Cardiac Biomarkers in Patients with Acute Pulmonary Embolism

Research progress on the association between lung cancer and pulmonary embolism

Pulmonary embolism (PE), a form of venous thromboembolism, is a frequently observed complication in malignancies, with a notably high incidence in individuals with lung cancer. The presence of PE markedly reduces the quality of life and has a significant impact on the prognosis of those diagnosed with both lung cancer and PE. As a result, timely diagnosis and intervention are of paramount importance. The presence of PE markedly reduces the quality of life and has a significant impact on the prognosis of those diagnosed with both lung cancer and PE. As a result, timely diagnosis and intervention are of paramount importance.

The Prognostic Value of Total Blood Count Parameter Ratios in Acute Pulmonary Embolism

Background/Objectives: Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality, characterized by nonspecific symptoms and variable clinical presentations. Accurate risk stratification is essential for effective management. While conventional tools like the simplified pulmonary embolism severity index (sPESI) and imaging modalities are widely used, they are often costly and have limitations in predictive accuracy. Inflammatory and coagulative markers, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean-platelet-volume-to-lymphocyte ratio (MPVLR), have shown promise in thrombotic conditions. This study explores their prognostic value in PE, focusing on their associations with risk stratification and clinical outcomes. Methods: This retrospective study included 231 adult patients diagnosed with PE at a tertiary care center. Exclusion criteria included recent infection, autoimmune diseases, or immunosuppressive therapy. Laboratory data, clinical parameters, and outcomes (e.g., hospitalization duration, complications, and mortality) were analyzed. Ratios were calculated from routine blood counts, and statistical comparisons were conducted between low- and high-risk groups based on sPESI. Results: High-risk patients (n = 203) exhibited significantly higher troponin, blood urea nitrogen, aspartate aminotransferase, lactate, the NLR (median 4.9 vs. 2.7, p = 0.005), and the MPVLR (median 7.1 vs. 3.9, p = 0.001) compared to low-risk patients. The PLR showed no significant difference between risk groups (p = 0.233). An elevated NLR, PLR, and MPVLR correlated with ICU admission, intubation, and mortality (p < 0.001, p < 0.007, and p < 0.001, respectively). The NLR was the most consistently associated with hospitalization duration and mortality, while the MPVLR and PLR were less predictive of overall hospitalization. Conclusions: The NLR, MPVLR, and PLR are cost-effective, easily calculable markers with the potential for improving risk stratification in PE patients. Among these, the NLR showed the strongest prognostic value, correlating with multiple clinical outcomes. Multicenter studies are needed to validate these findings further and establish clinical utility.

Apelin-13 as a novel diagnostic laboratory biomarker in thromboembolic disorders: a review of literature with prospective insights

Thromboembolic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are major global health concerns, causing significant morbidity and mortality. Early diagnosis is crucial for effective treatment and improved patient outcomes. Recent research has identified Apelin-13, a bioactive peptide in the apelin family, as a promising diagnostic biomarker for Thromboembolic disorders. Apelin-13 supports vascular health by regulating protease balance through plasminogen activator inhibitors and modulating endothelial cell function. Additionally, it plays a vital role in coagulation, with elevated levels associated with an increased risk of clot formation, suggesting its utility in predicting thrombosis risk, particularly in preoperative evaluations. Findings indicate that the Apelin-13 pathway shows significant promise as a biomarker for Thromboembolic disorders, underscoring its potential therapeutic applications and the need for further investigation. This review synthesizes current literature on thromboembolic disorders and associated laboratory biomarkers, with a particular focus on Apelin-13. It examines Apelin-13's role in disease mechanisms, its physiological functions, and its potential as a diagnostic biomarker in thromboembolic conditions.

The prognostic significance of pro-BNP and heart failure in acute pulmonary embolism: A systematic review

Pulmonary embolism (PE) is the third most common type of cardiovascular disease and carries a high mortality rate of 30% if left untreated. Although it is commonly known that individuals who suffer heart failure (HF) are more likely to experience a pulmonary embolism, little is known concerning the prognostic relationship between acute PE and HF. This study aims to evaluate the prognostic usefulness of heart failure and pro-BNP in pulmonary embolism cases. A scientific literature search, including PubMed, Medline, and Cochrane reviews, was used to assess and evaluate the most pertinent research that has been published. The findings showed that increased N-terminal brain natriuretic peptide (NT-proBNP) levels could potentially identify pulmonary embolism patients with worse immediate prognoses and were highly predictive of all-cause death. Important prognostic information can be obtained from NT-proBNP and Heart-type Fatty Acid Binding Proteins (H-FABP) when examining individuals with PE. The heart, distal tubular cells of the renal system, and skeletal muscle are where H-FABP is primarily found, with myocardial cells having the highest concentration. Recent studies have indicated that these biomarkers may also help assess the severity of PE and its long-term risk.

Pulmonary embolism in patients with chronic coronary syndrome masquerading as acute coronary syndrome: a case report and literature review

BACKGROUND

Pulmonary embolisms (PEs) exhibit clinical features similar to those of acute coronary syndrome (ACS), including electrocardiographic abnormalities and elevated troponin levels, which frequently lead to misdiagnoses in emergency situations.

CASE PRESENTATION

Here, we report a case of PE coinciding with chronic coronary syndrome in which the patient's condition was obscured by symptoms mimicking ACS. A 68-year-old female with syncope presented to the hospital. Upon admission, she was found to have elevated troponin levels and an electrocardiogram showing ST-segment changes across multiple leads, which initially led to a diagnosis of ACS. Emergency coronary arteriography revealed occlusion of the posterior branches of the left ventricle of the right coronary artery, but based on the complexity of the intervention, the occlusion was considered chronic rather than acute. On the 3rd day after admission, the patient experienced recurrent chest tightness and shortness of breath, which was confirmed as acute PE by emergency computed tomography pulmonary angiography. Following standardized anticoagulation treatment, the patient improved and was subsequently discharged.

CONCLUSIONS

This case report highlights the importance of recognizing the nonspecific features of PE. Clinicians should be vigilant when identifying other clinical features that are difficult to explain accompanying the expected disease, and it is necessary to carefully identify the causes to prevent missed diagnoses or misdiagnoses.

Role of serum biomarkers in predicting management strategies for acute pulmonary embolism

Background

Acute pulmonary embolism (APE) is a condition that can be fatal. The severity of the disease influences therapeutic decisions, and mortality varies significantly depending on the condition's severity. Identification of patients with a high mortality risk is crucial. Since inflammation, hemostatic, and coagulation abnormalities are linked to APE, serum biomarkers may be helpful for prognostication.

Aim

To evaluate the significance of serum biomarkers in APE risk assessment and the suitability of these biomarkers for management and decision-making.

Methods

This study involved 60 adult patients with APE who were divided according to risk categorization. It was conducted in Chest, Cardiology and Internal Medicine department, Zagazig University Hospitals from December 2022 to May 2023. Several hematological biomarkers and their significance in APE risk assessment were measured with a comparison with the latest risk stratification methods which include haemodynamic measures and right ventricular (RV) dysfunction echocardiographic markers.

Results

Each risk group involved 20 patients (high, intermediate (10 were intermediate-high and 10 were intermediate-low) and low risk group). They were 34 females and 26 males with the mean ± SD of their age was 59.25 ± 13.06 years. Regarding hematological biomarkers, there were statistically significant differences as regards; lymphocytes, platelet to lymphocyte ratio (PLR), albumin, blood urea nitrogen (BUN), C-reactive protein (CRP) and D-dimer with highly statistically significant differences as regards; neutrophil to lymphocyte ratio (NLR), BUN to albumin (B/A) ratio, troponin I (TnI), and brain natriuretic peptide (BNP). TnI had the highest specificity and predictive value positive (PVP) and BNP had the highest sensitivity and predictive value negative (PVN) in predicting high risk groups. The Lymphocyte and NLR showed the lowest sensitivity and the albumin and B/A ratio had the lowest specificity. Regarding transthoracic echocardiography (TEE); there was a statistically significant increase regarding pulmonary artery systolic pressure (PASP) and a highly statistically significant increase regarding the right ventricle/left ventricle (RV/LV) ratio. There were statistically significant decreases regarding tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity of tricuspid annulus (S') among risk groups.

Conclusion

APE prognosis can be judged accurately by simultaneously measuring a few biomarkers along with haemodynamic variables and echocardiographic parameters of RV dysfunction.

Comparison of therapeutic effect of catheter direct thrombolysis and peripheral venous thrombolysis on acute pulmonary embolism

We compared the therapeutic effect of catheter direct thrombolysis (CDT) and peripheral venous thrombolysis (PVT) for patients with acute pulmonary embolism (APE). Totally, 74 patients with APE were enrolled, including 37 in the CDT group and 37 in the PVT group. The changes in clinical indicators pre and posttreatment were observed. Clinical efficacy was evaluated. Kaplan-Meier method was used to analyze the survival of patients during follow-up. In both the PVT group and CDT group, partial pressure of oxygen after treatment increased significantly than that before treatment (P < .05). However, in both groups, the levels of partial pressure of carbon dioxide, D-dimer, B-type brain natriuretic peptide, pulmonary arterial pressure, and thrombus volume after treatment were significantly decreased than those before treatment (P < .05). After treatment, patients from the CDT group had significantly lower D-dimers, partial pressure of carbon dioxide, brain natriuretic peptide, and pulmonary arterial pressure, and significantly higher partial pressure of oxygen compared to patients from the PVT group (P < .05). The total effective rate was 97.2% in the CDT group and 81.0% in the PVT group. The bleeding incidence in the CDT group was significantly lower than that in the PVT group (P < .05). The median survival time in the CDT group was significantly longer than that in the PVT group (P < .05). CDT can more effectively improve symptoms, cardiac function, and survival rate of APE patients while reducing bleeding incidence than PVT, and thus is safe and effective in treating APE.

Editorial for the Special Issue "Emergency Medicine and Emergency Room Medical Issues"

Together with the "law of entropy", two of the main reasons for the risk of burnout among physicians who work in emergency departments around the world are the variety of clinical issues presented by patients and the absence of guidelines for managing most of them [...].

Pulmonary Embolism Presenting with Pulmonary Infarction: Update and Practical Review of Literature Data

Pulmonary infarction (PI) is a possible consequence of pulmonary embolism (PE). The real incidence of PI could be underestimated considering only non-fatal PE presentation. However, following postmortem examination, the prevalence of PI is considerably higher. This evidence suggests the necessity of proper diagnostic protocol for identifying PI. Unfortunately, PI diagnosis can sometimes be challenging, due to the overlapping of symptoms with other diseases. Nowadays, the diagnosis is mainly based on radiological evaluation, although the combination with emerging imaging techniques such as ultrasound and nuclear scanning might improve the diagnostic algorithm for PI. This review aims to summarize the available data on the prevalence of PI, the main predisposing factors for the development of PI among patients with PE, to resume the possible diagnostic tools, and finally the clinical and prognostic implications.