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Chornenki NLJ, Poorzargar K, Shanjer M, Mbuagbaw L, Delluc A, Crowther M, Siegal DM. Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta-analysis. J Thromb Haemost 2021; 19:2504-2513. [PMID: 34245115 DOI: 10.1111/jth.15453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Right ventricular (RV) dysfunction predicts worse outcomes in acute pulmonary embolism (PE). Because computed tomography (CT) pulmonary angiography visualizes cardiac structures, it is a potential method for assessing RV function without the delays associated with inpatient echocardiography. OBJECTIVES We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of CT scan findings for detecting RV dysfunction compared with echocardiography. METHODS We searched MEDLINE and EMBASE from inception to April 2020 for studies comparing RV dysfunction on CT scan with echocardiography standard. Study quality was assessed with the QUADAS-2 risk of bias tool. Meta-analysis was performed using a bivariate mixed effects regression framework. RESULTS After screening, 26 studies (3508 patients) were included. In a pooled analysis, septal deviation (5 studies; 459 patients) had a sensitivity of 0.31 (95% CI 0.25-0.38; I2 = 0%), specificity of 0.98 (95% CI 0.90-1.00; I2 = 59.4%), and positive likelihood ratio of 13.6 (95% CI 3.1-60.4) for RV dysfunction compared with echocardiography. The pooled sensitivity of increased RV/left ventricular ratio (21 studies; 3111 patients) was 0.83 (95% CI 0.78-0.87; I2 = 81.8%), whereas the pooled specificity was 0.75 (95% CI 0.66-0.82; I2 = 94.2%) and negative likelihood ratio was 0.23 (0.18-0.29). CONCLUSIONS Overall, RV dysfunction can be detected by CT imaging but the diagnostic accuracy when compared with echocardiography varies depending on specific findings. The presence of septal bowing appears to be highly specific for RV dysfunction. Our findings suggest that multiple CT findings of RV dysfunction may improve diagnostic accuracy and further studies are warranted.
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Affiliation(s)
| | | | | | | | - Aurelien Delluc
- Department of Medicine and Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
| | | | - Deborah M Siegal
- Department of Medicine and Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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2
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A novel clinical index for the assessment of RVD in acute pulmonary embolism: Blood pressure index. Am J Emerg Med 2017; 35:1400-1403. [PMID: 28431873 DOI: 10.1016/j.ajem.2017.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/18/2017] [Accepted: 04/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aims to investigate the role of the blood pressure index (BPI), which is a new index that we developed, in detection of right ventricular dysfunction (RVD) in acute pulmonary embolism (APE). METHODS A total of 539 patients, (253 males and 286 females), diagnosed with APE using computer tomography pulmonary angiography were included in the study. The BPI was obtained by dividing systolic blood pressure (SBP) by diastolic blood pressure (DBP). RESULTS Mean DBP (75±11mmHg vs 63±15mmHg; p<0.001, respectively) was found to be higher in RVD patients compared to those without RVD, whereas BPI (1.5±0.1 vs 1.9±0.2; p<0.001, respectively) was lower. Examining the performance of BPI in prediction of RVD using receiver operating characteristic curve analysis (area under curve±SE=0.975±0.006; p<0.001), it was found that BPI could predict RVD with very high sensitivity (92.8%) and specificity (100%) and had a positive predictive value of 100% and a negative predictive value of 42.1%. According to the analysis, the highest youden index for the optimal prediction value was found to be 0.478 and the BPI≤1.4 was found to predict mortality 68.6% sensitivity and 80.8% specificity (Area under curve±SE=0.777±0.051; p<0.001). CONCLUSIONS We found that BPI was an index with high positive predictive value and low negative predictive value in detection of RVD.
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Gonzalez Della Valle A, Blanes Perez A, Lee YY, Saboeiro GR, Konin GP, Endo Y, Sharrock NE, Salvati EA. The Clinical Severity of Patients Diagnosed With an In-Hospital Pulmonary Embolism Following Modern, Elective Joint Arthroplasty Is Unrelated to the Location of Emboli in the Pulmonary Vasculature. J Arthroplasty 2017; 32:1304-1309. [PMID: 28012721 DOI: 10.1016/j.arth.2016.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/07/2016] [Accepted: 11/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature. METHODS All 269 patients who developed an in-hospital, computed tomography pulmonary angiography-proved, PE following elective total hip arthroplasty or total knee arthroplasty in our institution were studied. The clinical severity of the PE was calculated using the Pulmonary Embolism Severity Index (PESI) that classifies patients in 5 classes (class 5: most severe). All computed tomography pulmonary angiographies were re-reviewed to determine the location of the emboli within the pulmonary vasculature (central, segmental, or subsegmental-unilateral or bilateral). The association between PESI and the PE location was examined. RESULTS The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. There were 180 unilateral and 89 bilateral PE patients. There was no association between the PESI and the location of the emboli within the pulmonary vasculature (P = .32). Patients with bilateral or unilateral lung involvement had similar PESI (P = .78). CONCLUSION The PESI, a recognized, validated predictor of mortality after PE was similar in patients with central, segmental, or subsegmental PE; and in patients with unilateral or bilateral lung involvement. The present study may aid clinicians while assessing and discussing the severity of PE symptoms with patients at the time of diagnosis.
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Affiliation(s)
| | - Alvaro Blanes Perez
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Yuo-Yu Lee
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Gregory R Saboeiro
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Gabrielle P Konin
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Yoshimi Endo
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Nigel E Sharrock
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Eduardo A Salvati
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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Ates H, Ates I, Kundi H, Yilmaz FM. Choice of marker for assessment of RV dysfunction in acute pulmonary embolism. Herz 2016; 42:758-765. [DOI: 10.1007/s00059-016-4513-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/04/2016] [Accepted: 11/13/2016] [Indexed: 01/07/2023]
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Liang HW, Zhao DL, Liu XD, Chen P, Zhou HT, Zhao CL, Wang GK, Xu ML, Zhang JL. ECG-gated pulmonary artery CTA for evaluation of right ventricular function in patients with acute pulmonary embolism. Echocardiography 2016; 34:257-263. [PMID: 27933648 DOI: 10.1111/echo.13419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate right ventricular function in patients with acute pulmonary embolism (APE) using electrocardiogram-gated CTA and to discuss the clinical value of pulmonary artery CTA PATIENTS AND METHODS: Based on death risk evaluation, 86 APE patients were divided into high-risk group (n=46) and non-high-risk group (n=40). The CT pulmonary embolism (PE) index and parameters of right ventricular function were analyzed from the CTPA images and compared between the two groups. Potential correlation between the two was also discussed. RESULT CT PE index (median 24.69%) of the high-risk group was obviously higher than that of the non-high-risk group (median 8.58%) (P<.05). Except the diameter of superior vena cava, all other parameters of right ventricular function were significantly different between the two groups (P<.05). CT PE index was correlated with the parameters of right ventricular function. CONCLUSION ECG-gated pulmonary artery CTA is suitable for assessing the severity of APE and right ventricular function.
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Affiliation(s)
- Hong-Wei Liang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - De-Li Zhao
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin-Ding Liu
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Chen
- Radiology Department of the Fourth Hospital of Harbin, Harbin, China
| | - Hai-Ting Zhou
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cheng-Lei Zhao
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guo-Kun Wang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mei-Ling Xu
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin-Ling Zhang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Zhu R, Zhang Z, Li Y, Hu Z, Xin D, Qi Z, Chen Q. Discovering Numerical Differences between Animal and Plant microRNAs. PLoS One 2016; 11:e0165152. [PMID: 27768749 PMCID: PMC5074594 DOI: 10.1371/journal.pone.0165152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/09/2016] [Indexed: 12/18/2022] Open
Abstract
Previous studies have confirmed that there are many differences between animal and plant microRNAs (miRNAs), and that numerical features based on sequence and structure can be used to predict the function of individual miRNAs. However, there is little research regarding numerical differences between animal and plant miRNAs, and whether a single numerical feature or combination of features could be used to distinguish animal and plant miRNAs or not. Therefore, in current study we aimed to discover numerical features that could be used to accomplish this. We performed a large-scale analysis of 132 miRNA numerical features, and identified 17 highly significant distinguishing features. However, none of the features independently could clearly differentiate animal and plant miRNAs. By further analysis, we found a four-feature subset that included helix number, stack number, length of pre-miRNA, and minimum free energy, and developed a logistic classifier that could distinguish animal and plant miRNAs effectively. The precision of the classifier was greater than 80%. Using this tool, we confirmed that there were universal differences between animal and plant miRNAs, and that a single feature was unable to adequately distinguish the difference. This feature set and classifier represent a valuable tool for identifying differences between animal and plant miRNAs at a molecular level.
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Affiliation(s)
- Rongsheng Zhu
- College of Science, Northeast Agricultural University, Harbin, China
| | - Zhanguo Zhang
- College of Science, Northeast Agricultural University, Harbin, China
| | - Yang Li
- College of Science, Northeast Agricultural University, Harbin, China
| | - Zhenbang Hu
- College of Agronomy, Northeast Agricultural University, Harbin, China
| | - Dawei Xin
- College of Agronomy, Northeast Agricultural University, Harbin, China
| | - Zhaoming Qi
- College of Agronomy, Northeast Agricultural University, Harbin, China
| | - Qingshan Chen
- College of Agronomy, Northeast Agricultural University, Harbin, China
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Estimation of right ventricular dysfunction by computed tomography pulmonary angiography: a valuable adjunct for evaluating the severity of acute pulmonary embolism. J Thromb Thrombolysis 2016; 43:271-278. [DOI: 10.1007/s11239-016-1438-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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One-Year All-Cause Mortality of Patients Diagnosed as Having In-Hospital Pulmonary Embolism After Modern Elective Joint Arthroplasty Is Low And Unaffected By Radiologic Severity. J Arthroplasty 2016; 31:473-9. [PMID: 26461488 DOI: 10.1016/j.arth.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We studied the 1-year complication rate of patients diagnosed as having a pulmonary embolism (PE) after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgery and the distribution of emboli in the pulmonary circulation, and determined if a relationship exists between the location of the PE and age, gender, body mass index, preoperative predisposing factors, American Society of Anesthesiology classification, type of surgery, prophylaxis, hospital stay, transfer to a higher level of care, and mortality. METHODS Two hundred sixty-nine patients who developed an in-hospital PE proved by computed tomography pulmonary angiography after elective THA or TKA between 2005 and 2012 were studied. RESULTS The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. Nineteen patients (7%) developed a bleeding complication during PE treatment. Twenty-nine patients (11%) were readmitted during the first year. Two patients (0.74%) died: one had a segmental PE after TKA. He died 11 months after surgery due to an autopsy-proven sepsis. The second patient developed a segmental PE after THA. She was anticoagulated, developed an intracranial bleed, and died 8 months after surgery. Multivariate analysis showed that demographic variables, American Society of Anesthesiology class, preoperative comorbidities (with the exception of arrhythmia), and the presence of preoperative predisposing factors had no effect in the location of the PE. CONCLUSION The 1-year mortality rate of these patients is low. Death can be caused by bleeding complications secondary to anticoagulation or by unrelated conditions. This information may aid clinicians while counseling patients who developed a PE after surgery, particularly those with small subsegmental emboli.
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John G, Marti C, Poletti PA, Perrier A. Hemodynamic indexes derived from computed tomography angiography to predict pulmonary embolism related mortality. BIOMED RESEARCH INTERNATIONAL 2014; 2014:363756. [PMID: 25147798 PMCID: PMC4087299 DOI: 10.1155/2014/363756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 12/05/2022]
Abstract
Pulmonary embolism (PE) induces an acute increase in the right ventricle afterload that can lead to right-ventricular dysfunction (RVD) and eventually to circulatory collapse. Hemodynamic status and presence of RVD are important determinants of adverse outcomes in acute PE. Technologic progress allows computed tomography angiography (CTA) to give more information than accurate diagnosis of PE. It may also provide an insight into hemodynamics and right-ventricular function. Proximal localization of emboli, reflux of contrast medium to the hepatic veins, and right-to-left short-axis ventricular diameter ratio seem to be the most relevant CTA predictors of 30-day mortality. These elements require little postprocessing time, an advantage in the emergency room. We herein review the prognostic value of RVD and other CTA mortality predictors for patients with acute PE.
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Affiliation(s)
- Gregor John
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Christophe Marti
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Department of Radiology, Emergency-Room Radiology Unit, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Arnaud Perrier
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals (HUG) and Geneva Faculty of Medicine, Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
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The use of axial diameters and CT obstruction scores for determining echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism. Jpn J Radiol 2014; 32:451-60. [DOI: 10.1007/s11604-014-0327-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
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11
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Trujillo-Santos J, den Exter PL, Gómez V, Del Castillo H, Moreno C, van der Hulle T, Huisman MV, Monreal M, Yusen RD, Jiménez D. Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013; 11:1823-32. [PMID: 23964984 DOI: 10.1111/jth.12393] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/15/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The ability of computed tomography (CT)-assessed right ventricular dysfunction (RVD) to identify normotensive patients with acute pulmonary embolism (PE) at high risk of mortality or adverse outcome lacks clarity. METHODS AND RESULTS We performed a systematic review and a meta-analysis of studies in normotensive patients with acute PE to assess the prognostic value of CT-assessed RVD for death and a predefined composite outcome of PE-related complications. We conducted unrestricted searches of MEDLINE and EMBASE from 1980 to March 2013, and used the terms 'computed tomography', 'pulmonary embolism', and 'prognos*'. We used a random-effects model to pool study results, funnel-plot inspection to evaluate for publication bias, and I(2) testing to assess for heterogeneity. The analysis included data from 10 studies (2288 patients). Overall, 99 of 1268 patients with RVD assessed by CT died (7.8%; 95% confidence interval [CI] 6.3-9.3) as compared with 52 of 1020 without RVD (5.1%; 95% CI 3.7-6.4). CT-assessed RVD had significant associations with mortality (odds ratio [OR] 1.8; 95% CI 1.3-2.6), with death resulting from PE (OR 7.4; 95% CI 1.4-39.5), and with PE-related complications (OR 2.4; 95% CI 1.2-4.7). Pooled likelihood ratios (LRs) were not extreme (negative LR 0.71; 95% CI 0.57-0.89; and positive LR 1.27; 95% CI 1.12-1.43). CONCLUSIONS Although RVD assessed by CT showed an association with an increased risk of mortality in patients with hemodynamically stable PE, it resulted in only small increases in the ability to classify risk.
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Affiliation(s)
- J Trujillo-Santos
- Department of Medicine, Santa Lucía Hospital, Cartagena, Murcia, Spain
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