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Su H, Han Z, Fu Y, Zhao D, Yu F, Heidari AA, Zhang Y, Shou Y, Wu P, Chen H, Chen Y. Detection of pulmonary embolism severity using clinical characteristics, hematological indices, and machine learning techniques. Front Neuroinform 2022; 16:1029690. [PMID: 36590906 PMCID: PMC9800512 DOI: 10.3389/fninf.2022.1029690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Pulmonary embolism (PE) is a cardiopulmonary condition that can be fatal. PE can lead to sudden cardiovascular collapse and is potentially life-threatening, necessitating risk classification to modify therapy following the diagnosis of PE. We collected clinical characteristics, routine blood data, and arterial blood gas analysis data from all 139 patients. Methods Combining these data, this paper proposes a PE risk stratified prediction framework based on machine learning technology. An improved algorithm is proposed by adding sobol sequence and black hole mechanism to the cuckoo search algorithm (CS), called SBCS. Based on the coupling of the enhanced algorithm and the kernel extreme learning machine (KELM), a prediction framework is also proposed. Results To confirm the overall performance of SBCS, we run benchmark function experiments in this work. The results demonstrate that SBCS has great convergence accuracy and speed. Then, tests based on seven open data sets are carried out in this study to verify the performance of SBCS on the feature selection problem. To further demonstrate the usefulness and applicability of the SBCS-KELM framework, this paper conducts aided diagnosis experiments on PE data collected from the hospital. Discussion The experiment findings show that the indicators chosen, such as syncope, systolic blood pressure (SBP), oxygen saturation (SaO2%), white blood cell (WBC), neutrophil percentage (NEUT%), and others, are crucial for the feature selection approach presented in this study to assess the severity of PE. The classification results reveal that the prediction model's accuracy is 99.26% and its sensitivity is 98.57%. It is expected to become a new and accurate method to distinguish the severity of PE.
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Affiliation(s)
- Hang Su
- College of Computer Science and Technology, Changchun Normal University, Changchun, Jilin, China
| | - Zhengyuan Han
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yujie Fu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Zhao
- College of Computer Science and Technology, Changchun Normal University, Changchun, Jilin, China,*Correspondence: Dong Zhao,
| | - Fanhua Yu
- College of Computer Science and Technology, Changchun Normal University, Changchun, Jilin, China
| | - Ali Asghar Heidari
- School of Surveying and Geospatial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Yu Zhang
- College of Computer Science and Technology, Changchun Normal University, Changchun, Jilin, China
| | - Yeqi Shou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peiliang Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiling Chen
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, Zhejiang, China,Huiling Chen,
| | - Yanfan Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Yanfan Chen,
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Mohebali D, Heidinger BH, Feldman SA, Matos JD, Dabreo D, McCormick I, Litmanovich D, Manning WJ, Carroll BJ. Right ventricular strain in patients with pulmonary embolism and syncope. J Thromb Thrombolysis 2021; 50:157-164. [PMID: 31667788 DOI: 10.1007/s11239-019-01976-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with acute pulmonary embolism (PE) can present with various clinical manifestations including syncope. The mechanism of syncope in PE is not fully elucidated and data of right ventricular (RV) function in patients has been limited. We retrospectively identified 477 consecutive patients hospitalized with acute PE diagnosed with a computed tomogram (CT) who also had a transthoracic echocardiogram (TTE) 24 h prior to or 48 h after diagnosis. Parameters of RV strain on CT, TTE, electrocardiogram (ECG), and clinical characteristics and adverse outcomes were collected. Patients with all three studies available for assessment were included (n = 369) and those with syncope (n = 34) were compared to patients without syncope (n = 335). Patients with syncope were more likely to demonstrate RV strain on all three modes of assessment compared to those without syncope [17 (50%) vs. 67 (20%); p = 0.001], and those patients were more likely to receive advanced therapies [9 (53%) vs. 15 (22%); p = 0.02]. PE-related mortality was highest among those presenting with high-risk PE and syncope (36%, OR 20.1, 95% CI 5.3-81.1; p < 0.001) and was low in patients with syncope without criteria for high-risk PE (3%, OR 1.2, 95% CI 0.2-10.0; p < 0.001). In conclusion, acute PE patients with syncope are more likely to demonstrate multimodality evidence of RV strain and to receive advanced therapies. Syncope was only associated with increased PE-related mortality in patients presenting with a high-risk PE. Syncope alone without evidence of RV strain is associated with low short-term adverse events and is similar to those without syncope.
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Affiliation(s)
- Donya Mohebali
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Benedikt H Heidinger
- Radiology and Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephanie A Feldman
- Department of Medicine (Section of Cardiovascular Medicine), Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jason D Matos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | | | - Ian McCormick
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Diana Litmanovich
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Radiology and Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA.,Radiology and Harvard Medical School, Boston, MA, USA
| | - Brett J Carroll
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA.
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Wu H, Cao H, Song Z, Xu X, Tang M, Yang S, Liu Y, Qin L. Rivaroxaban treatment for young patients with pulmonary embolism (Review). Exp Ther Med 2020; 20:694-704. [PMID: 32742315 PMCID: PMC7388139 DOI: 10.3892/etm.2020.8791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/17/2020] [Indexed: 12/16/2022] Open
Abstract
Pulmonary embolism (PE) is a serious, life-threatening condition that affects young populations (>18 and <50 years old, according to most literature reviews) with improved recognition of its clinical manifestations and the widespread use of sensitive imaging techniques, PE is increasingly diagnosed in younger patients. At present, there is limited understanding of the clinical features and adequate anticoagulant treatment options for this population. Most studies to date have yet to demonstrate significant differences in PE pathophysiology or symptoms between young and elderly patients. Although the overall incidence of PE is lower in young populations compared with elderly patients, important risk factors also apply for young patients. Hereditary thrombophilia is common and is a major cause of PE in younger patients. Immobilization, trauma, obesity, smoking and infection are also becoming increasingly frequent in young patients with PE. Among female patients, oral contraceptive use, pregnancy and postpartum status are predominant risk factors underlying PE. Rivaroxaban is a direct oral anticoagulant with a rapid onset of action that is associated with less drug-drug interactions compared with other therapies. Because the drug is administered at fixed doses with no requirement for routine coagulation monitoring, it is becoming an attractive option for anticoagulation treatment in young patients with PE. Therefore, the present literature review focuses on the clinical characteristics of PE and rivaroxaban therapy in younger patients.
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Affiliation(s)
- Haidi Wu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Hongyan Cao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Zikai Song
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Xiaoyan Xu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Minglong Tang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Shuo Yang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Yang Liu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Ling Qin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
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Ammar H, Ohri C, Hajouli S, Kulkarni S, Tefera E, Fouda R, Govindu R. Prevalence and Predictors of Pulmonary Embolism in Hospitalized Patients with Syncope. South Med J 2019; 112:421-427. [PMID: 31375838 DOI: 10.14423/smj.0000000000001009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Approximately one in six patients hospitalized with syncope have pulmonary embolism (PE), according to the PE in Syncope Italian Trial study. Subsequent studies using administrative data have reported a PE prevalence of <3%. The aim of the study was to determine the prevalence and predictors of PE in hospitalized patients with syncope. METHODS We retrospectively reviewed the records of patients who were hospitalized in the MedStar Washington Hospital Center between May 1, 2015 and June 30, 2017 with deep venous thrombosis, PE, and syncope. Only patients who presented to the emergency department with syncope were included in the final analysis. PE was diagnosed by either positive computed tomographic angiography or a high-probability ventilation-perfusion scan. Univariate and multivariate logistic regressions were used to assess the associations between clinical variables and the diagnosis of PE in patients with syncope. RESULTS Of the 408 patients hospitalized with syncope (mean age, 67.5 years; 51% men [N = 208]), 25 (6%) had a diagnosis of PE. Elevated troponin levels (odds ratio 6.6, 95% confidence interval 1.9-22.9) and a dilated right ventricle on echocardiogram (odds ratio 6.9, 95% confidence interval 2.0-23.6) were independently associated with the diagnosis of PE. Age, active cancer, and history of deep venous thrombosis were not associated with the diagnosis of PE. CONCLUSIONS The prevalence of PE in this study is approximately one-third of the reported prevalence in the PE in Syncope Italian Trial study and almost three times the value reported in administrative data-based studies. PE should be suspected in patients with syncope and elevated troponin levels or a dilated right ventricle on echocardiogram.
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Affiliation(s)
- Hussam Ammar
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Chaand Ohri
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Said Hajouli
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Shaunak Kulkarni
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Eshetu Tefera
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Ragai Fouda
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Rukma Govindu
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
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Badertscher P, du Fay de Lavallaz J, Hammerer-Lercher A, Nestelberger T, Zimmermann T, Geiger M, Imahorn O, Miró Ò, Salgado E, Christ M, Cullen L, Than M, Martin-Sanchez FJ, Di Somma S, Peacock WF, Keller DI, Costabel JP, Walter J, Boeddinghaus J, Twerenbold R, Méndez A, Gospodinov B, Puelacher C, Wussler D, Koechlin L, Kawecki D, Geigy N, Strebel I, Lohrmann J, Kühne M, Reichlin T, Mueller C, Rubini Giménez M, Kozhuharov N, Shrestha S, Sazgary L, Morawiec B, Muzyk P, Nowalany-Kozielska E, Bustamante Mandrión J, Poepping I, Freese M, Meissner K, Kulangara C, Fuenzalida Inostroza CI, Greenslade J, Hawkins T, Rentsch K, von Eckardstein A, Buser A, Kloos W, Steude J, Osswald S. Prevalence of Pulmonary Embolism in Patients With Syncope. J Am Coll Cardiol 2019; 74:744-754. [DOI: 10.1016/j.jacc.2019.06.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 01/21/2023]
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Frizell A, Fogel N, Steenblik J, Carlson M, Bledsoe J, Madsen T. Prevalence of pulmonary embolism in patients presenting to the emergency department with syncope. Am J Emerg Med 2018; 36:253-256. [PMID: 28811209 DOI: 10.1016/j.ajem.2017.07.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/03/2017] [Accepted: 07/30/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Nicole Fogel
- University of Utah, Salt Lake City, UT, United States
| | | | | | | | - Troy Madsen
- University of Utah, Salt Lake City, UT, United States
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Prandoni P, Lensing AWA, Prins MH, Ciammaichella M, Perlati M, Mumoli N, Bucherini E, Visonà A, Bova C, Imberti D, Campostrini S, Barbar S. Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med 2016; 375:1524-1531. [PMID: 27797317 DOI: 10.1056/nejmoa1602172] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients. METHODS We performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay. In all other patients, computed tomographic pulmonary angiography or ventilation-perfusion lung scanning was performed. RESULTS A total of 560 patients (mean age, 76 years) were included in the study. A diagnosis of pulmonary embolism was ruled out in 330 of the 560 patients (58.9%) on the basis of the combination of a low pretest clinical probability of pulmonary embolism and negative d-dimer assay. Among the remaining 230 patients, pulmonary embolism was identified in 97 (42.2%). In the entire cohort, the prevalence of pulmonary embolism was 17.3% (95% confidence interval, 14.2 to 20.5). Evidence of an embolus in a main pulmonary or lobar artery or evidence of perfusion defects larger than 25% of the total area of both lungs was found in 61 patients. Pulmonary embolism was identified in 45 of the 355 patients (12.7%) who had an alternative explanation for syncope and in 52 of the 205 patients (25.4%) who did not. CONCLUSIONS Pulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope. (Funded by the University of Padua; PESIT ClinicalTrials.gov number, NCT01797289 .).
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Affiliation(s)
- Paolo Prandoni
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Anthonie W A Lensing
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Martin H Prins
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Maurizio Ciammaichella
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Marica Perlati
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Nicola Mumoli
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Eugenio Bucherini
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Adriana Visonà
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Carlo Bova
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Davide Imberti
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Stefano Campostrini
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
| | - Sofia Barbar
- From the Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua (P.P., A.W.A.L.), the Department of Internal and Emergency Medicine, San Giovanni Addolorata Hospital, Rome (M.C.), the Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero, Camposampiero (M.P., S.B.), the Department of Internal Medicine, Civic Hospital of Livorno, Livorno (N.M.), the Angiology Unit, Civic Hospital of Ravenna, Ravenna (E.B.), the Angiology Unit, Civic Hospital of Castelfranco Veneto, Castelfranco Veneto (A.V.), the Department of Internal Medicine, Civic Hospital of Cosenza, Cosenza (C.B.), the Department of Internal Medicine, Civic Hospital of Piacenza, Piacenza (D.I.), and the Department of Economics, Ca' Foscari University of Venice, Venice (S.C.) - all in Italy; and the Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands (M.H.P.)
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Kocea P, Mischke K, Volk HP, Eberle U, Ortlepp JR. Prävalenz und Schwere der Lungenarterienembolie in Abhängigkeit von klinischen und paraklinischen Parametern. Med Klin Intensivmed Notfmed 2016; 112:227-238. [DOI: 10.1007/s00063-016-0144-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/26/2015] [Accepted: 12/20/2015] [Indexed: 01/04/2023]
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Tadlock MD, Chouliaras K, Kennedy M, Talving P, Okoye O, Aksoy H, Karamanos E, Zheng L, Grabo DJ, Rogers C, Noguchi T, Inaba K, Demetriades D. The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients. Am J Surg 2014; 209:959-68. [PMID: 25669120 DOI: 10.1016/j.amjsurg.2014.09.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/02/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The traditional theory that pulmonary emboli (PE) originate from the lower extremity has been challenged. METHODS All autopsies performed in Los Angeles County between 2002 and 2010 where PE was the cause of death were reviewed. RESULTS Of the 491 PE deaths identified, 36% were surgical and 64% medical. Venous dissection for clots was performed in 380 patients; the PE source was the lower extremity (70.8%), pelvic veins (4.2 %), and upper extremity (1.1%). No source was identified in 22.6% of patients. Body mass index (adjusted odds ratio [AOR] 1.044, 95% confidence interval [CI] 1.011 to 1.078, P = .009) and age (AOR 1.018, 95% CI 1.001 to 1.036, P = .042) were independent predictors for identifying a PE source. Chronic obstructive pulmonary disease (AOR .173, 95% CI .046 to .646, P = .009) was predictive of not identifying a PE source. CONCLUSIONS Most medical and surgical patients with fatal PE had a lower extremity source found, but a significant number had no source identified. Age and body mass index were positively associated with PE source identification. However, a diagnosis of chronic obstructive pulmonary disease was associated with no PE source identification.
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Affiliation(s)
- Matthew D Tadlock
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | | | - Martina Kennedy
- Los Angeles County Forensic Medical Division, Los Angeles, CA, USA
| | | | - Obi Okoye
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | - Hande Aksoy
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | - Efstathios Karamanos
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | - Ling Zheng
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | - Daniel J Grabo
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | | | - Thomas Noguchi
- Los Angeles County Forensic Medical Division, Los Angeles, CA, USA
| | - Kenji Inaba
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA
| | - Demetrios Demetriades
- Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
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10
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Time trends in pulmonary embolism: A matter of age and gender. Thromb Res 2013; 132:6-7. [DOI: 10.1016/j.thromres.2013.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 05/11/2013] [Accepted: 05/31/2013] [Indexed: 11/19/2022]
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11
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Perfusion SPECT in patients with suspected pulmonary embolism: how much sensitivity is needed to keep patients alive? Eur J Nucl Med Mol Imaging 2013; 40:1428-31. [PMID: 23748237 DOI: 10.1007/s00259-013-2470-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Olshansky B, Sullivan RM. Sudden death risk in syncope: the role of the implantable cardioverter defibrillator. Prog Cardiovasc Dis 2013; 55:443-53. [PMID: 23472783 DOI: 10.1016/j.pcad.2012.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Syncope is generally benign but when it is due to an underlying cardiovascular condition, the prognosis can be guarded. Patients with syncope may be at risk of dying suddenly from a ventricular arrhythmia especially if the collapse is caused by a poorly-tolerated, self-terminating, ventricular tachycardia (VT). If a similar VT recurs, and persists, it could initiate cardiac arrest, leading to sudden cardiac death. However, distinguishing which patient with syncope may benefit most from implantable cardioverter defibrillator (ICD) therapy, which can stop life-threatening and poorly tolerated VT, thereby preventing sudden cardiac death, remains an ongoing challenge. Careful assessment of the patient's underlying cardiovascular conditions, scrupulous attention to historical detail to assess potential causes for syncope, and risk stratification based upon clinical characteristics and short and long-term risks can help. This review focuses on the sudden death risk in patients with syncope and explores the role of the ICD to treat ventricular arrhythmias, prevent symptoms, and prevent death.
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