scholarly journals IS CT ANGIOGRAPHY-DERIVED RIGHT TO LEFT VENTRICULAR DIAMETER RATIO ADEQUATE FOR PULMONARY EMBOLISM RISK STRATIFICATION?

2018 ◽  
Vol 71 (11) ◽  
pp. A1929
Author(s):  
Zaid Ammari ◽  
Mohammed Ruzieh ◽  
Osama Dasa ◽  
Christopher Cooper ◽  
Rajesh Gupta
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Ct Angiography ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Left Ventricular Diameter

scholarly journals One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Gregory Piazza ◽  
Keith M. Sterling ◽  
Victor F. Tapson ◽  
Kenneth Ouriel ◽  
Andrew S.P. Sharp ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Embolism ◽  
Functional Status ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Left Ventricular Diameter ◽  
Submassive Pulmonary Embolism ◽  
Dosing Regimens ◽  
Minute Walk

Background: Accelerated tPA (tissue-type plasminogen activator) dosing regimens for ultrasound-facilitated, catheter-directed fibrinolysis improve short-term computed tomographic-measured right ventricular (RV)-to-left ventricular diameter ratio in massive and submassive pulmonary embolism. The impact on RV remodeling, functional status, and quality of life over the long-term remains unclear. Methods: To study 1-year changes in RV remodeling, functional status, and quality of life, we assessed patients with acute submassive pulmonary embolism randomly assigned to 1 of 4 tPA dosing regimens for ultrasound-facilitated, catheter-directed fibrinolysis in the OPTALYSE-PE trial (Optimum Duration and Dose of r-tPA With the Acoustic Pulse Thrombolysis Procedure for Intermediate-Risk Pulmonary Embolism; 8 mg/2 hours, 8 mg/4 hours, 12 mg/6 hours, and 24 mg/6 hours). Echocardiographic assessment included RV-to-left ventricular diameter ratio within 4 hours of treatment end, and at 48 hours, 30 days, 90 days, and 1 year. Functional status was assessed by 6-minute walk test at 30 days, 90 days, and 1 year and PROMIS-PF-6b scores at 30 days, 90 days, 180 days, 270 days, and 1 year. Quality of life was evaluated by PEmb-QOL scores at 30 days, 90 days, 180 days, 270 days, and 1 year. Results: Mean RV-to-left ventricular diameter ratio decreased from baseline to 4 hours and further at 48 hours and 30 days, with reductions maintained at 90 days and 1 year in all groups. Mean 6-minute walk distance, PROMIS-PF-6b, and PEmb-QOL scores improved over the course of 1 year in all groups. Conclusions: Accelerated lower-dose tPA regimens for ultrasound-facilitated, catheter-directed fibrinolysis resulted in sustained recovery of RV-to-left ventricular diameter ratio and tricuspid annular plane systolic excursion and improvements in functional status and quality of life over 1 year. Registration: URL: https://www.ClinicalTrials.gov . Unique Identifier: NCT02396758.

scholarly journals First-in-Human Study to Assess the Safety and Feasibility of the Bashir Endovascular Catheter for the Treatment of Acute Intermediate-Risk Pulmonary Embolism

2020 ◽  
Author(s):  
Akhilesh K. Sista ◽  
Rohit Bhatheja ◽  
Parth Rali ◽  
Kannan Natarajan ◽  
Philip Green ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Adverse Events ◽  
Right Ventricular ◽  
Human Study ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Tissue Type ◽  
Intermediate Risk ◽  
Unique Identifier ◽  
Left Ventricular Diameter

Background: The Bashir Endovascular Catheter (BEC) is a novel pharmaco-mechanical device designed to enhance thrombolysis by increasing the exposure of thrombus to endogenous and exogenous thrombolytics. The aim of this prospective, multicenter, single-arm study was to evaluate the feasibility and initial safety of the BEC in patients with acute intermediate-risk pulmonary embolism (PE). Methods: Patients with symptomatic PE and right ventricular to left ventricular diameter ratio ≥0.9 as documented by computer tomography angiography were eligible for enrollment. The primary safety end points were device related death or adverse events, and major bleeding within 72 hours after BEC directed therapy. Results: Nine patients were enrolled across 4 US sites. The total dose of r-tPA (recombinant tissue-type plasminogen activator) was 14 mgs in bilateral PE and 12 mgs in unilateral PE over 8 hours delivered via the expanded BEC. At 30-day follow-up, there were no deaths or device-related adverse events. At 48 hours post-BEC therapy, the right ventricular to left ventricular diameter ratio decreased from 1.52±0.26 to 0.97±0.06 ( P =0.0009 [95% CI, 0.33–0.82]; 37.0% reduction). Thrombus burden as measured by the Modified Miller Index decreased from 25.4±5.3 to 16.0±4.0 ( P =0.0005; [95% CI, 5.5–13.4]; 37.1% reduction). Conclusions: In this early feasibility study of the BEC for intermediate-risk PE, there were no deaths or device-related adverse events and a significant reduction in right ventricular to left ventricular diameter ratio and thrombus burden. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03927508.

scholarly journals Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242340
Author(s):  
Sung-uk Cho ◽  
Young-duck Cho ◽  
Sung-hyuk Choi ◽  
Young-hoon Yoon ◽  
Jong-hak Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Right Ventricular ◽  
Troponin T ◽  
Admission Rate ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Cardiac Biomarkers ◽  
Early Risk

Background Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED. Methods The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo). Results The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients’ cardiac enzymes were higher, and there were more RVD in RV/LV >1 group. Conclusion Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.

scholarly journals Accuracy and reproducibility of CT right-to-left ventricular diameter measurement in patients with acute pulmonary embolism

PLoS ONE ◽  
2017 ◽  
Vol 12 (11) ◽  
pp. e0188862 ◽  
Author(s):  
Yvonne M. Ende-Verhaar ◽  
Lucia J. M. Kroft ◽  
Inge C. M. Mos ◽  
Menno V. Huisman ◽  
Frederikus A. Klok
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Left Ventricular ◽  
Diameter Measurement ◽  
Left Ventricular Diameter

Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Kenneth Ouriel ◽  
Richard L Ouriel ◽  
Yeun J Lim ◽  
Gregory Piazza ◽  
Samuel Z Goldhaber
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Computed Tomography Angiography ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Observer Agreement ◽  
Left Ventricular Diameter ◽  
The Right

Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

Sign in / Sign up

Export Citation Format

Share Document