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Ozden Sertcelik U, Ozkan E, Sertcelik A, Karalezli A. The relation between thrombus burden and early mortality risk in inpatients diagnosed with COVID-19-related acute pulmonary embolism: a retrospective cohort study. BMC Pulm Med 2023; 23:345. [PMID: 37704993 PMCID: PMC10500925 DOI: 10.1186/s12890-023-02647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND COVID-19-related acute pulmonary thromboembolism (APE) is associated with poor outcomes in patients with COVID-19. There are studies investigating the association between thrombus burden and high risk of early mortality in the pre-COVID-19 period. This study aimed to evaluate the relationship between clot burden and early mortality risk in COVID-19-related APE patients. METHODS In this single-center retrospective cohort study, the data of hospitalized adult patients followed up for COVID-19-related APE between April 1, 2020, and April 1, 2021, were electronically collected. A radiologist evaluated the computed tomography (CT) findings and calculated the Mastora scores to determine clot burden. The early mortality risk group of each patient was determined using 2019 the European Society of Cardiology guidelines. RESULTS Of the 87 patients included in the study, 58 (66.7%) were male, and the mean age was 62.5±16.2 years. There were 53 (60.9%) patients with a low risk of mortality, 18 (20.7%) with an intermediate-low risk, and 16(18.4%) with an intermediate-high/high risk. The median total simplified Mastora scores were 11.0, 18.5, and 31.5 in the low, the intermediate-low, and the intermediate-high/high-risk groups, respectively (p = 0.002). With the 80.61% of post-hoc power of the study, intermediate-high/high early mortality risk was associated statistically significantly with the total simplified Mastora score (adj OR = 1.06, 95%CI = 1.02-1.11,p = 0.009). Total simplified Mastora score was found to predict intermediate-high/high early mortality risk with a probability of 0.740 (95% CI = 0.603-0.877): At the optimal cut-off value of 18.5, it had 75.0% sensitivity, 66.2% specificity, 33.3% positive predictive value, and 92.2% negative predictive value. CONCLUSIONS The total simplified Mastora score was found to be positively associated with early mortality risk and could be useful as decision support for the risk assessment in hospitalized COVID-19 patients. Evaluation of thrombus burden on CT angiography performed for diagnostic purposes can accelerate the decision of close monitoring and thrombolytic treatment of patients with moderate/high risk of early mortality.
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Affiliation(s)
| | - Erdem Ozkan
- Ankara Bilkent City Hospital, Department of Radiology, Ankara, Türkiye
| | - Ahmet Sertcelik
- Faculty of Medicine, Department of Public Health, Division of Epidemiology, Hacettepe University, Ankara, Türkiye
| | - Aysegul Karalezli
- Faculty of Medicine, Department of Chest Diseases, Ankara Yildirim Beyazit University, Ankara, Türkiye
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Sametzadeh M, Dadgostar S, Hanafi MG, Mohammadi M. Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross-sectional study. Health Sci Rep 2023; 6:e1546. [PMID: 37670847 PMCID: PMC10476463 DOI: 10.1002/hsr2.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
Background Pulmonary Embolism (PE) is an acute and potentially fatal condition defined as the blockage of pulmonary arteries by an embolism that can be from various origins. Objective The present study aimed to investigate the findings of computed tomography pulmonary angiography (CTPA) and echocardiography in patients with acute PE. Methods The present cross-sectional study included some patients with clinical manifestations of PE who underwent CTPA and echocardiography. The radiologic findings, PE severity, and outcome of the patients were recorded. Moreover, echocardiography was performed by an expert cardiologist using a high-resolution device, while CTPA was performed by an expert radiologist using a 16-slice device and a two-step selective test bolus method. Results According to our findings, a total number of 147 patients were diagnosed with PE, including 44 (29.93%), 44 (29.93%), and 59 (40.14%) cases of mild, moderate, and severe PE, respectively. Moreover, 25 patients (17%) finally expired due to PE. Regarding the CTPA findings, 31 patients (21.1%) had septum flattening, while 35 (23.8%) had a septum deviation toward the left ventricle. Also, there were significant correlations between mortality and some CTPA findings, including severe PE (p < 0.001), the presence of septal deviation (p = 0.007), and higher diameters of the main pulmonary artery (p < 0.001) and right ventricle (p = 0.008). Conclusion CTPA is a valid and accessible modality for diagnosing and evaluating PE in suspected patients. Moreover, several findings in CTPA could predict adverse outcomes, such as death, in patients with PE.
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Affiliation(s)
- Mozhgan Sametzadeh
- Department of Radiology, School of Medicine, Golestan HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Sahar Dadgostar
- Department of Radiology, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Mohammad Ghasem Hanafi
- Department of Radiology, School of Medicine, Imam Khomeini HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Mohammad Mohammadi
- Department of Cardiology, School of Medicine, Golestan HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
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Ak M, Gumus S, Aghayev A, Chang CH, Fu B, Roberts MS, Woodard PK, Bae KT. The Resolution Rate of Pulmonary Embolism on CT Pulmonary Angiography: a Prospective Study. Eur J Radiol 2022; 155:110466. [PMID: 35986988 DOI: 10.1016/j.ejrad.2022.110466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively assess the rate of clot resolution from CT pulmonary angiography (CTPA) in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS This prospective cohort study included 290 patients (136 men, 154 women; mean age, 51.9 years) with acute PE. All patients had a CTPA at the presentation and had at least one follow-up within 6 months (mean 72.7 days). Sixty-four percent of patients had follow-up scans for research purposes within a pre-determined period (between 28 and 184 days; mean, 78.27 days) and 36 % had (between 2 and 184 days; mean, 62.78 days) for a clinical indication. The volume of each clot was measured using a semi-automated quantification program. The resolution rate was evaluated by interval-censored analysis. RESULTS The overall estimated probability of complete resolution was 42 % at 7 days, 56 % at 10 days, and 71 % at 45 days. Achieving complete resolution was significantly faster in patients with peripheral clots (HR: 1.78; CI: 1.05-3.03, p = 0.032) but slower in patients with consolidation and history of venous thromboembolism (VTE), (HR: 0.37; CI: 0.18-0.79, p = 0.01 and HR: 0.57; CI: 0.35-0.91, p = 0.019, respectively). Although the patients with cancer showed a faster resolution rate (HR: 1.67; CI: 1.05-2.68, p = 0.032), the mortality rate was significantly higher than non-cancer patients. CONCLUSION The resolution rate of clot burden in acute PE was associated with patients' clinical presentation variables and CTPA imaging biomarkers. This information may be incorporated into designing a prediction rule and determining the appropriate duration of anticoagulation therapy in patients with acute PE.
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Affiliation(s)
- M Ak
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - S Gumus
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - A Aghayev
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - C H Chang
- Department of Medicine, School of Medicine, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - B Fu
- Data and Statistical Sciences, Abbvie, Inc., Lake Bluff, IL, United States
| | - M S Roberts
- Department of Medicine, School of Medicine, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - P K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, United States
| | - K T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Tao R, Burivalova Z, Masri SC, Dharmavaram N, Baber A, Deaño R, Hess T, Dhingra R, Runo J, Jarjour N, Vanderpool RR, Chesler N, Kusmirek JE, Eldridge M, Francois C, Raza F. Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes. Egypt Heart J 2022; 74:37. [PMID: 35527310 PMCID: PMC9080642 DOI: 10.1186/s43044-022-00274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. RESULTS We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. CONCLUSIONS In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.
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Affiliation(s)
- Ran Tao
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Zuzana Burivalova
- Nelson Institute for Environmental Studies, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - S Carolina Masri
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Naga Dharmavaram
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Aurangzeb Baber
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Roderick Deaño
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Timothy Hess
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Ravi Dhingra
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - James Runo
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Nizar Jarjour
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Rebecca R Vanderpool
- Department of Biomedical Engineering, The University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA
| | - Naomi Chesler
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA, 92697, USA
| | - Joanna E Kusmirek
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Marlowe Eldridge
- Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | | | - Farhan Raza
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
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Zhang H, Cheng Y, Chen Z, Cong X, Kang H, Zhang R, Guo X, Liu M. Clot burden of acute pulmonary thromboembolism: comparison of two deep learning algorithms, Qanadli score, and Mastora score. Quant Imaging Med Surg 2022; 12:66-79. [PMID: 34993061 DOI: 10.21037/qims-21-140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The deep learning convolution neural network (DL-CNN) benefits evaluating clot burden of acute pulmonary thromboembolism (APE). Our objective was to compare the performance of the deep learning convolution neural network trained by the fine-tuning [DL-CNN (ft)] and the deep learning convolution neural network trained from the scratch [DL-CNN (fs)] in the quantitative assessment of APE. METHODS We included the data of 680 cases for training DL-CNN by DL-CNN (ft) and DL-CNN (fs), then retrospectively included 410 patients (137 patients with APE, 203 males, mean age 60.3±11.4 years) for testing the models. The distribution and volume of clots were respectively assessed by DL-CNN(ft) and DL-CNN(fs), and sensitivity, specificity, and area under the curve (AUC) were used to evaluate their performances in detecting clots on a per-patient and clot level. Radiologists evaluated the distribution of clots, Qanadli score, and Mastora score and right ventricular metrics, and the correlation of clot volumes with right ventricular metrics were analyzed with Spearman correlation analysis. RESULTS On a per-patient level, the two DL-CNN models had high sensitivities and moderate specificities [DL-CNN (ft): 100% and 77.29%; DL-CNN (fs): 100% and 75.82%], and their AUCs were comparable (Z=0.30, P=0.38). On a clot level, DL-CNN (ft) and DL-CNN (fs) sensitivities and specificities in detecting central clots were 99.06% and 72.61%, and 100% and 70.63%, respectively. DL-CNN (ft) sensitivities and specificities in detecting peripheral clots were mostly higher than those of DL-CNN (fs), and their AUCs were comparable. Clot volumes measured with the two models were similar (U=85094.500, P=0.741), and significantly correlated with Qanadli scores [DL-CNN(ft) r=0.825, P<0.001, DL-CNN(fs) r=0.827, P<0.001] and Mastora scores [DL-CNN(ft) r=0.859, P<0.001, DL-CNN(fs) r=0.864, P<0.001]. Clot volumes were also correlated with right ventricular metrics. Clot burdens were increased in the low-risk, moderate-risk, and high-risk patients. Binary logistic regression revealed that only the ratio of right ventricular area/left ventricular area (RVa/LVa) was an independent predictor of in-hospital death (odds ratio 6.73; 95% CI, 2.7-18.12, P<0.001). CONCLUSIONS Both DL-CNN (ft) and DL-CNN (fs) have high sensitivities and moderate specificities in detecting clots associated with APE, and their performances are comparable. While clot burdens quantitatively calculated by the two DL-CNN models are correlated with right ventricular function and risk stratification, RVa/LVa is an independent prognostic factor of in-hospital death in patients with APE.
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Affiliation(s)
- Hongxia Zhang
- Department of Radiology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yan Cheng
- Intensive Care Unit, Erlonglu Hospital of Beijing, Beijing, China
| | - Zhenbo Chen
- Department of Radiology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Xinying Cong
- Department of Radiology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Han Kang
- Institute of AI-Advanced Research, Infervision Medical Technology Co., Ltd., Beijing, China
| | - Rongguo Zhang
- Institute of AI-Advanced Research, Infervision Medical Technology Co., Ltd., Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Planek MIC, Ruge M, Du Fay de Lavallaz JM, Kyung SB, Gomez JMD, Suboc TM, Williams KA, Volgman AS, Simmons JA, Rao AK. Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes. Am Heart J Plus 2021; 11:100052. [PMID: 34667971 PMCID: PMC8511552 DOI: 10.1016/j.ahjo.2021.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients. SETTING/PARTICIPANTS 245 COVID-19 patients who underwent chest CT at Rush University Health System were included. DESIGN Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians. INTERVENTIONS/MAIN OUTCOME MEASURES These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation, in-hospital and 60-day mortality. Secondary endpoints included individual components of the ACO. RESULTS Aortic calcification was independently associated with an increased risk of the ACO (odds ratio 1.86, 95% confidence interval (1.11-3.17) p < 0.05). Aortic calcification, CAC, abnormal septal position, or IVC reflux of contrast were all significantly associated with 60-day mortality and major adverse cardiovascular events. IVC reflux was associated with in-hospital mortality (p = 0.005). CONCLUSION Incidental cardiovascular findings on chest CT are clinically important imaging markers in COVID-19. It is important to ascertain and routinely report cardiovascular findings on CT imaging of COVID-19 patients as they have potential to identify high risk patients.
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Key Words
- Ao, aorta
- Aortic calcification
- CAC, coronary artery calcification
- CAD, coronary artery disease
- CI, confidence intervals
- COVID-19
- CT, computed tomography
- CVD, cardiovascular disease
- Chest computed tomography
- Coronary artery calcification
- ECMO, extracorporeal membrane oxygenation
- ICU, intensive care unit
- IVC, inferior vena cava
- LV, left ventricular
- MACE, major adverse cardiovascular events
- PA, pulmonary artery
- RV, right ventricular
- Right ventricular strain
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Affiliation(s)
| | - Max Ruge
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | | | - Stella B. Kyung
- Division of Cardiology, Loyola University Medical Center, Chicago, IL, United States of America
| | | | - Tisha M. Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Kim A. Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | | | - J. Alan Simmons
- Department of Research Core, Rush University Medical Center, Chicago, IL, United States of America
| | - Anupama K. Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
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Roller FC, Yildiz SM, Kriechbaum SD, Harth S, Breithecker A, Liebetrau C, Schüßler A, Mayer E, Hamm CW, Guth S, Krombach GA, Wiedenroth CB. Noninvasive prediction of pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension by electrocardiogram-gated computed tomography. Eur J Radiol Open 2021; 8:100384. [PMID: 34712746 PMCID: PMC8528681 DOI: 10.1016/j.ejro.2021.100384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022] Open
Abstract
Easily measurable parameters from chest CT examinations enable prediction of pulmonary hemodynamics. ECG-gated CTPA is superior to non-gated CT. Non-invasive pH therapy monitoring or follow-up might be implemented in the future.
Purpose The aim of the study was to investigate the potential of electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) as a predictor of disease severity in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Method Forty-five CTEPH patients with a mean age of 63.8 years±12.7 y (±standard deviation) who had undergone ECG-gated CTPA and right heart catheterization (RHC) were included in the study. Right ventricular to left ventricular volume ratio (RVV/LVV), diameter ratio on 4-chamber view (RVD4CH/LVD4CH), pulmonary trunk (PT) diameter, PT to aortic diameter ratio (PT/A), and septal angle were correlated to mean pulmonary artery pressure (mPAP). Moreover, RVV/LVV and RVD4CH/LVD4CH were adjusted to pulmonary diameter index (PADi) and PT/A index. Areas under the curve (AUC) for predicting mPAP above 40 mmHg, 35 mmHg, and 30 mmHg were calculated. Results RVD4CH/LVD4CH revealed the strongest correlation to mPAP before (r = 0.6507) and after (r = 0.7650; p < 0.0001) PT/A adjustment. The AUCs for predicting pH with mPAP over 40 mmHg and 30 mmHg were 0.9229 and 0.864, respectively. A cutoff value of 1.298 enabled prediction of pH with mPAP over 40 mmHg with a sensitivity, specificity, positive predictive, and negative predictive value of 80.00 %, 95.83 %, 88.46 %, and 94.12 %, respectively. Intra- and interobserver variability were excellent for all parameters. Conclusion Combining different and easily evaluable ECG-gated CTPA parameters enables excellent prediction of pulmonary hemodynamics in CTEPH patients. Ventricular diameter ratio on 4-chamber view adjusted by the PT/A ratio yielded the best correlation to mPAP.
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Key Words
- 4CH, four-chamber view
- AUC, Area under the curve
- CI, Confidence interval
- CT, Computed tomography
- CTEPH
- CTEPH, Chronic thromboembolic pulmonary hypertension
- CTPA
- CTPA, Computed tomography pulmonary angiography
- ECG, Electrocardiogram
- HU, Hounsfield units
- ICC, intra-class concordance correlation coefficient
- LV, Left ventricular
- LVD, Left ventricular diameter
- LVV, Left ventricular volume
- MDCT, Multidetector computed tomography
- NPV, Negative predictive value
- PADi, Pulmonary artery diameter index
- PH, Pulmonary hypertension
- PPV, Positive predictive value
- PT, Pulmonary trunk
- Pulmonary hypertension
- RHC, Right heart catheterization
- ROC, Receiver operating characteristics
- RV, Right ventricular
- RVD, Right ventricular diameter
- RVV, Right ventricular volume
- Right heart catheterization
- SD, Standard deviation
- mPAP, mean pulmonary artery pressure
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Affiliation(s)
- Fritz C Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Selcuk M Yildiz
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Steffen D Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Sebastian Harth
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Andreas Breithecker
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Armin Schüßler
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.,Department of Cardiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany.,German Center for Cardiovascular Research (DZHK), RheinMain Chapter, Frankfurt am Main, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Gabriele A Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
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Desai PV, Krepostman N, Collins M, De Sirkar S, Hinkleman A, Walsh K, Fareed J, Darki A. Neurological Complications of Pulmonary Embolism: a Literature Review. Curr Neurol Neurosci Rep 2021; 21:59. [PMID: 34669060 DOI: 10.1007/s11910-021-01145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The present review discusses in-depth about neurological complications following acute venous thromboembolism (VTE). RECENT FINDINGS Intracranial hemorrhage, acute ischemic cerebrovascular events, and VTE in brain tumors are described as central nervous system (CNS) complications of PE, while peripheral neuropathy and neuropathic pain are reported as peripheral nervous system (PNS) sequelae of PE. Syncope and seizure are illustrated as atypical neurological presentations of PE. Mounting evidence suggests higher risk of venous thromboembolism (VTE) in patients with neurological diseases, but data on reverse, i.e., neurological sequelae following VTE, is underexplored. The present review is an attempt to explore some of the latter issues categorized into CNS, PNS, and atypical complications following VTE.
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10
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Cau R, Pacielli A, Fatemeh H, Vaudano P, Arru C, Crivelli P, Stranieri G, Suri JS, Mannelli L, Conti M, Mahammedi A, Kalra M, Saba L. Complications in COVID-19 patients: Characteristics of pulmonary embolism. Clin Imaging 2021; 77:244-249. [PMID: 34029929 PMCID: PMC8130594 DOI: 10.1016/j.clinimag.2021.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022]
Abstract
Objective The purpose of this study is to evaluate chest CT imaging features, clinical characteristics, laboratory values of COVID-19 patients who underwent CTA for suspected pulmonary embolism. We also examined whether clinical, laboratory or radiological characteristics could be associated with a higher rate of PE. Materials and methods This retrospective study included 84 consecutive patients with laboratory-confirmed SARS-CoV-2 who underwent CTA for suspected PE. The presence and localization of PE as well as the type and extent of pulmonary opacities on chest CT exams were examined and correlated with the information on comorbidities and laboratory values for all patients. Results Of the 84 patients, pulmonary embolism was discovered in 24 patients. We observed that 87% of PE was found to be in lung parenchyma affected by COVID-19 pneumonia. Compared with no-PE patients, PE patients showed an overall greater lung involvement by consolidation (p = 0.02) and GGO (p < 0.01) and a higher level of D-Dimer (p < 0,01). Moreover, the PE group showed a lower level of saturation (p = 0,01) and required more hospitalization (p < 0,01). Conclusion Our study showed a high incidence of PE in COVID-19 pneumonia. In 87% of patients, PE was found in lung parenchyma affected by COVID-19 pneumonia with a worse CT severity score and a greater number of lung lobar involvement compared with non-PE patients. CT severity, lower level of saturation, and a rise in D-dimer levels could be an indication for a CTPA. Advances in knowledge Certain findings of non-contrast chest CT could be an indication for a CTPA.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554, Monserrato (Cagliari) 09045, Italy
| | - Alberto Pacielli
- Department of Radiology, Ospedale S. Giovanni Bosco, 10154 Turin, Italy
| | - Homayounieh Fatemeh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Paolo Vaudano
- Department of Radiology, Ospedale S. Giovanni Bosco, 10154 Turin, Italy
| | - Chiara Arru
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554, Monserrato (Cagliari) 09045, Italy
| | - Paola Crivelli
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Sassari - Sassari, Italy
| | | | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | | | - Maurizio Conti
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Sassari - Sassari, Italy
| | - Abdelkader Mahammedi
- Department of Neuroradiology, University of Cincinnati Medical Center, OH 45267, USA
| | - Mannudeep Kalra
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554, Monserrato (Cagliari) 09045, Italy.
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11
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Cozzi D, Moroni C, Cavigli E, Bindi A, Caviglioli C, Nazerian P, Vanni S, Miele V, Bartolucci M. Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism. Radiol Med 2021; 126:1030-1036. [PMID: 33961187 DOI: 10.1007/s11547-021-01364-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Computed tomographic pulmonary angiography (CTPA) is the first-line test in acute pulmonary embolism (APE) diagnostic algorithm, but its correlation with short-term outcome remains not clear at all. The aim is to determine whether CTPA findings can predict 30-day mortality of patients with APE in Emergency Department. METHODS This retrospective monocentric study involved 780 patients with APE diagnosed at the Emergency Department of our institution (period 2010-2019). These CTPA findings were evaluated: embolic obstruction burden score (Qanadli score), common pulmonary artery trunk diameter, right-to-left ventricular ratio, azygos vein and coronary sinus diameters. Comorbidities and fatal/nonfatal adverse outcomes within 30 days were recorded. Troponin I values were correlated with angiographic parameters with multiple logistic regression analysis. RESULTS The all-cause and APE-related 30-day mortality rates were 5.9% and 3.6%, respectively. Patients who died within 30 days were older with higher prevalence rates of malignancy. Qanadli score and all CTPA parameters correlate with Troponin I level and the presence of RVD at echocardiography (p values < 0.0001). Instead, RV/LV ratio and coronary sinus diameter correlate with 30-day mortality (p values < 0.05). At the multivariate logistic regression analysis, only coronary sinus and RVD remained significant with an HR = 2.5 (95% CI 1.1-5.6) and HR = 1.9 (95% CI 0.95-3.7), respectively. CONCLUSION CTPA quantification of right ventricular strain is an accurate predictor of 30-day mortality. In particular, it seems that a dilated coronary sinus (>9 mm) has an additional prognostic value in association with echocardiographic signs of right-heart disfunction and high Troponin I levels.
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Affiliation(s)
- Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Cosimo Caviglioli
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
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12
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Kaptein FHJ, Kroft LJM, Hammerschlag G, Ninaber MK, Bauer MP, Huisman MV, Klok FA. Pulmonary infarction in acute pulmonary embolism. Thromb Res 2021; 202:162-169. [PMID: 33862471 DOI: 10.1016/j.thromres.2021.03.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 01/10/2023]
Abstract
Pulmonary infarction results from occlusion of the distal pulmonary arteries leading to ischemia, hemorrhage and ultimately necrosis of the lung parenchyma. It is most commonly caused by acute pulmonary embolism (PE), with a reported incidence of around 30%. Following an occlusion of the pulmonary artery, the bronchial arteries are recruited as primary source of perfusion of the pulmonary capillaries. The relatively higher blood pressure in the bronchial circulation causes an increase in the capillary blood flow, leading to extravasation of erythrocytes (i.e. alveolar hemorrhage). If this hemorrhage cannot be resorbed, it results in tissue necrosis and infarction. Different definitions of pulmonary infarction are used in literature (clinical, radiological and histological), although the diagnosis is nowadays mostly based on radiological characteristics. Notably, the infarcted area is only replaced by a fibrotic scar over a period of months. Hence and formally, the diagnosis of pulmonary infarction cannot be confirmed upon diagnosis of acute PE. Little is known of the impact and relevance of pulmonary infarction in acute PE, and whether specific management strategies should be applied to prevent and/or treat complications such as pain, pneumonia or post-PE syndrome. In this review we will summarize current knowledge on the pathophysiology, epidemiology, diagnosis and prognosis of pulmonary infarction in the setting of acute PE. We highlight the need for dedicated studies to overcome the current knowledge gaps.
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Affiliation(s)
- F H J Kaptein
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - L J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - G Hammerschlag
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - M K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - M P Bauer
- Department of Medicine - Acute Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
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13
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Nguyen ET, Hague C, Manos D, Memauri B, Souza C, Taylor J, Dennie C. Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 1: Acquisition and Safety Considerations. Can Assoc Radiol J 2021; 73:203-213. [PMID: 33781098 DOI: 10.1177/08465371211000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute pulmonary embolism (APE) is a well-recognized cause of circulatory system compromise and even demise which can frequently present a diagnostic challenge for the physician. The diagnostic challenge is primarily due to the frequency of indeterminate presentations as well as several other conditions which can have a similar clinical presentation. This often obliges the physician to establish a firm diagnosis due to the potentially serious outcomes related to this disease. Computed tomography pulmonary angiography (CTPA) has increasingly cemented its role as the primary investigation tool in this clinical context and is widely accepted as the standard of care due to several desired attributes which include great accuracy, accessibility, rapid turn-around time and the ability to suggest an alternate diagnosis when APE is not the culprit. In Part 1 of this guidance document, a series of up-to-date recommendations are provided to the reader pertaining to CTPA protocol optimization (including scan range, radiation and intravenous contrast dose), safety measures including the departure from breast and gonadal shielding, population-specific scenarios (pregnancy and early post-partum) and consideration of alternate diagnostic techniques when clinically deemed appropriate.
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Affiliation(s)
- Elsie T Nguyen
- Department of Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Cameron Hague
- Department of Radiology, University of British Columbia, Ontario, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Ontario, Canada
| | - Brett Memauri
- Department of Radiology, University of Manitoba, Cardiothoracic Sciences Division, St. Boniface General Hospital, Ontario, Canada
| | - Carolina Souza
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Jana Taylor
- Department of Radiology, McGill University Health Centre, Ontario, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada.,Department of Radiology, University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
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14
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Huo YR, Chan MV, Ridley L. Measuring right ventricular lateral wall thickness on CTPA and inpatient mortality in patients with acute PE-promising but more evidence required. Emerg Radiol 2021; 28:863-864. [PMID: 33580851 DOI: 10.1007/s10140-021-01916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ya Ruth Huo
- Level 1, Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, 2137, Australia. .,Concord Hospital Clinical Medical School, Faculty of Medicine, University of Sydney, Concord, 2137, NSW, Australia.
| | - Michael Vinchill Chan
- Level 1, Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, 2137, Australia.,Concord Hospital Clinical Medical School, Faculty of Medicine, University of Sydney, Concord, 2137, NSW, Australia
| | - Lloyd Ridley
- Level 1, Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, 2137, Australia.,Concord Hospital Clinical Medical School, Faculty of Medicine, University of Sydney, Concord, 2137, NSW, Australia
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15
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Triantafyllou GA, O'Corragain O, Rivera-Lebron B, Rali P. Risk Stratification in Acute Pulmonary Embolism: The Latest Algorithms. Semin Respir Crit Care Med 2021; 42:183-198. [PMID: 33548934 DOI: 10.1055/s-0041-1722898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further assess the patients' short-term mortality risk. Integrated prediction models incorporate more information toward an individualized and precise mortality prediction. Additionally, bleeding risk scores should be utilized prior to initiation of anticoagulation and/or reperfusion therapy administration. Here, we review the latest algorithms for a comprehensive risk stratification of the patient with acute PE.
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Affiliation(s)
- Georgios A Triantafyllou
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Oisin O'Corragain
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Belinda Rivera-Lebron
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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16
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Bailis N, Lerche M, Meyer HJ, Wienke A, Surov A. Contrast reflux into the inferior vena cava on computer tomographic pulmonary angiography is a predictor of 24-hour and 30-day mortality in patients with acute pulmonary embolism. Acta Radiol 2021; 62:34-41. [PMID: 32241170 DOI: 10.1177/0284185120912506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE. PURPOSE To search possible CTPA predictors of 24-h and 30-day mortality in PE. MATERIAL AND METHODS Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC). RESULTS Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3-17.7; P < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01-1.21; P = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82-1.01, P = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99-1.02, P = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7-7.0; P = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97-1.12; P = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89-1.04; P = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976-0.999, P = 0.045). CONCLUSION Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.
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Affiliation(s)
- Nikolaos Bailis
- Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Marianne Lerche
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Department of Radiology, University of Leipzig, Leipzig, Germany
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17
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Koutsouflianiotis K, Daniil G, Paraskevas G, Piagkou M, Chrysanthou C, Natsis K. Computed tomography angiography study of the azygos vein course and termination into superior vena cava: gender and age impact. Surg Radiol Anat 2020; 43:353-361. [PMID: 33011921 DOI: 10.1007/s00276-020-02583-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The study highlights azygos vein (AV) topography, arrangement and confluence morphometry in dyspnoea and tachycardia patients of extrapulmonary and extracardiac aetiology. METHOD Computed-tomography angiography of 25 male and 26 female patients (mean age 66.5 years) were studied for: thoracic vertebral (T) height of AV- superior vena cava-SVC confluence, AV course and deviations from vertebral column (VC) midline, AV and SVC diameters, distance (AV arch- lower border of carina) and gender and age impact. RESULTS Commonest heights of the AV-SVC confluence were T5 (56.9%), T4 (31.4%), T6 (9.8%) and T3 (2%). The AV terminated into SVC after crossing the left side of VC midline in 56.9%, slightly deviated right of the midline in 37.3% and coursed right of VC in 5.9%. Mean AV and SVC diameters were 0.96 ± 0.18 cm and 1.86 ± 0.27 cm. Male predominance in AV and SVC diameters and a slight AV diameter significant increase with the age were found. The (AV highest point-lower border of carina) mean distance was 2.05 ± 0.44 cm and male predominance existed. CONCLUSION The commonest termination height of the AV was T5, while T3 was the rarest one. Aging induces the AV leftward displacement, while gender had no impact. AV and SVC diameters had higher significant values in males, while ageing had a significant impact only in AV diameter. The AV higher diameters will be used as predictors for higher values of SVC diameter and mediastinum pathology. Such findings can be useful in mediastinal surgery, mediastinoscopy and surgery of VC deformations, neurovascular surgery of retroperitoneal organs, disc herniation and T fractures.
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Affiliation(s)
- Konstantinos Koutsouflianiotis
- Department of Anatomy and Surgical Anatomy, Medical School, Faculty Health and Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Georgios Daniil
- Department of Radiology, General Hospital of Thessaloniki "G.Gennimatas", Thessaloniki, Greece
| | - Georgios Paraskevas
- Department of Anatomy and Surgical Anatomy, Medical School, Faculty Health and Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, Medical School, Faculty of Health and Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysanthos Chrysanthou
- Department of Anatomy and Surgical Anatomy, Medical School, Faculty Health and Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Medical School, Faculty Health and Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Irmak I, Sertçelik Ü, Öncel A, Er B, İnam G, Durhan G, Demir A, Çöplü L. Correlation of thrombosed vessel location and clot burden score with severity of disease and risk stratification in patients with acute pulmonary embolism. Anatol J Cardiol 2020; 24:247-53. [PMID: 33001050 DOI: 10.14744/AnatolJCardiol.2020.55013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Computed tomography pulmonary angiography (CTPA) is used for the main diagnosis in acute pulmonary embolism (APE). Determining the thrombus location in the pulmonary vascular tree is also important for predicting disease severity. This study aimed to analyze the correlation of the thrombus location and the clot burden with the disease severity and the risk stratification in patients with APE. Methods: The study included patients with APE diagnosed by CTPA who were admitted to the hospital between January 28, 2016, and July 1, 2019. Data collected were markers of severity in APE, including patient demographics, comorbidities, length of hospital stay, pulmonary embolism severity index (PESI) score, modified PESI score, Wells score, risk stratification according to the American Heart Association, systolic blood pressure (SBP), right ventricle diameter to left ventricle diameter ratio, pulmonary arterial pressure, brain natriuretic peptide, troponin, D-dimer, and plasma lactate levels, and vessel location of the thrombus, clot burden score, ratio of the pulmonary artery trunk diameter/aortic diameter, superior vena cava diameter (SVC) by CTPA, and survival. All parameters were analyzed in correlation with clot load and vessel location. Results: Thrombus vascular location was found to be correlated with risk stratification and negatively correlated with SBP. Simplified Mastora score was correlated with risk stratification, SVC diameter, and D-dimer and negatively correlated with SBP. Occlusion of both the pulmonary artery trunk and any pulmonary artery with thrombus was associated with massive APE. Conclusion: The level of the occluded vessel on CTPA may provide the ability to risk-stratify, and the clot burden score may be used for assessing both risk stratification and cardiac strain.
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19
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Karri J, Truong T, Hasapes J, Trujillo DO, Chua S, Shiralkar K, Aisenberg G. Correlating computed tomography pulmonary angiography signs of right ventricular strain in pulmonary embolisms to clinical outcomes. Ann Thorac Med 2020; 15:64-69. [PMID: 32489440 PMCID: PMC7259395 DOI: 10.4103/atm.atm_264_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/27/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION: Right ventricular strain (RVS) in pulmonary embolism (PE) can be used to stratify risk and direct intervention. The clinical significance of computed tomography pulmonary angiogram (CTPA)-derived radiologic signs of RVS, however, remains incompletely characterized. We retrospectively analyzed a cohort of persons with acute PE to determine which, if any, findings of RVS on CTPA correlate with clinical outcomes. METHODS: All patients with PE diagnosed on CTPA from March 2013 through February 2015 at Lyndon B. Johnson Hospital were identified. Their records were retrospectively reviewed to identify length of stay, intensive care unit (ICU) placement, hemodynamic failure, use of thrombolytics, vasopressor requirement, mechanical ventilation, and attributable mortality. Three radiologists, blinded to clinical outcomes, separately reviewed the cohort's CTPAs to identify signs of RVS – pulmonary trunk size, internal size of the right and left ventricles, paradoxical interventricular septal bowing, inferior vena cava (IVC) contrast reflux, and hepatic vein contrast reflux. RESULTS: In our cohort of 102 persons, 12 demonstrated hemodynamic failure, 13 required ICU placement, 3 received thrombolysis, and 5 had death attributable to PE. The greatest interobserver agreement among radiologists existed for the presence of increased pulmonary trunk size (0.76 kappa by %agreement) and hepatic vein contrast reflux (0.92 kappa by %agreement). A multiple regression analysis found that when 100% radiologist agreement existed, presence of paradoxical intravenous septal bowing predicted thrombolytic usage (P = 0.02), and the presence of IVC reflux predicted attributable mortality (P = 0.03). CONCLUSION: Only IVC contrast reflux was associated with increased mortality, and no other sign of RVS on CTPA correlated with clinical outcomes. This suggests that most signs of RVS on CTPA do not reliably predict PE severity. Therefore, RVS seen by CTPA should be used cautiously in weighing the decision to initiate thrombolytics.
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Affiliation(s)
- Jay Karri
- Department of Internal Medicine, McGovern Medical School, UTHSC, Houston, Texas, USA
| | - Tiffany Truong
- Department of Internal Medicine, McGovern Medical School, UTHSC, Houston, Texas, USA
| | - Joseph Hasapes
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, UTHSC, Houston, Texas, USA
| | - Daniel Ocazionez Trujillo
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, UTHSC, Houston, Texas, USA
| | - Steven Chua
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, UTHSC, Houston, Texas, USA
| | - Kaustubh Shiralkar
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, UTHSC, Houston, Texas, USA
| | - Gabriel Aisenberg
- Department of Internal Medicine, McGovern Medical School, UTHSC, Houston, Texas, USA
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20
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El Ghoul J, Bendayekh A, Fki W, Yengui I, Ferjani S, Milouchi S, Ayadi H. [Risk factors for hospital mortality during pulmonary embolism]. Ann Cardiol Angeiol (Paris) 2020; 69:7-11. [PMID: 32127194 DOI: 10.1016/j.ancard.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of our work is to identify the risk factors for hospital mortality during pulmonary embolism in a pneumology department. MATERIAL AND METHOD All patients admitted to the pneumology department of Habib-Bourguiba hospital between 2014 and 2019, with a final diagnosis of PE are analyzed. RESULTS One hundred patients were included, 62% of whom were female, with an average age of 63±16 years. Pulmonary fibrosis was noted in eight patients. On admission, the mean Simplified Pulmonary Embolism Severity Index score was 1.46±1.05. The mean duration of hospitalization was 10.6±7 days. The hospital mortality rate was 12%. The independent risk factors for intra-hospital mortality were arterial hypotension (OR: 6.13; 95%CI: 2.88-14.35; p=0.001), cancer (OR: 2.66; 95%CI: 1.22-9.54; p=0.026), a VD/LV ratio at echocardiography>0.9 (OR: 1.84; 95%CI: 1.06-7.69; p=0.039) and severe hypoxemia (OR: 4.86; 95%CI: 2.19-11,34; p=0.006). CONCLUSION Pulmonary embolism mortality remains high despite improvements in diagnostic and therapeutic management. It is important for our country to take these results into consideration for a better management of patients admitted for pulmonary embolism, and to improve survival.
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Akhoundi N, Langroudi TF, Rajebi H, Haghi S, Paraham M, Karami S, Langroudi FK. Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test. Pol J Radiol 2019; 84:e436-46. [PMID: 31969963 DOI: 10.5114/pjr.2019.89896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/01/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Pulmonary embolism (PE) is a potentially fatal cardiopulmonary disease; therefore, rapid risk stratification is necessary to make decisions of appropriate management strategies. The aim of this study was to assess various computed tomography (CT) findings in order to find new prognostic factors of adverse outcome and mortality. Material and methods The study enrolled 104 patients with acute PE. Based on their outcome, patients were categorised into four groups. Comorbidities such as ischaemic heart disease were obtained from their medical records. Patients CT angiography were reviewed for recording variables such as main pulmonary artery diameter and right ventricle (RV)/left ventricle (LV) ratio. Patient deaths up to three months since diagnosis of PE had been registered. Logistic regression analysis was performed to find predictors. Results Based on multiple logistic regression, RV/LV ratio, LV diameter, and right-sided pulmonary infarction are predictors of mortality in 30 days. An RV/LV ratio of 1.19 could successfully discriminate patients who died within 30 days and those who did not. Conclusions RV/LV ratio, LV diameter, right-sided pulmonary infarction, assessed with helical CT, can help predict 30-day mortality.
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Williams MC, Morley NCD, Muir KC, Reid JH, van Beek EJR, Murchison JT. Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study. Clin Radiol 2019; 74:973.e7-973.e14. [PMID: 31615632 DOI: 10.1016/j.crad.2019.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/23/2019] [Indexed: 01/10/2023]
Abstract
AIM To assess coronary artery calcification (CAC) and vascular calcification in patients with pulmonary embolism (PE) and correlate this with mortality. MATERIALS AND METHODS PE severity was quantified using computed tomography pulmonary angiography (CTPA) in 400 consecutive cases using the modified Miller score (1-5, mild; 6-11, moderate; 12-16, severe). Right ventricle strain was assessed using the right/left ventricle diameter (RV/LV) ratio. CAC score (CACS) was assessed using a four-point scale (CACS mild 1-3, moderate 4-8, severe 9-12) for each vessel and summed to give the total CACS. Follow-up for mortality was obtained at 3 years. RESULTS PE severity was classified as mild in 48%, moderate in 21%, and severe in 32% of cases. The median modified Miller score was 6 (Interquartile range [IQR] 2, 14) and median total CACS was 2 (IQR 0, 7). All-cause mortality occurred in 128 (32%) patients. Patients with CAC were three times more likely to die than patients without CAC (Hazard ratio [HR] 2.96; 95% CI 1.84, 4.77; p<0.001), and patients with severe CAC were at the highest risk (HR 4.62; 95% CI 2.73, 7.83, p<0.001). Gender, modified Miller score and RV/LV ratio were not predictive of mortality. In multivariate analysis both CACS and age were independent predictors of 3-year all-cause mortality. Of the patients with CAC who died, the presence of coronary artery disease was only documented in 34 (32%). CONCLUSION CACS is an independent predictor of all-cause mortality in patients with PE, and has important implications for subsequent patient management.
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Affiliation(s)
- M C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.
| | - N C D Morley
- PET Centre, University Hospital of Wales, Cardiff, UK
| | - K C Muir
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J H Reid
- Borders General Hospital, Melrose, Edinburgh, UK
| | - E J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - J T Murchison
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Abdelghany EA, Othman AM, Abdelfatah RA, Magdy ME, Abd Elghany HS, Higazi MM. Can alveolar—arterial oxygen gradient predict severity of pulmonary embolism? Egypt J Bronchol 2019. [DOI: 10.4103/ejb.ejb_62_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Lerche M, Bailis N, Akritidou M, Meyer HJ, Surov A. Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism. J Clin Med 2019; 8:jcm8050584. [PMID: 31035342 PMCID: PMC6571763 DOI: 10.3390/jcm8050584] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to analyze possible relationships between pulmonary vessel obstruction and clinically relevant parameters and scores in patients with pulmonary embolism (PE). Overall, 246 patients (48.8% women and 51.2% men) with a mean age of 64.0 ± 17.1 years were involved in the retrospective study. The following clinical scores were calculated in the patients: Wells score, Geneva score, and pulmonary embolism severity index (PESI) score. Levels of D-dimer (µg/mL), lactate, pH, troponin, and N-terminal natriuretic peptide (BNP, pg/mL) were acquired. Thrombotic obstruction of the pulmonary arteries was quantified according to Mastora score. The data collected were evaluated by means of descriptive statistics. Spearman’s correlation coefficient was used to analyze associations between the investigated parameters. P values < 0.05 were taken to indicate statistical significance. Mastora score correlated weakly with lactate level and tended to correlate with D-dimer and BNP levels. No other clinical or serological parameters correlated significantly with clot burden. Thrombotic obstruction of pulmonary vessels did not correlate with clinical severity of PE.
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Affiliation(s)
- Marianne Lerche
- Department of Respiratory Medicine, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Nikolaos Bailis
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Mideia Akritidou
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Alexey Surov
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
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Aissa A, Mallat N, Aissa S, Alouini R. [Contribution of pulmonary CT angiography in assessing the severity of acute pulmonary embolism]. Ann Cardiol Angeiol (Paris) 2019; 68:71-79. [PMID: 30172353 DOI: 10.1016/j.ancard.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
Chest CT angiography has taken a major role in the management of patients with suspected pulmonary embolism. Meanwhile, it became necessary to determine the severity criteria at the time of diagnosis in order to properly assess the risk/benefit of treatment to consider. In recent years, pulmonary CT angiography has emerged as a useful tool for assessing the severity of acute lung embolism, based on morphological criteria. The two main approaches that were studied were the quantification of obstruction of pulmonary arterial bed and recognition of signs of right heart failure. The aim of our work is to define the morphological parameters in cardiovascular pulmonary CT angiography and to determine their value in the current clinical prognostic stratification of acute pulmonary embolism of, especially their correlation with the risk of developing signs of clinical severity at diagnosis and at 3 months of the occurrence of pulmonary embolism.
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Affiliation(s)
- A Aissa
- Service d'imagerie médicale, CHU Ibn EL Jazzar de Kairouan, 3100 Kairouan, Tunisie.
| | - N Mallat
- Service d'imagerie médicale, CHU Ibn EL Jazzar de Kairouan, 3100 Kairouan, Tunisie
| | - S Aissa
- Service de pneumologie clinique, CHU Farhat Hached de Sousse, Sousse Tunisie
| | - R Alouini
- Service d'imagerie médicale, CHU Ibn EL Jazzar de Kairouan, 3100 Kairouan, Tunisie
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26
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Jen WY, Kristanto W, Teo L, Phua J, Yip HS, MacLaren G, Teoh K, Sim TB, Loh J, Ong CC, Chee YL, Kojodjojo P. Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism. Heart Lung Circ 2019; 29:345-353. [PMID: 30910512 DOI: 10.1016/j.hlc.2019.02.190] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) care has traditionally been fragmented. The newly introduced Pulmonary Embolism Response Team (PERT) model provides streamlined care based on expedient, multi-disciplinary decision-making. This study aimed to quantify the impact of PERT, as part of a hospital-wide PE treatment protocol, on clinical outcomes. METHODS Consecutive adult patients with acute PE diagnosed via computed tomography pulmonary angiogram (CTPA) were included. The PERT and treatment protocol were introduced in January 2015. Patient characteristics, therapies, quality measures of CTPA reporting, and clinical outcomes of PE patients treated for 2 years before and after implementation of these changes were evaluated. Primary endpoints were median length of stay in intensive care (ICU) and survival to discharge. RESULTS A total of 321 consecutive PE patients were enrolled, of which 154 (treated in 2013-2014) and 167 (2015-2016) patients formed the historical control and study groups, respectively. Implementation of the algorithm was associated with less variance in anticoagulation and improved reporting of right heart strain parameters on CTPA. The ICU stay was reduced from a median of 5 to 2 days (p < 0.01). Eligible massive PE patients receiving reperfusion increased from 30% to 92% (p = 0.01), with mean delay from diagnosis to reperfusion decreasing from 763 to 181 minutes (p < 0.01). Bleeding complications were not increased, but overall survival to discharge remained unchanged. CONCLUSIONS Introducing a PERT and treatment protocol reduced ICU stay, enhanced quality measures, and improved access of massive PE patients to reperfusion therapies, without increasing bleeding complications or health care costs.
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Affiliation(s)
- Wei-Ying Jen
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - William Kristanto
- Department of Cardiology, National University Heart Centre, Singapore
| | - Lynette Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Jason Phua
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore
| | - Hwee Seng Yip
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore
| | - Graeme MacLaren
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Kristine Teoh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Tiong Beng Sim
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Joshua Loh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore.
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27
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Witkin A, Wilcox SR, Chang Y, Huang F, Dudzinski D, Zheng H, Channick R, Kabrhel C. Impact of chronic right ventricular pressure overload in short-term outcomes of acute pulmonary embolism: A retrospective analysis. J Crit Care 2019; 51:1-5. [PMID: 30673622 DOI: 10.1016/j.jcrc.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Evaluate the association between chronic right ventricle (RV) dysfunction by transthoracic echocardiogram (TTE) and outcomes in patients with acute pulmonary embolism (PE). METHODS This was a retrospective analysis of TTE findings in acute PEs. TTEs were used to classify the presence of chronic right ventricular pressure overload (RPVO), defined as RV hypertrophy or RV systolic pressure (RVSP) >50 mmHg, acute RVPO, defined as RV dysfunction not meeting the chronic RVPO definition, or no RV dysfunction. The primary outcome was a composite of death or need for advanced PE therapies at 7 days. RESULTS Of 466 patients, 288 had evidence of RV dysfunction. Thirty percent (140) had evidence of chronic RVPO and 148 patients had evidence of acute RVPO. Chronic RVPO patients were older (P = .004), more likely to have COPD, and had lower heart rates and troponin-t values. The acute RVPO patients included more women and were less likely to have a prior PE. There was no difference in outcomes between the acute and chronic RVPO cohorts. CONCLUSIONS Chronic RVPO patients had lower heart rates and troponin-t values. Despite these differences there were no differences in need for advanced therapeutic interventions or 7 day mortality.
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Affiliation(s)
- Alison Witkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Susan R Wilcox
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Yuchiao Chang
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Fei Huang
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - David Dudzinski
- Division of Cardiology, Department of Medicine Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Hui Zheng
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Richard Channick
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
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Friedman T, Winokur RS, Quencer KB, Madoff DC. Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team. Semin Intervent Radiol 2018; 35:116-121. [PMID: 29872247 DOI: 10.1055/s-0038-1642040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pulmonary embolism (PE) is currently the third leading cause of death and moreover is likely underdiagnosed. PE remains the most common preventable cause of hospital deaths in the United States, which may be attributable to its diagnostic challenges. Although difficult to diagnose, patient mortality rates are time-dependent, and thus, the suspicion and diagnosis of PE in a timely manner is imperative. Diagnosis based on several criteria which may dictate imaging workup as well as laboratory tests and clinical parameters are discussed. The evolution of treatment guidelines via various clinical trials and recommendations is outlined, setting the stage for the use of fibrinolytics, whether systemic or catheter directed. Treatment, including fibrinolytics, is predicated on patient triage into three large categories-massive, submassive, or low-risk PE. Additionally, a relatively new concept of a multidisciplinary team composed of several subspecialty experts known as the PE response team (PERT) is discussed. PERT's timely and unified recommendations have been shown to optimize care and decrease mortality while tailoring treatment to each individual afflicted by PE.
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Affiliation(s)
- Tamir Friedman
- Section of Interventional Radiology, Department of Radiology, Advanced Medical Imaging, Torrington, Connecticut
| | - Ronald S Winokur
- Section of Interventional Radiology, Department of Radiology, Weill Cornell/New York Presbyterian Hospital, New York, New York
| | - Keith B Quencer
- Section of Interventional Radiology, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - David C Madoff
- Section of Interventional Radiology, Department of Radiology, Weill Cornell/New York Presbyterian Hospital, New York, New York
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29
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Kirsch J, Brown RKJ, Henry TS, Javidan-Nejad C, Jokerst C, Julsrud PR, Kanne JP, Kramer CM, Leipsic JA, Panchal KK, Ravenel JG, Shah AB, Mohammed TL, Woodard PK, Abbara S. ACR Appropriateness Criteria ® Acute Chest Pain-Suspected Pulmonary Embolism. J Am Coll Radiol 2018; 14:S2-S12. [PMID: 28473076 DOI: 10.1016/j.jacr.2017.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacobo Kirsch
- Principal Author, Cleveland Clinic, Weston, Florida.
| | | | - Travis S Henry
- University of California San Francisco, San Francisco, California
| | - Cylen Javidan-Nejad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
| | | | | | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher M Kramer
- University of Virginia Health System, Charlottesville, Virginia; American College of Cardiology
| | | | | | - James G Ravenel
- Medical University of South Carolina, Charleston, South Carolina
| | - Amar B Shah
- Westchester Medical Center, Valhalla, New York
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
| | - Pamela K Woodard
- Specialty Chair, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
| | - Suhny Abbara
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
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Bach AG, Taute B, Surov A. Time to threshold as a new indicator of circulatory state and prognosis in patients with pulmonary embolism. Thromb Res 2018; 161:26-32. [DOI: 10.1016/j.thromres.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/28/2017] [Accepted: 11/12/2017] [Indexed: 11/21/2022]
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Nelson SM, Craig SH. Ekosonic Endovascular System (EKOS) in a trauma patient with intracranial bleed, recent major surgery, and massive pulmonary embolus: A case report. Radiol Case Rep 2017; 13:156-160. [PMID: 29487650 PMCID: PMC5826738 DOI: 10.1016/j.radcr.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 01/17/2023] Open
Abstract
Pulmonary embolism is a life-threatening condition treated with anticoagulation and systemic thrombolysis when appropriate. In patients with contraindications to thrombolysis, catheter-directed thrombolysis may be considered. Here, we present a patient with massive pulmonary embolus and 3 contraindications to systemic thrombolysis who was successfully treated with pharmacomechanical thrombolysis using the Ekosonic Endovascular System.
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Affiliation(s)
- Steve M Nelson
- San Antonio Uniformed Services Health Education Consortium (SAUSCHEC), 3551 Roger Brooke Dr., San Antonio, Texas 78234 USA
| | - Steven H Craig
- San Antonio Uniformed Services Health Education Consortium (SAUSCHEC), 3551 Roger Brooke Dr., San Antonio, Texas 78234 USA
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Jiménez-Fonseca P, Carmona-Bayonas A, Font C, Plasencia-Martínez J, Calvo-Temprano D, Otero R, Beato C, Biosca M, Sánchez M, Benegas M, Varona D, Faez L, Antonio M, de la Haba I, Madridano O, Solis MP, Ramchandani A, Castañón E, Marchena PJ, Martín M, de la Peña FA, Vicente V. The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism. Clin Transl Oncol 2017; 20:230-242. [DOI: 10.1007/s12094-017-1713-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/03/2017] [Indexed: 02/13/2023]
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Çildag MB, Gok M, Karaman CZ. Pulmonary Artery Obstruction Index and Right Ventricular Dysfunction Signs in Initial and Follow up Pulmonary Computed Tomography Angiography in Acute Pulmonary Embolism. J Clin Diagn Res 2017; 11:TC21-TC25. [PMID: 28893001 DOI: 10.7860/jcdr/2017/28740.10296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/24/2017] [Indexed: 12/14/2022]
Abstract
INTODUCTION Acute Pulmonary Embolism (APE) increases the pressure of the pulmonary arterial system with resulting Right Ventricle Dysfunction (RVD). AIM The aim of this study was to evaluate the relationship between Pulmonary Artery Obstruction Index (PAOI) and signs of right heart dysfunction with computed tomography angiography in APE patients. MATERIALS AND METHODS We evaluated 72 consecutive patients (mean age 64.1±16.9 years; 59.7% female) with APE who had initial echocardiography with computed tomography angiography. Among these 72 patients, only 25 (34.7%) patients had follow up computed tomography angiography images and we evaluate right heart dysfunction with PAOI and Right Ventricle (RV) diameter. RESULTS In 72 patients with APE, PAOI and RVD signs were significantly high. Twenty five of these 72 patients (34.7%) had follow up computed tomography angiography images and among those 25 patients, there was correlation between reduction of PAOI and RV diameter in follow up period. CONCLUSION PAOI and RVD signs in initial computed tomography angiography and in follow up computed tomography angiography can be used in the management of Pulmonary Embolism (PE) patients.
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Affiliation(s)
- Mehmet Burak Çildag
- Assistant Professor, Department of Radiology, Adnan Menderes University-Faculty of Medicine, Aydin/TURKEY
| | - Mustafa Gok
- Assistant Professor, Department of Radiology, Adnan Menderes University-Faculty of Medicine, Aydin/TURKEY
| | - Can Zafer Karaman
- Professor, Department of Radiology, Adnan Menderes University-Faculty of Medicine, Aydin/TURKEY
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Kumamaru KK, George E, Aghayev A, Saboo SS, Khandelwal A, Rodríguez-López S, Cai T, Jiménez-Carretero D, Estépar RS, Ledesma-Carbayo MJ, González G, Rybicki FJ. Implementation and Performance of Automated Software for Computing Right-to-Left Ventricular Diameter Ratio From Computed Tomography Pulmonary Angiography Images. J Comput Assist Tomogr 2016; 40:387-92. [PMID: 26938697 DOI: 10.1097/RCT.0000000000000375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to prospectively test the performance and potential for clinical integration of software that automatically calculates the right-to-left ventricular (RV/LV) diameter ratio from computed tomography pulmonary angiography images. METHODS Using 115 computed tomography pulmonary angiography images that were positive for acute pulmonary embolism, we prospectively evaluated RV/LV ratio measurements that were obtained as follows: (1) completely manual measurement (reference standard), (2) completely automated measurement using the software, and (3 and 4) using a customized software interface that allowed 2 independent radiologists to manually adjust the automatically positioned calipers. RESULTS Automated measurements underestimated (P < 0.001) the reference standard (1.09 [0.25] vs1.03 [0.35]). With manual correction of the automatically positioned calipers, the mean ratio became closer to the reference standard (1.06 [0.29] by read 1 and 1.07 [0.30] by read 2), and the correlation improved (r = 0.675 to 0.872 and 0.887). The mean time required for manual adjustment (37 [20] seconds) was significantly less than the time required to perform measurements entirely manually (100 [23] seconds). CONCLUSIONS Automated CT RV/LV diameter ratio software shows promise for integration into the clinical workflow for patients with acute pulmonary embolism.
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Gjonbrataj E, Kim JN, Gjonbrataj J, Jung HI, Kim HJ, Choi WI. Risk factors associated with provoked pulmonary embolism. Korean J Intern Med 2017; 32:95-101. [PMID: 27097772 PMCID: PMC5214719 DOI: 10.3904/kjim.2015.118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/17/2015] [Accepted: 08/13/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to investigate the risk factors associated with provoked pulmonary embolism (PE). METHODS This retrospective cohort study included 237 patients with PE. Patients that had transient risk factors at diagnosis were classified as having provoked PE, with the remaining patients being classified as having unprovoked PE. The baseline clinical characteristics and factors associated with coagulation were compared. We evaluated the risk factors associated with provoked PE. RESULTS Of the 237 PE patients, 73 (30.8%) had provoked PE. The rate of respiratory failure and infection, as well as the disseminated intravascular coagulation score and ratio of right ventricular diameter to left ventricular diameter were significantly higher in patients with provoked PE than in those with unprovoked PE. The protein and activity levels associated with coagulation, including protein C antigen, protein S antigen, protein S activity, anti-thrombin III antigen, and factor VIII, were significantly lower in patients with provoked PE than in those with unprovoked PE. Multivariate analysis showed that infection (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and protein S activity (OR, 0.97; 95% CI, 0.95 to 0.99) were significantly associated with provoked PE. CONCLUSIONS Protein S activity and presence of infection were important factors associated with provoked PE. We should pay attention to the presence of infection in patients with provoked PE.
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Affiliation(s)
- Endri Gjonbrataj
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji Na Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Juarda Gjonbrataj
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Department of Internal Medicine, Mother Theresa University Hospital Centre, Tirana, Albania
| | - Hye In Jung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Won-Il Choi
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Plasencia-Martínez JM, Carmona-Bayonas A, Calvo-Temprano D, Jiménez-Fonseca P, Fenoy F, Benegas M, Sánchez M, Font C, Varona D, Martínez de la Haza D, Pueyo J, Biosca M, Antonio M, Beato C, Solís P, Fáez L, de Al Haba I, Hernández-Muñiz S, Madridano O, Martín M, Castañón E, Ramchandani A, Marchena P, Sánchez-Cánovas M, Vicente MÁ, Martínez MJ, Fernández-Plaza Á, Martínez-Encarnación L, Puerta A, Domínguez Á, Rodríguez D, Marín G, Otero R, Sánchez-Lasheras F, Vicente V. Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study. Eur J Radiol 2016; 87:66-75. [PMID: 28065377 DOI: 10.1016/j.ejrad.2016.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/02/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). METHODS We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations. RESULTS RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes. CONCLUSIONS Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.
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Affiliation(s)
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - David Calvo-Temprano
- Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Francisco Fenoy
- Department of Physiology, Faculty of Medicine, Campus Universitario de Espinardo, University of Murcia, s/n, 30100 Espinardo, Murcia, Spain
| | - Mariana Benegas
- Radiology Department, Hospital Clínic de Barcelona (HCB), Villarroel, 170, 08036, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Department, Hospital Clínic de Barcelona (HCB), Villarroel, 170, 08036, Barcelona, Spain
| | - Carme Font
- Medical Oncology Department, Hospital Clínic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Diego Varona
- Radiology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - David Martínez de la Haza
- Radiology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda Granvia, 199-203, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Pueyo
- Radiology Department, Clínica Universitaria de Navarra (CUN), Avda. Pío XII, 36. 31008, Pamplona, Spain
| | - Mercè Biosca
- Medical Oncology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Maite Antonio
- Medical Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda Granvia, 199-203, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Beato
- Medical Oncology Department, Hospital Nisa-Aljarafe, Avda. Plácido Fernández Viagas, s/n, 41950, Seville, Spain
| | - Pilar Solís
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Laura Fáez
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Irma de Al Haba
- Internal Medicine Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda Granvia, 199-203, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Hernández-Muñiz
- Radiology Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de los Reyes, Madrid, Spain
| | - Olga Madridano
- Internal Medicine Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de los Reyes, Madrid, Spain
| | - Mar Martín
- Internal Medicine Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de los Reyes, Madrid, Spain
| | - Eduardo Castañón
- Medical Oncology Department, Clínica Universitaria de Navarra (CUN), Avda. Pío XII, 36. 31008, Pamplona, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur, s/n. 35016 - Las Palmas de Gran Canaria, Spain
| | - Pablo Marchena
- Internal Medicine Department, Parc Sanitari Sant Joan de Déu, Carrer Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Manuel Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - María Ángeles Vicente
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Mari José Martínez
- Medical Oncology Department, Hospital Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Cartagena, Spain
| | - Ángela Fernández-Plaza
- Radiology Department, Hospital Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Cartagena, Spain
| | | | - Alejandro Puerta
- Radiology Department, Hospital General Universitario Reina Sofía, Av. Intendente Jorge Palacios, 1, Murcia, Spain
| | - Ángel Domínguez
- Radiology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, CIBER de Enfermedades Respiratorias, Seville, Spain
| | - Daniel Rodríguez
- Radiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera de Cartagena, s/n, Murcia, Spain
| | - Gema Marín
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera de Cartagena, s/n, Murcia, Spain
| | - Remedios Otero
- Pneumology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, CIBER de Enfermedades Respiratorias, Seville, Spain
| | - Fernando Sánchez-Lasheras
- Department of Construction and Manufacturing Engineering, Calle San Francisco, 1, 33003, University of Oviedo, Spain
| | - Vicente Vicente
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
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Wong CC, Ng AC, Lau JK, Chow V, Sindone AP, Kritharides L. The prognostic impact of chest pain in 1306 patients presenting with confirmed acute pulmonary embolism. Int J Cardiol 2016; 221:794-9. [DOI: 10.1016/j.ijcard.2016.07.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/08/2016] [Indexed: 11/24/2022]
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Weekes AJ, Thacker G, Troha D, Johnson AK, Chanler-Berat J, Norton HJ, Runyon M. Diagnostic Accuracy of Right Ventricular Dysfunction Markers in Normotensive Emergency Department Patients With Acute Pulmonary Embolism. Ann Emerg Med 2016; 68:277-91. [DOI: 10.1016/j.annemergmed.2016.01.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/29/2015] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
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John G, Platon A, Poletti PA, Perrier A, Bendjelid K. Contrast Circulation Time to Assess Right Ventricular Dysfunction in Pulmonary Embolism: A Retrospective Pilot Study. PLoS One 2016; 11:e0159674. [PMID: 27551831 PMCID: PMC4994948 DOI: 10.1371/journal.pone.0159674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To optimize enhancement of pulmonary arteries and facilitate diagnosis of pulmonary embolism (PE), modern computed tomography angiography (CTA) contains a contrast bolus tracking system. We explored the diagnostic accuracy of the time-intensity curves given by this automated system to identify right ventricular dysfunction (RVD) in acute PE. Methods 114 CTAs with a diagnosis of PE were reviewed. RVD was defined as right-to-left ventricular diameter ratio of 1 or greater. Four parameters on time-intensity curves were identified. Parameters between CTAs with and those without RVD were compared with the Wilcoxon rank-sum test. The ability of the four parameters to discriminate patients with RVD was explored by compiling the area under the operating curves (AUC). Results The time needed by the contrast media to reach the pulmonary artery [8 seconds (IQR: 7–9) versus 7 seconds (IQR: 6–8), p<0.01], the time needed to reach 40 Hounsfield units (HU) [11 seconds (IQR: 8.5–14) versus 9.5 seconds (IQR: 8–10.5), p<0.01], and the contrast intensity reached after 10 seconds [19 HU (IQR: 4–67) versus 53 HU (IQR: 32–80), p<0.05] were all statistically different between CTA with and CTA without RVD. Those three parameters changed gradually across severity categories of RVD (p<0.05 for trend). Their AUC to identify RVD ranged from 0.63 to 0.66. The slope of contrast intensity over time was not informative: [31 HU/s (IQR: 20–57) in CTA with, compared to 36 HU/s (IQR: 22.5–53) in CTA without RVD, p = 0.60]. Conclusion Several parameters of the time-intensity curve obtained by the bolus tracking system are associated with RVD assessed on CTA images. Of those, the time needed to reach a predefined threshold seems to be the easiest to obtain in any CTA without additional processing time or contrast injection. However, the performance of those parameters is globally low.
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Affiliation(s)
- Gregor John
- Department of Internal medicine, Hôpital neuchâtelois, Chasseral 20, 2300 La Chaux-de-Fonds, Switzerland
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
- * E-mail:
| | - Alexandra Platon
- Department of radiology, Emergency-room radiology unit, 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), Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
- Geneva Faculty of Medicine, Michel-Servet 1, 1206 Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Service, Geneva University Hospitals, and Geneva Faculty of Medicine, Gabrielle Perret-Gentil 4, 1211 Geneva, Switzerland
- Geneva Hemodynamic Research Group, Geneva Faculty of Medicine, Michel-Servet 1, 1206 Geneva, Switzerland
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Plasencia-Martínez JM, Carmona-Bayonas A, Calvo-Temprano D, Jiménez-Fonseca P. Prognostic value of computed tomography in acute pulmonary thromboembolism. Radiologia 2016; 58:391-403. [PMID: 27492053 DOI: 10.1016/j.rx.2016.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 12/14/2022]
Abstract
In addition to being the standard reference for the diagnosis of acute pulmonary thromboembolism, CT angiography of the pulmonary arteries can also provide valuable information about the patient's prognosis. Although which imaging findings are useful for prognosis remains controversial, signs of right ventricular dysfunction on CT are now included in clinical algorithms for the management of pulmonary thromboembolism. However, the optimal method for obtaining these measurements while maintaining a balance between the ease of use necessary to include their evaluation in our daily activity and the loss of precision in its predictive capacity remains to be determined. Moreover, other variables associated with pulmonary thromboembolism that often go unobserved can complement the prognostic information we can offer to clinicians. This review aims to clarify some of the more controversial aspects related to the prognostic value of CT in patients with pulmonary embolisms according to the available evidence. Knowing which variables are becoming more important in the prognosis, how to detect them, and why it is important to include them in our reports will help improve the management of patients with pulmonary embolism.
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Kumamaru KK, George E, Ghosh N, Quesada CG, Wake N, Gerhard-Herman M, Rybicki FJ. Normal ventricular diameter ratio on CT provides adequate assessment for critical right ventricular strain among patients with acute pulmonary embolism. Int J Cardiovasc Imaging 2016; 32:1153-61. [PMID: 27076224 DOI: 10.1007/s10554-016-0887-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/29/2016] [Indexed: 01/21/2023]
Abstract
There is variability in guideline recommendations for assessment of the right ventricle (RV) with imaging as prognostic information after acute pulmonary embolism (PE). The objective of this study is to identify a clinical scenario for which normal CT-derived right-to-left ventricular (RV/LV) ratio is sufficient to exclude RV strain or PE-related short-term death. This retrospective cohort study included 579 consecutive subjects (08/2003-03/2010) diagnosed with acute PE with normal CT-RV/LV ratio (<0.9), 236 of whom received subsequent echocardiography. To identify a clinical scenario for which CT-RV/LV ratio was considered sufficient to exclude RV strain or PE-related short-term death, a multivariable logistic model was created to detect factors related to subjects for whom subsequent echocardiography detected RV strain or those who did not receive echocardiography and died of PE within 14 days (n = 55). The final model included five variables (c-statistic = 0.758, over-fitting bias = 2.52 %): congestive heart failure (adjusted odds ratio, OR 4.32, 95 % confidence interval, CI 1.88-9.92), RV diameter on CT >45 mm (OR 3.07, 95 % CI 1.56-6.03), age >60 years (OR 2.59, 95 % CI 1.41-4.77), central embolus (OR 1.96, 95 % CI 1.01-3.79), and stage-IV cancer (OR 1.94, 95 % CI 0.99-3.78). If these five factors were all absent (37.1 % of the population), the probability that "CT-RV/LV ratio is sufficient to exclude RV strain/PE-related short-term death" was 0.97 (95 % CI = 0.95-0.99). Normal CT-RV/LV ratio plus readily obtained five clinical predictors were adequate to exclude RV strain or PE-related short-term mortality.
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Affiliation(s)
- Kanako K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Juntendo Univeristy, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nina Ghosh
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos Gonzalez Quesada
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole Wake
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,The Sackler Institute of Graduate Biomedical Sciences, New York University, New York, NY, USA
| | - Marie Gerhard-Herman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,The Department of Radiology, The Ottawa Hospital Research Institute, The University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
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Etesamifard N, Shirani S, Jenab Y, Lotfi-Tokaldany M, Pourjafari M, Jalali A. Role of clinical and pulmonary computed tomography angiographic parameters in the prediction of short- and long-term mortality in patients with pulmonary embolism. Intern Emerg Med 2016; 11:405-13. [PMID: 26712594 DOI: 10.1007/s11739-015-1376-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/10/2015] [Indexed: 11/24/2022]
Abstract
The utility of pulmonary computed tomography angiography (CTA) in the prediction of short- and long-term outcomes after pulmonary embolism (PE) is controversial. Between November 2011 and September 2014, 190 normotensive patients (age, 61 ± 16.90 years, 53.7 % female) were diagnosed with acute PE using a 128-slice dual-source pulmonary CTA scanner. All the related clinical and cardiovascular measurements were recorded. Primary endpoints were 30-day PE-related death, 30-day composite complications (death, hemodynamic instability, thrombolysis and thrombectomy, inotrope, and mechanical ventilation use), and long-term all-cause mortality during a median follow-up of 14.78 months. Overall 1-month mortality is 5.8 %, and death is PE-related in 4.7 % of total patients. Although non-significant, O2 saturation <90 % and the right ventricular short-axis to left ventricular short-axis diameters (RV/LV) ratio increase the risk of PE-related death by 3.5 and 2 times, respectively. The independent predictors of 30-day complications (15.8 %) are O2 saturation <90 % (OR: 3.924, 95 % CI 1.505-10.229), RV/LV ratio (OR: 3.018, 95 % CI 1.455-6.263), and heart rate ≥ 110 beats/min (OR: 2.607, 95 % CI 1.063-6.391). For long-term mortality (13.7 %), O2 saturation <90 % is an independent predictor (HR: 4.454, 95 % CI 2.016-8.862). The independent impact of the RV/LV ratio on the long-term mortality has a trend towards statistical significance (HR: 1.762, 95 % CI 0.968-4.218; p value = 0.064). The PE-related death is 4.7 % within 30 days after admisson and 13.7 % after a median follow-up of 14 months. Among the pulmonary CTA parameters, only the RV/LV ratio and among the clinical and paraclinical measures, O2 saturation <90 % remain independent predictors of short- and long-term mortality and complications after the diagnosis of PE.
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Affiliation(s)
- Nasrin Etesamifard
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, 1411713138, Tehran, Iran
| | - Shapoor Shirani
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, 1411713138, Tehran, Iran
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, 1411713138, Tehran, Iran.
| | - Masoumeh Lotfi-Tokaldany
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, 1411713138, Tehran, Iran
| | - Marzieh Pourjafari
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, 1411713138, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, 1411713138, Tehran, Iran
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Bach AG, Bandzauner R, Nansalmaa B, Schurig N, Meyer HJ, Taute BM, Wienke A, Surov A. Timing of pulmonary embolism diagnosis in the emergency department. Thromb Res 2016; 137:53-57. [DOI: 10.1016/j.thromres.2015.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
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Meyer M, Haubenreisser H, Sudarski S, Doesch C, Ong MM, Borggrefe M, Schoenberg SO, Henzler T. Where do we stand? Functional imaging in acute and chronic pulmonary embolism with state-of-the-art CT. Eur J Radiol 2015; 84:2432-7. [DOI: 10.1016/j.ejrad.2015.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/17/2015] [Indexed: 01/26/2023]
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Cimsit NC, Cimsit C, Onaygil C, Kuzan TY. Correlation of clot distribution with morphometric measurements and pleuroparenchymal findings in acute pulmonary embolism: experience with 692 cases. Clin Imaging 2015; 39:1012-7. [DOI: 10.1016/j.clinimag.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/19/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022]
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Korkmaz O, Yucel H, Zorlu A, Berkan O, Kaya H, Goksel S, Beton O, Yilmaz MB. Elevated gamma glutamyl transferase levels are associated with the location of acute pulmonary embolism. Cross-sectional evaluation in hospital setting. SAO PAULO MED J 2015; 133:488-94. [PMID: 26648276 PMCID: PMC10496562 DOI: 10.1590/1516-3180.2015.00131806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/08/2015] [Accepted: 06/18/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.
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Affiliation(s)
- Ozge Korkmaz
- MD. Associate Professor, Department of Cardiovascular Surgery, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Hasan Yucel
- MD. Associate Professor, Department of Cardiology, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Ali Zorlu
- MD. Associate Professor, Department of Cardiology, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Ocal Berkan
- MD. Professor and Head of Department of Cardiovascular Surgery, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Hakki Kaya
- MD. Associate Professor, Department of Cardiology, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Sebahattin Goksel
- MD. Associate Professor, Department of Cardiovascular Surgery, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Osman Beton
- MD. Associate Professor, Department of Cardiology, Cumhuriyet University Medical Faculty, Sivas, Turkey.
| | - Mehmet Birhan Yilmaz
- MD. Professor and Head of Department of Cardiology, Cumhuriyet University Medical Faculty, Sivas, Turkey.
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Oz II, Altınsoy B, Serifoglu I, Sayın R, Buyukuysal MC, Erboy F, Akduman EI. Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality. Eur J Radiol 2015; 84:2526-32. [PMID: 26349409 DOI: 10.1016/j.ejrad.2015.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/31/2015] [Accepted: 08/30/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. METHODS This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. RESULTS There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (p<0.001 and 0.002, respectively). Furthermore, there was a statistically significant difference in the RA/RV diameter ratio, but not in the RV/LV diameter ratio, between those with and without 30-day mortality (p=0.002 and 0.148, respectively). CONCLUSIONS Measurement of the RA/RV diameter ratio may be an alternative and useful method for predicting 30-day mortality and adverse outcome in patients with APE.
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Affiliation(s)
- Ibrahim Ilker Oz
- Bulent Ecevit University, School of Medicine, Department of Radiology, Esenköy, Kozlu, Zonguldak 67600, Turkey.
| | - Bülent Altınsoy
- Bulent Ecevit University, School of Medicine, Department of Pulmonology, Esenköy, Kozlu, Zonguldak 67600, Turkey.
| | - Ismail Serifoglu
- Bulent Ecevit University, School of Medicine, Department of Radiology, Esenköy, Kozlu, Zonguldak 67600, Turkey.
| | - Rasit Sayın
- Bulent Ecevit University, School of Medicine, Department of Cardiology, Esenköy, Kozlu, Zonguldak 67600, Turkey.
| | - Mustafa Cagatay Buyukuysal
- Bulent Ecevit University, School of Medicine, Department of Biostatistics, Esenköy, Kozlu, Zonguldak 67600, Turkey.
| | - Fatma Erboy
- Bulent Ecevit University, School of Medicine, Department of Pulmonology, Esenköy, Kozlu, Zonguldak 67600, Turkey.
| | - Ece Isin Akduman
- Saint Louis University, School of Medicine, Department of Radiology, St. Louis, Missouri 63110, United States.
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Tang CX, Schoepf UJ, Chowdhury SM, Fox MA, Zhang LJ, Lu GM. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism. Pediatr Radiol 2015; 45:1431-9. [PMID: 25846076 PMCID: PMC4553120 DOI: 10.1007/s00247-015-3336-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 02/03/2015] [Accepted: 03/02/2015] [Indexed: 12/29/2022]
Abstract
Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations.
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Affiliation(s)
- Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - U. Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Mary A. Fox
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
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49
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Li C, Lin CT, Kligerman SJ, Hong SN, White CS. Enhancement Characteristics of the Computed Tomography Pulmonary Angiography Test Bolus Curve and Its Use in Predicting Right Ventricular Dysfunction and Mortality in Patients With Acute Pulmonary Embolism. J Thorac Imaging 2015; 30:274-81. [DOI: 10.1097/rti.0000000000000141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Meinel FG, Nance JW, Schoepf UJ, Hoffmann VS, Thierfelder KM, Costello P, Goldhaber SZ, Bamberg F. Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-analysis. Am J Med 2015; 128:747-59.e2. [PMID: 25680885 DOI: 10.1016/j.amjmed.2015.01.023] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many computed tomography (CT) parameters have been proposed as potential predictors of outcome in acute pulmonary embolism. We sought to summarize available evidence on the predictive value of CT severity parameters for short-term clinical outcome in pulmonary embolism. METHODS We searched PubMed and EMBASE through February 2014 for studies that reported on the association between CT parameters of acute pulmonary embolism severity and short-term (≤6 months) clinical outcome. Risk estimates for quantitative parameters of right ventricular (RV) dysfunction (abnormally increased RV/left ventricular [LV] diameter ratio on transverse sections and 4-chamber views), qualitative parameters of RV dysfunction (abnormal septal morphology and contrast reflux), thrombus load, and central thrombus location were derived using random effect regression analysis. Meta-regression analysis was performed to quantify and explain study heterogeneity. RESULTS A total of 49 studies with 13,162 patients with acute pulmonary embolism (median age of 61 years, 55.1% were women) who underwent diagnostic CT imaging were included in the analysis. An abnormally increased RV/LV diameter ratio measured on transverse sections was associated with an approximately 2.5-fold risk for all-cause mortality (pooled odds ratio [OR], 2.5; 95% confidence interval [CI], 1.8-3.5) and adverse outcome (OR, 2.3; 95% CI, 1.6-3.4) and a 5-fold risk for pulmonary embolism-related mortality (OR, 5.0; 95% CI, 2.7-9.2). Thrombus load (OR, 1.6, 95% CI, 0.7-3.9; P = .2896) and central location (OR, 1.7; 95% CI, 0.7-4.2; P = .2609) were not predictive for all-cause mortality, although both were associated with adverse clinical outcome. CONCLUSIONS Across all end points, the RV/LV diameter ratio on transverse CT sections has the strongest predictive value and most robust evidence base for adverse clinical outcomes in patients with acute pulmonary embolism.
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Affiliation(s)
- Felix G Meinel
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - John W Nance
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston.
| | - Verena S Hoffmann
- Institute of Biomedical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Kolja M Thierfelder
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Philip Costello
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston
| | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Fabian Bamberg
- Department of Radiology, University of Tübingen, Tübingen, Germany
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