Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

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Computed tomography pulmonary perfusion imaging and 3-months clinical outcomes after acute pulmonary embolism

Thrombosis Research ◽

10.1016/j.thromres.2020.12.010 ◽

2021 ◽

Vol 199 ◽

pp. 32-34

Author(s):

Lisette F. van Dam ◽

Lucia J.M. Kroft ◽

Gudula J.A.M. Boon ◽

Menno V. Huisman ◽

Maarten K. Ninaber ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Clinical Outcomes ◽

Perfusion Imaging ◽

Acute Pulmonary Embolism ◽

Pulmonary Perfusion

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The predictive value of RS time for short term mortality in patients with acute pulmonary embolism

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2020.07.013 ◽

2020 ◽

Vol 62 ◽

pp. 94-99

Author(s):

Ayça Gümüşdağ ◽

Cengiz Burak ◽

Muhammed Süleymanoğlu ◽

Mahmut Yesin ◽

Veysel Ozan Tanık ◽

...

Keyword(s):

Pulmonary Embolism ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Short Term ◽

Short Term Mortality

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Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-analysis

The American Journal of Medicine ◽

10.1016/j.amjmed.2015.01.023 ◽

2015 ◽

Vol 128 (7) ◽

pp. 747-759.e2 ◽

Cited By ~ 89

Author(s):

Felix G. Meinel ◽

John W. Nance ◽

U. Joseph Schoepf ◽

Verena S. Hoffmann ◽

Kolja M. Thierfelder ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Pulmonary Embolism ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Meta Analysis

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The Impact of Age on the Delay in Diagnosis in Patients With Acute Pulmonary Embolism

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029611404218 ◽

2011 ◽

Vol 17 (6) ◽

pp. 605-610 ◽

Cited By ~ 5

Author(s):

T. M. Berghaus ◽

C. Thilo ◽

W. von Scheidt ◽

M. Schwaiblmair

Keyword(s):

Pulmonary Embolism ◽

Hospital Mortality ◽

Older Patients ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Late Diagnosis ◽

Hospital Death ◽

Delay In Diagnosis ◽

The Impact ◽

Acute Pe

It has been speculated that the atypical clinical presentation of acute pulmonary embolism (PE) in older patients leads to a late diagnosis and therefore contributes to a worse prognosis. Therefore, we prospectively evaluated the delay in diagnosis and its relation to the in-hospital mortality in 202 patients with acute PE. Patients >65 years presented more often with hypoxia ( P = .017) and with a history of syncope ( P = .046). Delay in diagnosis was not statistically different in both age groups. Older age was significantly associated with an increased risk for in-hospital mortality (OR 4.36, 95% CI 0.93-20.37, P = .043), whereas the delay in diagnosis was not associated with an increase of in-hospital mortality. We therefore conclude that the clinical presentation of acute PE in older patients cannot be considered as a risk factor for late diagnosis and is not responsible for their higher in-hospital death rate.

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Does Baseline BUN Have an Additive Effect on the Prediction of Mortality in Patients with Acute Pulmonary Embolism?

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v15i2.4184 ◽

2020 ◽

Author(s):

Yaser Jenab ◽

Ali-Mohammad Haji-Zeinali ◽

Mohammad Javad Alemzadeh-Ansari ◽

Shapour Shirani ◽

Mojtaba Salarifar ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Acute Pulmonary Embolism ◽

Low Risk ◽

Cardiac Biomarkers ◽

Operating Characteristics ◽

Short Term ◽

Prediction Of Mortality ◽

Short Term Mortality ◽

Acute Pe

Background: In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE). Methods: Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology’s risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk). Results: Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43–19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01–5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01–1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008). Conclusion: An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group.

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Pulmonary Embolism Readmission Trend Over the Years: A National Readmission Database Study

10.1101/2021.12.08.21267500 ◽

2021 ◽

Author(s):

Mukunthan Murthi ◽

Sujitha Velagapudi ◽

Dae Yong Park ◽

Hafeez Shaka

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Cox Regression ◽

Short Term ◽

Number Of Patients ◽

Increasing Trend ◽

And Gender ◽

Acute Pe ◽

National Readmission Database

Abstract: Introduction: Acute pulmonary embolism (PE) is known to be associated with significant short-term and long-term complications. However, with the evolution of PE management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in PE patients from the years 2010 to 2018. Methods: We utilized the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute pulmonary embolism. Identified the total number of readmissions for acute PE from 2010 to 2018. A multivariate cox regression model was used to identify independent predictors of readmission. Results: The number of patients with 30-day readmissions has gradually increased from 14,508 in 2010 to 19,703 in 2018. The proportion of females admitted was higher than males in all years. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (p<0.001). Risk-adjusted readmission specific for PE showed a decrease from 1.2 to 1% (p=0.023) from 2010 to 2018. When adjusted to age and gender, an increase in the proportion of readmissions with intracranial bleeding was seen among both the 30-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p<0.001) and 90-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p-trend 0.003) cohorts. Similarly, an increasing trend of readmissions for UGI bleed was seen among both 30-day (0.9% vs 4.3%, aOR=1.26, p-trend <0.001) and 90-day readmissions (0.7% vs 3.8%, aOR=1.27, p-trend <0.001). The units of blood transfusion required per readmission reduced in both cohorts during the study period. Conclusion: Our study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018, but an increase in all-cause readmissions. We also report an increase in non-major bleeding during readmissions, including ICH and UGI bleed. These findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission but possible causes for the increase in all-cause readmission in the hope of optimizing management and continuing improving outcomes.

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