Reply to letter to editor: Association between pulmonary arterial obstruction index and right lateral ventricular wall thickness with in-hospital mortality in patients with acute pulmonary embolism

Purpose. Pulmonary embolism (PE) is a common and potentially fatal form of venous thromboembolism. The aim of this study is to investigate the association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism. Basic Procedure. The study consisted of 86 patients with clinical symptoms of PE. Out of 86 individuals, 50 patients were diagnosed with PE and considered as the patient group. The others were considered as the control group. All patients were scanned by a multidetector CT scanner. Using the radiology workstation, an expert radiologist calculated the left atrium (LA) and right atrium (RA) areas from planimetric measurements obtained from free-hand delineation of the atrial boarders using an electronic pen. Quantitative volumetric measurements of LA and RA were obtained from original axial images. Main Findings. There were 25 males and 25 females with PE, who had a mean age of 58 years. There was not a significant difference in the positive history of diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary diseases, ischemic heart disease, and smoking between patients and control group. There was a significant negative correlation between almost all LA measurements and the PAOI. RA area and volume had the highest area under the curves for recognizing larger clot burden. Principal Conclusions. A higher clot load is associated with a smaller LA size and increased RA/LA ratios, measured with CTPA. Atrial measurements are correlated with POAI, and they could be used as sensitive parameters in predicting heart failure in patients with PE.

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Echocardiographic markers of pulmonary hemodynamics and right ventricular hypertrophy in rat models of pulmonary hypertension The first two authors contributed equally to this manuscript.

Pulmonary Circulation ◽

10.1177/2045894020910976 ◽

2020 ◽

Vol 10 (2) ◽

pp. 204589402091097

Author(s):

Fotios Spyropoulos ◽

Sally H. Vitali ◽

Marlin Touma ◽

Chase D. Rose ◽

Carter R. Petty ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Wall Thickness ◽

Ventricular Wall ◽

Right Ventricular Systolic Pressure ◽

Acceleration Time ◽

Non Invasive ◽

Right Ventricular Wall ◽

Ventricular Wall Thickness ◽

Pulmonary Arterial

Echocardiography is the gold standard non-invasive technique to diagnose pulmonary hypertension. It is also an important modality used to monitor disease progression and response to treatment in patients with pulmonary hypertension. Surprisingly, only few studies have been conducted to validate and standardize echocardiographic parameters in experimental animal models of pulmonary hypertension. We sought to define cut-off values for both invasive and non-invasive measures of pulmonary hemodynamics and right ventricular hypertrophy that would reliably diagnose pulmonary hypertension in three different rat models. The study was designed in two phases: (1) a derivation phase to establish the cut-off values for invasive measures of right ventricular systolic pressure, Fulton's index (right ventricular weight/left ventricle + septum weight), right ventricular to body weight ratio, and non-invasive echocardiographic measures of pulmonary arterial acceleration time, pulmonary arterial acceleration time to ejection time ratio and right ventricular wall thickness in diastole in the hypoxic and monocrotaline rat models of pulmonary hypertension and (2) a validation phase to test the performance of the cut-off values in predicting pulmonary hypertension in an independent cohort of rats with Sugen/hypoxia-induced pulmonary hypertension. Our study demonstrates that right ventricular systolic pressure ≥35.5 mmHg and Fulton's Index ≥0.34 are highly sensitive (>94%) and specific (>91%) cut-offs to distinguish animals with pulmonary hypertension from controls. When pulmonary arterial acceleration time/ejection time and right ventricular wall thickness in diastole were both measured, a result of either pulmonary arterial acceleration time/ejection time ≤0.25 or right ventricular wall thickness in diastole ≥1.03 mm detected right ventricular systolic pressure ≥35.5 mmHg or Fulton's Index ≥0.34 with a sensitivity of 88% and specificity of 100%. With properly validated non-invasive echocardiography measures of right ventricular performance in rats that accurately predict invasive measures of pulmonary hemodynamics, future studies can now utilize these markers to test the efficacy of different treatments with preclinical therapeutic modeling.

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Predictive role of the modified Glasgow prognostic score for in-hospital mortality in stable acute pulmonary embolism

Medicina Clínica ◽

10.1016/j.medcli.2020.11.041 ◽

2021 ◽

Author(s):

Aziz Inan Celik ◽

Tahir Bezgin ◽

Murat Biteker

Keyword(s):

Pulmonary Embolism ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Prognostic Score ◽

Glasgow Prognostic Score ◽

Modified Glasgow Prognostic Score ◽

Predictive Role

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In-hospital mortality of acute pulmonary embolism: Predictive value of shock index, modified shock index, and age shock index scores

Medicina Clínica ◽

10.1016/j.medcli.2021.04.035 ◽

2021 ◽

Author(s):

Kemal Gökçek ◽

Aysel Gökçek ◽

Ahmet Demir ◽

Birdal Yıldırım ◽

Ethem Acar ◽

...

Keyword(s):

Pulmonary Embolism ◽

Hospital Mortality ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Shock Index

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Ultrasonic Measurements of Left Ventricular Wall Thickness

CHEST Journal ◽

10.1378/chest.57.1.37 ◽

1970 ◽

Vol 57 (1) ◽

pp. 37-40 ◽

Cited By ~ 40

Author(s):

A-L. Sjögren ◽

I. Hytönen ◽

M.H. Frick

Keyword(s):

Wall Thickness ◽

Left Ventricular ◽

Left Ventricular Wall ◽

Ventricular Wall ◽

Left Ventricular Wall Thickness ◽

Ultrasonic Measurements ◽

Ventricular Wall Thickness

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Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES)

European Respiratory Journal ◽

10.1183/13993003.02963-2020 ◽

2021 ◽

pp. 2002963

Author(s):

Zhenguo Zhai ◽

Dingyi Wang ◽

Jieping Lei ◽

Yuanhua Yang ◽

Xiaomao Xu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Stratification ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Severity Index ◽

Disease Diagnosis ◽

Initial Therapy ◽

European Respiratory Society ◽

Systemic Thrombolysis ◽

All Cause Mortality

BackgroundSimilar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries.ObjectivesWe retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES).MethodsAdult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.ResultsAmong overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted Pfor trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, Pfor trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function.ConclusionsThe considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.

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