Trend of in-hospital deaths by pulmonary embolism in Ecuador. Findings from 2011-2018 national reports

BACKGROUND

Pulmonary embolism (PE) is a potentially fatal disease related to venous thromboembolism. Information regarding this pathology in the Ecuadorian population is limited. This study aims to present the PE hospital mortality rates (HMR) in Ecuador, analyze its trend and risk factors.

METHODS

An epidemiological, descriptive and cross-sectional study based on the reporting and trend analysis of pulmonary embolism HMR in the Ecuadorian population from 2011 to 2018 through the governmental database of the Ecuadorian National Statistics and Census Institute, was conducted.

RESULTS

In Ecuador, PE hospital discharges (HD) varied from 358 in 2011 to 424 in 2018. More than 60% of patients were older than 60 years. Also, the frequency of PE with acute cor pulmonale increased from 3.07% in 2011 to 16.98% in 2018 (P<0.05). The HMR by 100 HD increased between 2011 (12.85/100 HD) and 2018 (17.02/100 HD) (P<0.05), with the highest rate reported in 2017 (21.52/100 HD). In the period studied, 505 in-hospital deaths were reported in patients with PE, the average age in this group was 64.3 years, 58.42% were female, and 10.89% had acute cor pulmonale (ICD-10 I26.0). Risk factors associated with PE in-hospital death were acute cor pulmonale (OR 1.63, 95% CI: 1.18 to 2.25, P<0.01) and 60 years or more (OR 1.73, 95% CI 1.40-2.15, P<0.01).

CONCLUSION

A significant increase in PE HMR in Ecuador was found. Also, acute cor pulmonale and age of 60 years or more may be potential risk factors for in-hospital death in patients with PE.

Cardiovocal Syndrome: A rare cause of hoarseness in a patient with a history of pulmonary tuberculosis

Hoarseness is a common clinical condition with underlying causes which can vary from reversible and benign to life-threatening and malignant. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when the recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structures. We report a 28-year-old male who presented to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness. He had undergone irregular treatment for pulmonary tuberculosis (TB) two years previously. Fiber-optic laryngoscopy indicated left vocal cord palsy and a computed tomography scan of the chest revealed features of pulmonary hypertension with extensive enlargement of the pulmonary arteries. An echocardiogram confirmed severe pulmonary arterial hypertension with severe tricuspid regurgitation. He was diagnosed with left recurrent laryngeal palsy secondary to cardiovocal syndrome. Although reports exist of recurrent laryngeal palsy in TB, this case appears to be the first to report cardiovocal syndrome in a patient treated for pulmonary TB.

Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging

Purpose

Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models.

Methods

Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size.

Results

Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030).

Conclusion

CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis.

Key Points

• Pulmonary hypertension is a marker of poor outcome in COPD.

• MRI can predict invasively measured mean pulmonary artery pressure.

• Cardiac MRI allows for estimation of survival in COPD.

• Cardiac MRI may be useful for follow up or future trials.

• MRI is potentially useful to assess pulmonary hypertension in patients with COPD.

A case of pulmonary alveolar microlithiasis with Cor Pulmonale

Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the formation and deposition of microliths within the alveoli and a paucity of symptoms in contrast to the imaging findings. It has familial tendency and is thought to be an autosomal recessive disorder with the mutation in the SLC34A2 gene. We describe a case of PAM with Cor Pulmonale. Ultrasonic cardiogram showed pulmonary hypertension (82 mmHg). Chest radiography revealed diffuse, bilateral sandstorm-like micronodules with greater density in the lower lung fields. HRCT scans demonstrated diffuse ground-grass opacities, thickening and calcification of interlobular septa and confluent calcified nodules. A diagnosis of PAM was suggested and confirmed by transbronchial lung biopsy (TBLB).