Syncope in relation to pulmonary arterial obstructive burden, hemodynamic status and short- and long-term outcome in patients with acute pulmonary embolism

Abstract Background and aims Although syncope (S) has been reported as one of the presenting findings in patients (pts) with acute pulmonary embolism (APE), its clinical and haemodynamic correlates and impacts on the long-term outcome in this setting remains to be determined. In this single-centre study we evaluated the clinical and haemodynamic significance of S in APE in initial asessment, and during short- and long-term follow-up period. Methods Our study was based on the retrospective and prospective analysis of the overall 641 pts (age 65 (51–74 IQR) yrs, 56.2% female) with diagnosis of documented APE who underwent anticoagulant (n=207), thrombolytic (n=164), utrasound-facilitated thrombolysis (UFT) (n=218) or rheolytic thrombectomy (RT) (n=52). The systematic work- up including multidetector computed tomography (MDCT), Echo, biomarkers, and PE severity indexes were performed in all pts, and Qanadli score (QS) was used as the measure of the thrombotic burden in the pulmonary arteries (PA). Results The S as the presenting symptom In 30.2% of pts with APE. At baseline assessment, S(+) vs S(−) APE subgroups had a significantly shorter symptom-diagnosis interval, a higher risk status according to the significant elevations in troponin T, D-dimer, the higher PE severity indexes, a more deteriorated right ventricle/left ventricle ratio (RV/LV r), right atrial/left atrial ratio (LA/RAr) and RV longitudinal function indexes including tricuspid annular planary excursion (TAPSE) and tissue velocity (St), a significantly higher PA obstructive burden as assessed by QS and PA pressures. Thrombolytic therapy (36.2% vs 21%, p<0.001) and RT (11.9% vs 6.47%, p=0.037) were more frequently utilized S(+) as compared to S(−) group. However, all these differences between two subgroups were found to disappear after evidence-based APE treatments. In-hospital mortality (IHM) (12.95% vs 6%, p=0.007) and minor bleeding (10.36% vs 2.9%, p<0.001) were significantly higher in S(+) pts as compared to those in S(−) subgroup. Binominal logistic regression analysis revealed that PESI score and RV/LVr independently associated with S while IHM was only predicted by age and heart rate. The COX proportional hazard method showed that RV/LVr at discharge and malignancy were independently associated with cumulative mortality during follow-up duration of 620 (200–1170 IQ) days. Conclusions The presence of S in pts with APE was found to be asociated with a higher PA obstructive burden, a more deteriorated RV function and haemodynamics and higher risk status which may need more agressive reperfusion treatments. However, in the presence of the optimal treatments, S did not predict neither in-hospital outcome, nor long-term mortality. Funding Acknowledgement Type of funding source: None

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Short- and Long-Term Outcome after Surgical Therapy in Acute Pulmonary Embolism

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1628105 ◽

2018 ◽

Vol 66 (S 01) ◽

pp. S1-S110

Author(s):

K. Dohle ◽

D. Dohle ◽

R. Chaban ◽

I. Halbroth ◽

A. Beiras-Fernandez ◽

...

Keyword(s):

Pulmonary Embolism ◽

Surgical Therapy ◽

Acute Pulmonary Embolism ◽

Term Outcome ◽

Long Term Outcome ◽

Short And Long Term

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Long-term outcome of patients with persistent vascular obstruction on computed tomography pulmonary angiography 6 months after acute pulmonary embolism

Acta Radiologica ◽

10.1258/ar.2012.110697 ◽

2012 ◽

Vol 53 (7) ◽

pp. 728-731 ◽

Cited By ~ 11

Author(s):

Rafael Golpe ◽

Luis A Pérez de Llano ◽

Olalla Castro-Añón ◽

Manuel Vázquez-Caruncho ◽

Carlos González-Juanatey ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

Computed Tomography Pulmonary Angiography ◽

Term Outcome ◽

Long Term Outcome ◽

Vascular Obstruction

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Long-Term Effects of the Treatment of Depressive Female Inpatients in a Naturalistic Study: Is Early Improvement a Valid Predictor of Outcome?

Depression Research and Treatment ◽

10.1155/2014/780237 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8

Author(s):

Elian Zuercher-Huerlimann ◽

Martin grosse Holtforth ◽

Ernst Hermann

Keyword(s):

Binary Logistic Regression ◽

Inpatient Setting ◽

Long Term Effects ◽

Term Outcome ◽

Long Term Outcome ◽

Early Improvement ◽

Valid Predictor ◽

Short And Long Term

Objectives.To examine the predictive value of early improvement for short- and long-term outcome in the treatment of depressive female inpatients and to explore the influence of comorbid disorders (CD).Methods.Archival data of a naturalistic sample of 277 female inpatients diagnosed with a depressive disorder was analyzed assessing the BDI at baseline, after 20 days and 30 days, posttreatment, and after 3 to 6 months at follow-up. Early improvement, defined as a decrease in the BDI score of at least 30% after 20 and after 30 days, and CD were analyzed using binary logistic regression.Results.Both early improvement definitions were predictive of remission at posttreatment. Early improvement after 30 days showed a sustained treatment effect in the follow-up phase, whereas early improvement after 20 days failed to show a persistent effect regarding remission at follow-up. CD were not significantly related neither at posttreatment nor at follow-up. At no time point CD moderated the prediction by early improvement.Conclusions.We show that early improvement is a valid predictor for short-term remission and at follow-up in an inpatient setting. CD did not predict outcome. Further studies are needed to identify patient subgroups amenable to more tailored treatments.

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Predictors of short- and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up

Internal and Emergency Medicine ◽

10.1007/s11739-010-0499-x ◽

2010 ◽

Vol 6 (5) ◽

pp. 413-421 ◽

Cited By ~ 8

Author(s):

Francesca Cecchi ◽

Raffaele Molino-Lova ◽

Anita Paperini ◽

Roberta Boni ◽

Chiara Castagnoli ◽

...

Keyword(s):

Cohort Study ◽

Neck Pain ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rehabilitation Program ◽

Term Outcome ◽

Long Term Outcome ◽

Short And Long Term

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Outcome of patients with chronic limb-threatening ischemia with and without revascularization

VASA ◽

10.1024/0301-1526/a000831 ◽

2020 ◽

Vol 49 (2) ◽

pp. 121-127 ◽

Cited By ~ 1

Author(s):

Jacqueline Stella ◽

Christiane Engelbertz ◽

Katrin Gebauer ◽

Juan Hassu ◽

Matthias Meyborg ◽

...

Keyword(s):

Real World ◽

Limb Amputation ◽

Hospital Treatment ◽

Term Outcome ◽

Long Term Outcome ◽

Short And Long Term ◽

Causal Conclusion ◽

Overall Mortality

Summary: Background: Patients with chronic critical limb-threatening ischemia (CLTI) are at high risk of amputation and death. Despite the general recommendation for revascularization in CTLI in the guidelines, the underlying evidence for such a recommendation is limited. The aim of our study was to assess the outcome of patients with CLTI depending on the use of revascularization in a retrospective real-world cohort. Patients and methods: Administrative data of the largest German Health insurance (BARMER GEK) were provided for all patients that were hospitalized for the treatment of CLTI Rutherford category (RF) 5 and 6 between 2009 and 2011. Patients were followed-up until December 31st, 2012 for limb amputation and death in relation to whether patients did (Rx +) or did not have (Rx −) revascularization during index-hospitalization. Results: We identified 15,314 patients with CLTI at RF5 (n = 6,908 (45.1%)) and RF6 (n = 8,406 (54.9%)), thereof 7,651 (50.0%) underwent revascularization (Rx +) and 7,663 (50.0%) were treated conservatively (Rx −). During follow-up (mean 647 days; 95% CI 640–654 days) limb amputation (46.5% Rx− vs. 40.6% Rx+, P < 0.001) and overall mortality (48.2% Rx− vs. 42.6% Rx+, P < 0.001) were significantly lower in the subgroup Rx+. Conclusions: In a real-world setting, only half of CLTI were revascularized during the in-hospital treatment. Though, revascularization was associated with significantly better observed short- and long-term outcome. These data do not allow causal conclusion due to lack of data on the underlying reason for applied or withheld revascularization and therefore may involve a relevant selection bias.

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Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2019.08.005 ◽

2019 ◽

Vol 62 ◽

pp. 30-37 ◽

Cited By ~ 6

Author(s):

Katharina Beck ◽

Erich Studerus ◽

Christina Andreou ◽

Laura Egloff ◽

Letizia Leanza ◽

...

Keyword(s):

High Risk ◽

Psychosocial Functioning ◽

Original Sample ◽

Clinical High Risk ◽

Term Outcome ◽

Risk Status ◽

Long Term Outcome ◽

Long Term Follow Up

Abstract Background: Few studies have followed up patients with a clinical high risk (CHR) for psychosis for more than 2–3 years. We aimed to investigate the rates and baseline predictors for remission from CHR and transition to psychosis over a follow-up period of up to 16 years. Additionally, we examined the clinical and functional long-term outcome of CHR patients who did not transition. Methods: We analyzed the long-term course of CHR patients that had been included in the longitudinal studies “Früherkennung von Psychosen” (FePsy) or “Bruderholz” (BHS). Those patients who had not transitioned to psychosis during the initial follow-up periods (2/5 years), were invited for additional follow-ups. Results: Originally, 255 CHR patients had been included. Of these, 47 had transitioned to psychosis during the initial follow-ups. Thus, 208 were contacted for the long-term follow-up, of which 72 (34.6%) participated. From the original sample of 255, 26%, 31%, 35%, and 38% were estimated to have transitioned after 3, 5, 10, and 16 years, respectively, and 51% had remitted from their high risk status at the latest follow-up. Better psychosocial functioning at baseline was associated with a higher rate of remission. Of the 72 CHR patients re-assessed at long-term follow-up, 60 had not transitioned, but only 28% of those were fully recovered clinically and functionally. Conclusions: Our study shows the need for follow-ups and clinical attention longer than the usual 2–3 years as there are several CHR patients with later transitions and only a minority of CHR those without transition fully recovers.

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Prognostic Impact of Serum Sodium Fluctuations on In-hospital and Long-term Outcome Following Acute Pulmonary Embolism

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.631 ◽

2012 ◽

Vol 21 ◽

pp. S257-S258

Author(s):

A. Ng ◽

V. Chow ◽

A. Yong ◽

T. Chung ◽

L. Kritharides

Keyword(s):

Pulmonary Embolism ◽

Serum Sodium ◽

Acute Pulmonary Embolism ◽

Prognostic Impact ◽

Term Outcome ◽

Long Term Outcome

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Lipocalin-2 Predicts Long-Term Outcome of Normotensive Patients with Acute Pulmonary Embolism

Cardiovascular Toxicology ◽

10.1007/s12012-019-09525-w ◽

2019 ◽

Vol 20 (2) ◽

pp. 101-110

Author(s):

Haixu Yu ◽

Zhuohui Liu ◽

Jie Lu ◽

Xinying Yang ◽

Xin-Xin Yan ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Lipocalin 2 ◽

Term Outcome ◽

Long Term Outcome

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Fourteen-Year Long-Term Results after Gastric Banding

Journal of Obesity ◽

10.1155/2011/128451 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 48

Author(s):

Christine Stroh ◽

Ulrich Hohmann ◽

Harald Schramm ◽

Frank Meyer ◽

Thomas Manger

Keyword(s):

Weight Loss ◽

Gastric Banding ◽

Therapeutic Option ◽

Reoperation Rate ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome ◽

Short And Long Term

Background. Gastric banding (GB) is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up.Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome.Results. The mean postoperative follow up time was 94.4 months (range 2–144). The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up.Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

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