledge and Laboratory Role in Diagnosis and Risk Stratification of Thoracic Aortic Aneurysm and Dissection. Diagnostics (Basel) 2022; 12:diagnostics12081785. [PMID: 35892496 PMCID: PMC9329974 DOI: 10.3390/diagnostics12081785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023] Open
Abstract
The main challenge in diagnosing and managing thoracic aortic aneurysm and dissection (TAA/D) is represented by the early detection of a disease that is both deadly and “elusive”, as it generally grows asymptomatically prior to rupture, leading to death in the majority of cases. Gender differences exist in aortic dissection in terms of incidence and treatment options. Efforts have been made to identify biomarkers that may help in early diagnosis and in detecting those patients at a higher risk of developing life-threatening complications. As soon as the hereditability of the TAA/D was demonstrated, several genetic factors were found to be associated with both the syndromic and non-syndromic forms of the disease, and they currently play a role in patient diagnosis/prognosis and management-guidance purposes. Likewise, circulating biomarker could represent a valuable resource in assisting the diagnosis, and several studies have attempted to identify specific molecules that may help with risk stratification outside the emergency department. Even if promising, those data lack specificity/sensitivity, and, in most cases, they need more testing before entering the “clinical arena”. This review summarizes the state of the art of the laboratory in TAA/D diagnostics, with particular reference to the current and future role of molecular-genetic testing.
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Khan NA, Alharbi AF, Alshehri AQ, Attieh AI, Farouk HH, Alshammri HH, Alqahtani HA, Alassaf MF, Alrejaye MS, Aljthalin RA, Hafez TS, Abojalid WS, Zailae Z, Binsweileh FM, Alsaleh AA. Early Diagnosis of Pulmonary Embolism Related to Clinical Presentation and Vital Signs in the Emergency Department at King Saud Medical City. Cureus 2022; 14:e27087. [PMID: 36000129 PMCID: PMC9391762 DOI: 10.7759/cureus.27087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Pulmonary embolism (PE) is a common acute life-threatening cardiovascular disorder. It is the third most common cause of hospital-related death and early detection and management of PE are crucial. The study aimed to evaluate the association between vital signs and laboratory investigations with PE. Methods: This is a retrospective, hospital records-based, observational study, conducted among patients who were admitted to the emergency department of King Saud Medical City in Riyadh, Saudi Arabia with a suspected diagnosis of PE during the period of March 2021 to March 2022. Data were collected by searching patients’ files and recording demographic data, and information about the clinical presentation, workup, and outcome. Data were entered and analyzed using SPSS version 26 (IBM, Armonk, NY), utilizing Chi-square statistics to test differences between groups, and logistic regression analyses to identify predictors of PE. Results: The study included 92 patients, with a preponderance of females (70.7%), and those aged 40-60 years (51.1%). Diabetes mellitus (44.6%), and hypertension (30.4%) were the most common comorbidities among others, while shortness of breath (SOB) (83.7%), and chest pain (44.6%) were among the most commonly reported symptoms. A majority of patients had tachycardia (64.1%), while about half had low oxygen saturation (51.5%), and nearly one-third had tachypnea (29.3%), which was more predominant among those not diagnosed with PE. Logistic regression analysis revealed that SOB, respiratory rate, and oxygen saturation were the only significant predictors of PE. Conclusion: Although being an integral part of the initial assessment in the hospital, measuring the vital signs is not always reflective of the likelihood of PE, and they should not be the only metric relied upon to make decisions about treatment approaches in patients with PE. Physicians should ensure the employment of evidence-based clinical prediction rules and guidelines when diagnosing and managing PE.
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Kara H, Bayir A, Altug E, Degirmenci S, Unlu A, Ak A, Kayis SA. Diagnostic Value of Galectin-3 for Identifying Acute Pulmonary Embolism in the Emergency Department. J Emerg Med 2022; 63:93-101. [PMID: 35934654 DOI: 10.1016/j.jemermed.2022.04.001] [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: 06/07/2021] [Revised: 03/04/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is a common disease associated with high mortality and morbidity. Diagnosing PE is challenging due to diverse clinical presentations and the lack of specific biomarkers. OBJECTIVE We hypothesized that plasma galectin-3 (Gal-3) levels might reflect the severity of acute PE and be useful for diagnostic assessment. METHODS In this prospective study, 150 patients (100 patients with PE and 50 control patients) were included. Patients were stratified into high-risk, medium-risk, and low-risk groups according to the Wells and revised Geneva scoring systems, and Gal-3 levels were compared among the groups. PE was diagnosed by means of computed tomography pulmonary angiography. RESULTS In this study, of the 100 PE patients included in the study, 69 patients recovered and were discharged and 31 patients died. Median Gal-3 value in the PE group was 27.0 ng/mL (range 11.5-35.0 ng/mL), whereas the median Gal-3 value in the control group was significantly lower at 8.8 ng/mL (range 1.0-21.0 ng/mL) (p < 0.001). When the Gal-3 values of the PE group and the control group were evaluated with the receiver operator characteristic curve, the area under the curve was calculated as 0.99 (95% confidence interval 0.979-1). At a Gal-3 cutoff value of 13.55 ng/mL, which was determined to be the most appropriate value for PE diagnosis, the sensitivity was 98% and the specificity was 92%. CONCLUSIONS A biomarker that rapidly and accurately diagnoses acute PE in the emergency department can be an extremely useful tool. We concluded that plasma Gal-3 levels can be regarded as a promising marker of acute PE.
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Affiliation(s)
- Hasan Kara
- Faculty of Medicine, Department of Emergency Medicine, Selçuk University, Konya, Turkey.
| | - Aysegul Bayir
- Faculty of Medicine, Department of Emergency Medicine, Selçuk University, Konya, Turkey
| | - Ertugrul Altug
- Department of Emergency Medicine, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Selim Degirmenci
- Department of Emergency Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey
| | - Ali Unlu
- Faculty of Medicine, Department of Biochemistry, Selçuk University, Konya, Turkey
| | - Ahmet Ak
- Faculty of Medicine, Department of Emergency Medicine, Selçuk University, Konya, Turkey
| | - Seyit Ali Kayis
- Faculty of Medicine, Department of Biostatistics, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Tong S, Zhao W, Zhao D, Zhang W, Zhang Z. Biomaterials-Mediated Tumor Infarction Therapy. Front Bioeng Biotechnol 2022; 10:916926. [PMID: 35757801 PMCID: PMC9218593 DOI: 10.3389/fbioe.2022.916926] [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: 04/10/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022] Open
Abstract
Agents for tumor vascular infarction are recently developed therapeutic agents for the vascular destruction of tumors. They can suppress the progression of the tumor by preventing the flow of nutrition and oxygen to its tissues. Agents of tumor vascular infarction can be divided into three categories according to the differences in their pathways of action: those that use the thrombin-activating pathway, fibrin-activating pathway, and platelet-activating pathway. However, poor targeting ability, low permeation, and potential side-effects restrict the development of the corresponding drugs. Biomaterials can subtly avoid these drawbacks to suppress the tumor. In this article, the authors summarize currently used biomaterials for tumor infarction therapy with the goal of identifying its mechanism, and discuss outstanding deficiencies in methods of this kind.
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Affiliation(s)
- Shizheng Tong
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Duoyi Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Weilin Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiyu Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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