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Latsios G, Mantzouranis E, Kachrimanidis I, Theofilis P, Dardas S, Stroumpouli E, Aggeli C, Tsioufis C. Recent advances in risk stratification and treatment of acute pulmonary embolism. World J Cardiol 2025; 17:104983. [DOI: 10.4330/wjc.v17.i5.104983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 03/06/2025] [Accepted: 04/08/2025] [Indexed: 05/23/2025] Open
Abstract
Pulmonary embolism (PE) represents the third leading cause of cardiovascular death, despite the implementation of European Society of Cardiology guidelines, the establishment of PE response teams and advances in diagnosis and treatment modalities. Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration. In this light, research has been focused to identify novel risk stratification tools, based on the hemodynamic impact of PE on right ventricular function. Furthermore, a growing body of evidence has demonstrated that novel interventional treatments for PE, including catheter directed thrombolysis, mechanical thrombectomy and computer-assisted aspiration, are promising solutions in terms of efficacy and safety, when targeted at specific populations of the intermediate-high- and high-risk spectrum. Various therapeutic protocols have been suggested worldwide, regarding the indications and proper timing for interventional strategies. A ST-elevation myocardial infarction-like timing approach has been suggested in high-risk PE with contraindications for fibrinolysis, while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate; however, early interventions, within 24-48 hours of presentation, are associated with more favorable outcomes.
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Affiliation(s)
- George Latsios
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Emmanouil Mantzouranis
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Ioannis Kachrimanidis
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Sotirios Dardas
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Evaggelia Stroumpouli
- Department of Radiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Constantina Aggeli
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
| | - Costas Tsioufis
- 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
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Lübcke J, Peters F, Acar L, Marschall U, Behrendt CA. Short Term Outcomes and Treatment Intensity of Major Cardiovascular Emergencies During the COVID-19 Pandemic in Germany. Eur J Vasc Endovasc Surg 2024; 68:82-89. [PMID: 38493960 DOI: 10.1016/j.ejvs.2024.03.010] [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: 08/07/2023] [Revised: 02/17/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE There has been a decline in hospital admission rates in many countries since the beginning of the COVID-19 pandemic. Patient selection differed from episodes before the pandemic. This study investigated changes in baseline characteristics as well as the short term mortality rate and probability of receiving an invasive procedure while considering sex disparities. METHODS Claims data provided by Germany's second largest insurance fund, BARMER, were used. Patients without COVID-19 who were treated for ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), acute limb ischaemia (ALI), and stroke between 1 January 2018 and 31 December 2021 were included. Outcomes were compared separately for both sexes between the years before the pandemic (2018/2019) and during the pandemic (2020/2021). Propensity scores with exact matching were used to balance confounders including age, drug prescriptions in the previous year, federal state, month of admission, domiciliary care, and the Elixhauser comorbidities. Short term death and probability of invasive procedures were determined using cumulative incidence functions and Cox regressions. RESULTS The cohort consisted of 140 989 hospitalisations of 122 340 individual patients (48.3% female) with 102 960 matched cases. Baseline characteristics were similar between episodes in the unmatched cohort. Earlier discharge was observed for all strata except for males with ALI or STEMI, where the probability of early discharge was unchanged. The probability of receiving an invasive procedure was increased for both sexes with ALI, NSTEMI, and STEMI but not for stroke. The analyses suggested neither a statistically significant increase of the in hospital mortality rate nor the 30 day mortality rate after the pandemic started. CONCLUSION There was no evidence for a direct or indirect impact of the pandemic on major short term hospital outcomes. While the probability of receiving an invasive procedure increased for STEMI, NSTEMI, and ALI, the overall short term mortality rate was unaffected for both sexes.
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Affiliation(s)
- Jenny Lübcke
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Christian-Alexander Behrendt
- Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; Medical School Brandenburg Theodor-Fontane, Neuruppin, Germany.
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Talwar S, Gangoor N, Maldar SB, Pinto CJ. Isolated unilateral pulmonary artery atresia in an adult presenting with cor pulmonale. BMJ Case Rep 2023; 16:e256663. [PMID: 38160026 PMCID: PMC10759026 DOI: 10.1136/bcr-2023-256663] [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] [Indexed: 01/03/2024] Open
Abstract
Unilateral pulmonary artery atresia (UPAA) is a rare embryonic vascular malformation, leading to general presentations of exertional dyspnoea, pneumonia and haemoptysis. Our patient, a man in his early 30s, presented with a history of progressive breathlessness over a period of 2 years. History showed multiple admissions for pneumonia over his childhood and adolescence. Physical examination revealed a loud P2, an ejection systolic murmur and coarse crepitations in multiple lung fields. Severe pulmonary artery hypertension was noted on two-dimensional echocardiography. CT studies confirmed right pulmonary artery atresia with aspergilloma and bronchiectasis. With this diagnosis of UPAA, this case report intends to raise awareness among clinicians to consider this as a rare cause of cor pulmonale in an adult.
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Affiliation(s)
- Sidhant Talwar
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
- Department of General Medicine, Vijaynagar Institute of Medical Sciences, Bellary, Karnataka, India
| | - Niranjan Gangoor
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Shadab B Maldar
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Christopher Jude Pinto
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
- Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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Oliynyk OV, Rorat M, Solyarik SO, Lukianchuk VA, Dubrov SO, Guryanov VH, Oliynyk YV, Yaroslavskaya SM, Szalast R, Barg W. Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism. Viruses 2023; 15:1513. [PMID: 37515199 PMCID: PMC10385676 DOI: 10.3390/v15071513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
COVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 2021. Patients with or without confirmed right heart thrombi (RHT) were treated with unfractionated heparin or alteplase. The mortality rate in patients with RHT treated with heparin was 100% compared to 37.9% and 55.2% in those treated with alteplase without RHT and alteplase with RHT, respectively. The risk of death in the alteplase group increased with delayed thrombolysis (p = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14-2.62), increased D-dimer concentration (p = 0.02, OR = 1.43 95% CI 1.06-1.93), and decreased PaO2/FiO2 ratio (p = 0.001, OR = 0.56 95% CI 0.41-0.78). The receiver operating characteristic method determined that a 1-day delay in thrombolytic treatment, D-dimer concentration >5.844 mg/L, and PaO2/FiO2 <144 mmHg predicted a fatal outcome. The risk of death in patients with severe COVID-19 with ARDS and PE increases with higher D-dimer levels, decreased PaO2/FiO2, and delayed thrombolytic treatment. Thrombolysis seems to be treatment of choice in severe COVID-19 with PE and RHT. It should be carried out as soon as possible after the diagnosis is established.
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Affiliation(s)
- Oleksandr Valentynovych Oliynyk
- Department of Anaesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, Ukraine
- Department of Emergency Medicine, Rzeszow University, 35-310 Rzeszow, Poland
| | - Marta Rorat
- Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | | | | | | | | | - Yanina Volodymyrivna Oliynyk
- Department of Civilization Diseases, University of Information Technology and Management in Rzeszow, 35-310 Rzeszow, Poland
| | | | - Roman Szalast
- Department of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Wojciech Barg
- Department of Human Physiology, Rzeszow University, 35-310 Rzeszow, Poland
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Behrendt CA, Twerenbold R, Blankenberg S. The everlasting challenge to identify deep vein thrombosis in both clinical practice and research. Eur Heart J 2022; 43:1882-1883. [PMID: 35567564 DOI: 10.1093/eurheartj/ehac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK, Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK, Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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