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Zeng Y, Liu P, Xie A, Che Y, Yi X, Liu S, Sun W, Liu J, Wang G. Alterations and Significance of Computed Tomography Pulmonary Angiography-Derived Parameters in Older Patients With Acute Pulmonary Embolism. J Comput Assist Tomogr 2024; 48:226-232. [PMID: 37965776 DOI: 10.1097/rct.0000000000001558] [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: 11/16/2023]
Abstract
OBJECTIVE This study aimed to investigate changes of computed tomography pulmonary angiography (CTPA)-derived parameters in older adults with acute pulmonary embolism (APE). METHODS According to the pulmonary artery obstruction index (PAOI), patients with APE were divided into the A1 (PAOI ≥30%, n = 57) and A2 (PAOI <30%, n = 40) groups. Participants without APE were placed in group B (n = 170). The left atrial (LA) and left ventricular (LV) parameters among the three groups were compared, and the parameter changes in the 44 patients with APE were analyzed before and after treatment. The correlation between APE severity and the parameters was analyzed using correlation analysis. RESULTS The left-to-right diameters (LR) of LA, and LR × anteroposterior diameters (AP) of LA and LV: A1 < A2 < B; LR of LV: A1 < A2, B; AP of LA and LV: A1, A2 < B. After treatment, LR and LR × AP of the LA and LV were significantly increased in the group A1 and LR of the LV and LR × AP of the LA and LV were elevated in the group A2. Acute pulmonary embolism severity was closely associated with LR × AP ( r = -0.557) and LR ( r = -0.477) of LA. CONCLUSIONS With an increase in the degree of obstruction, older adults had a smaller LA and LV. Furthermore, the LR and LR × AP values of the LA were significantly decreased. These results contribute to in-time risk stratification.
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Affiliation(s)
- Yuli Zeng
- From the Department of Radiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, People's Republic of China
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Zuin M, Bilato C, Bongarzoni A, Zonzin P, Casazza F, Roncon L. Prognostic impact of the e-TAPSE ratio in intermediate-high risk pulmonary embolism patients. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:467-476. [PMID: 38032504 DOI: 10.1007/s10554-023-03010-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
We assess the prognostic role of a new index (Age-T index), based on age and the tricuspid annular plane systolic excursion (TAPSE) for the estimation of 30-day mortality and risk of 48-h clinical deterioration since admission, in intermediate-high risk Pulmonary Embolism (PE) patients. A post-hoc analysis of intermediate-high risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. The Age-T index was calculated as the ratio between age and TAPSE. The primary outcome was the 30-day mortality risk while the risk of clinical deterioration within 48 h in the same patients was chosen as the secondary outcome. Among 450 intermediate-high risk PE patients (mean age 71.4 ± 13.8 years, 298 males), 40 (8.8%) experienced clinical deterioration within 48 h since admission and 32 (7.1%) died within 30-day. Receiver operating characteristic analysis established ≥ 4.9 as the optimal cut-off value for the Age-T index in predicting 30-day mortality (AUC of 0.76 ± 0.1). Sensitivity, specificity, PPV and NPV were 81.2, 85.6, 30.2 and 98.3%, respectively. Multivariate Cox regression analysis showed that an Age-T index ≥ 4.9 predicts 30-day mortality (HR: 3.24, 95% CI: 1.58-4.96, p < 0.001) and was also associated with a significantly higher risk of 48-h clinical deterioration (HR: 2.02, 95% CI 1.96-2.08, p < 0.0001) in intermediate-high risk PE patients. Age-T Index appears as a useful, bed-side and non-invasive prognostic tool to identify intermediate-high risk PE patients at higher risk of death and/or 48-h clinical deterioration.
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Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Vicenza, Italy.
- Department of Translational Medicine, University of Ferrara, 44124, Ferrara, Italy.
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Vicenza, Italy
| | - Amedeo Bongarzoni
- Department of Cardiology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Pietro Zonzin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Franco Casazza
- Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
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Abdelkader OA. ChatGPT's influence on customer experience in digital marketing: Investigating the moderating roles. Heliyon 2023; 9:e18770. [PMID: 37576290 PMCID: PMC10415881 DOI: 10.1016/j.heliyon.2023.e18770] [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: 04/30/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023] Open
Abstract
ChatGPT is an artificial intelligence model intended for conversational purposes that has grown in popularity in digital marketing, offering organizations a vital tool for engaging with clients and enhancing their marketing efforts. The main objective of this research is to investigate the impact of ChatGPT on the customer experience in digital marketing. Additionally, the study intends to investigate the moderating impacts of business type and technology familiarity and comfort on the customer experience. Furthermore, the research explores the moderating roles of gender, age, and education level. The data for this study were collected electronically from 394 clients who have interacted with ChatGPT in digital marketing using an open-access questionnaire. The results support the significance of the moderating role of (Familiarity and Comfort with Technology, Business Type, Age, and Education level on the relation between customer experience with ChatGPT and overall satisfaction with digital marketing, while Gender is not supported. This article's findings are intended to contribute to the current literature on the use of conversational AI models in digital marketing and customer experience, providing insights and recommendations for future research.
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Affiliation(s)
- Osama Ahmed Abdelkader
- Marketing Department, College of Business Administration, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Wang D, Fan G, Zhang X, Xi L, Chen Y, Li A, Zhai Z. Prevalence of long-term right ventricular dysfunction after acute pulmonary embolism: a systematic review and meta-analysis. EClinicalMedicine 2023; 62:102153. [PMID: 37638233 PMCID: PMC10448274 DOI: 10.1016/j.eclinm.2023.102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Right ventricular dysfunction (RVD) is associated with adverse outcomes of acute pulmonary embolism (PE). However, there are no studies describing the long-term, full-spectrum right ventricular parameters on morphology, pressure and function at certain follow-up time points after PE onset. More exploration of right ventricular function would provide useful clues for long-term management of patients with PE. Methods For this systematic review and meta-analysis, we completed a literature search in Pubmed, EMBASE and WebofScience (from Jan 1st, 1998 to April 20th, 2023). Studies of patients with acute PE followed-up longer than 3 months with right ventricle assessment and written in English-language were included. Right ventricular function was assessed by either echocardiography or computed tomographic pulmonary angiography (CTPA). The primary outcome was structural and functional parameters of the right ventricle, and the secondary outcomes were functional assessments [New York Heart Association (NYHA) functional classification and 6-min walk test distance (6 MWD)], at each follow-up time points. Random effect meta-analyses were performed using R software (PROSPERO: CRD42023433332). Findings A total of 33 studies (3920 patients) were included in the final analysis. The 3-month, 6-month and 1-year prevalence of right ventricular dysfunction (RVD) was 0.34 [95% confidence interval (CI) 0.21-0.48, I2 = 96%], 0.26 (95% CI 0.17-0.36, I2 = 93%) and 0.34 (95% CI 0.19-0.48, I2 = 94%), respectively. Pooled tricuspid annulus plane systolic excursion (TAPSE), right ventricular to left ventricular diameter (RV/LV) ratio and pulmonary artery systolic pressure (PASP) at 1-year was 21.80 mm (95% CI 20.08-23.52, I2 = 93%), 0.64 (95% CI 0.48-0.81, I2 = 92%) and 27.33 mmHg (95% CI 18.88-35.78) (I2 = 96%), respectively. The proportion of NYHA III-IV was 0.06 (95% CI 0.0-0.12) and the pooled 6 MWD was 462.98 m (95% CI 447.55-478.41) over 1 year. Patients treated with thrombolysis had lower prevalence of RVD (1-year 0.17 and 0.07 in systemic thrombolysis and catheter-directed thrombolysis, respectively) than those treated with anticoagulation therapy alone (1-year 0.24) but the pooled risk ratio (RR) was not statistically significant. Interpretation Although the conclusion of this study may be limited by its high heterogeneity from varied study designs, inclusion criteria and definition of RVD of each study, our findings suggested that persistent RVD and functional impairment were of considerable high prevalence during long-term follow-up after acute PE. Treatment strategy may influence the prevalence of long-term RVD. Funding This study is supported by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-061). The National Key Research and Development Program of China (2016YFC0905600). National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-02-03). CAMS Institute of Respiratory Medicine Grant for Young Scholars (2023-ZF-8).
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Affiliation(s)
- Dingyi Wang
- National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Guohui Fan
- National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Xiaomeng Zhang
- National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- China-Japan Friendship Hospital, Peking University Health Science Center, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‑Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing, P.R. China
| | - Linfeng Xi
- National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‑Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing, P.R. China
- China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Yinong Chen
- National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- China-Japan Friendship Hospital, Peking University Health Science Center, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‑Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing, P.R. China
| | - Aili Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‑Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing, P.R. China
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Tratar G, Batič A, Svetina K. Home Treatment of Patients with Pulmonary Embolism: A Single Center 10-Year Experience from Ljubljana Registry. Clin Appl Thromb Hemost 2023; 29:10760296231203209. [PMID: 37807770 PMCID: PMC10563459 DOI: 10.1177/10760296231203209] [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: 05/06/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Current guidelines suggest careful risk stratification using a structured clinical approach when selecting patients with pulmonary embolism (PE) for home treatment. The aim of our study was to assess whether PE patients referred to home treatment are appropriately risk-stratified according to guidelines prior to referral and what the real-life course of the disease in these patients is. We included patients with confirmed PE referred to outpatient management and treated with anticoagulants between 2010 and 2019, whose data were collected in a prospective management registry. Using simplified PE severity index and/or signs of right ventricular strain, we classified patients to either appropriate or inappropriate low-risk classes for outpatient management. We compared 30-day mortality, overall mortality, and rates of recurrent thromboembolism or major bleeding between both classes. Among 278 patients, 188 (67.6%) and 90 (32.4%) were classified as appropriate or inappropriate class, respectively. In total, 30-day mortality was low in both groups: 0% in appropriate class and 1.1% in inappropriate class. The overall mortality rate was higher in the inappropriate than in the appropriate class (12.1 vs 0.9/100 patient-years, respectively, P < .001). Rates of recurrent thromboembolism and major bleeding were similar for both classes. We conclude that in real-life, a significant proportion of inappropriate low-risk class PE patients are referred to outpatient management. However, with careful follow-up, early mortality is low, even in home-treated patients inappropriately classified as low-risk.
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Affiliation(s)
- Gregor Tratar
- Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
- University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
| | - Anteja Batič
- University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
| | - Klara Svetina
- University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
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Right heart strain assessment on CTPA following acute pulmonary embolism: Interobserver variability between expert radiologists and physicians. Respir Med 2022; 200:106928. [PMID: 35853266 DOI: 10.1016/j.rmed.2022.106928] [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: 03/11/2022] [Revised: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Accuracy of right heart strain (RHS) measured on computed tomography pulmonary angiogram (CTPA) scans by non-radiologists is unknown. We assessed inter-observer variability of four RHS features and determined the accuracy of measurements by respiratory physicians. METHOD 1560 consecutive patients with acute PE were identified, and those who had a CTPA and an echocardiogram within 24-h included. CTPAs were independently scored prospectively by two radiologists, two thoracic physicians and a specialist registrar. Inter-observer variability was assessed, and diagnostic accuracy compared to echocardiography. RESULTS 182 patients (median age 62.8 years, IQR 49.8-71.5) with acute PE (7.7% high-risk, 40.7% intermediate high-risk, 31.3% intermediate low-risk and 20.3% low-risk) were included. Right ventricle to left ventricle diameter ratio (RV:LV) measurement had low inter-observer variability among the radiologists and non-radiologists with interclass correlation coefficient (ICC) of 0.95 (95%CI 0.92-0.97) and 0.96 (95%CI 0.94-0.97) respectively. RV:LV ratio had high diagnostic accuracy compared to RV dilatation on echocardiography (AUC 0.89, 95%CI 0.84-0.94 for radiologists and AUC 0.84, 95%CI 0.77-0.90 for non-radiologists). Main pulmonary artery to ascending aorta diameter ratio (MPA:Ao) measurement also had excellent agreement amongst the radiologists and non-radiologists (ICC 0.93 (95%CI 0.88-0.96) and 0.92 (95%CI 0.81-0.96) respectively). Significant variability was seen in the assessment of subjective features of RHS (leftward bowing of interventricular septum and contrast reflux into inferior vena cava) amongst the non-radiologists. CONCLUSION RV:LV and MPA:Ao diameter ratios on CTPA measured by non-radiologists have low inter-observer variability and good agreement with radiologists, and can be reliably used where an expert report is unavailable.
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Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med 2022; 11:jcm11092533. [PMID: 35566658 PMCID: PMC9104204 DOI: 10.3390/jcm11092533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Risk stratification is one of the cornerstones of the management of acute pulmonary embolism (PE) and determines the choice of both diagnostic and therapeutic strategies. The first step is the identification of patent circulatory failure, as it is associated with a high risk of immediate mortality and requires a rapid diagnosis and prompt reperfusion. The second step is the estimation of 30-day mortality based on clinical parameters (e.g., original and simplified version of the pulmonary embolism severity index): low-risk patients without right ventricular dysfunction are safely managed with ambulatory anticoagulation. The remaining group of hemodynamically stable patients, labeled intermediate-risk PE, requires hospital admission, even if most of them will heal without complications. In recent decades, efforts have been made to identify a subgroup of patients at an increased risk of adverse outcomes (intermediate-high-risk PE), who might benefit from a more aggressive approach, including reperfusion therapies and admission to a monitored unit. The cur-rent approach, combining markers of right ventricular dysfunction and myocardial injury, has an insufficient positive predictive value to guide primary thrombolysis. Sensitive markers of circulatory failure, such as plasma lactate, have shown interesting prognostic accuracy and may play a central role in the future. Furthermore, the improved security of reduced-dose thrombolysis may enlarge the indication of this treatment to selected intermediate–high-risk PE.
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