283: BOVA RISK SCORE MAY NOT IDENTIFY NORMOTENSIVE PULMONARY EMBOLISM PATIENTS WITH LOW CARDIAC INDEX

Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart catheterization (RHC) and identified those with low cardiac index (CI < 2.2 L/min/m2). We utilized regression models to identify echocardiographic predictors of low CI and Kaplan Meier curve to evaluate PE-related mortality when stratified by the echocardiographic predictor. Of 174 intermediate-risk PE patients, 41 underwent RHC. Within this cohort, 46.3% had low CI. Univariable linear regression identified right ventricular outflow tract velocity time integral (RVOT VTI), right/left ventricular ratio, S prime, inferior vena cava diameter, and pulmonary artery systolic pressure as potential predictors of low CI. Multivariable linear regression identified RVOT VTI as significant predictor of low CI (β coefficient 0.124, 95% confidence interval [CI]: 0.01-0.24, P = .034). Right ventricular outflow tract velocity time integral <9.5 cm was associated with increased PE-related mortality, P = .002. A substantial proportion of intermediate-risk PE patients referred for catheter-based interventions had low CI despite normotension. Right ventricular outflow tract velocity time integral was a significant predictor of low CI. Low RVOT VTI was associated with increased PE-related mortality.

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Troponin I and right ventricular dysfunction for risk assessment in patients with nonmassive pulmonary embolism in the Emergency Department in combination with clinically based risk score

Internal and Emergency Medicine ◽

10.1007/s11739-008-0134-2 ◽

2008 ◽

Vol 3 (2) ◽

pp. 131-138 ◽

Cited By ~ 32

Author(s):

Vittorio Palmieri ◽

Giovanni Gallotta ◽

Domenico Rendina ◽

Silvana De Bonis ◽

Vittorio Russo ◽

...

Keyword(s):

Risk Assessment ◽

Emergency Department ◽

Pulmonary Embolism ◽

Right Ventricular ◽

Risk Score ◽

Ventricular Dysfunction ◽

Troponin I ◽

Right Ventricular Dysfunction

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Pulmonary Vasodilation by Sildenafil in Acute Pulmonary Embolism—A Randomized Explorative Trial

10.21203/rs.3.rs-17489/v1 ◽

2020 ◽

Author(s):

Asger Andersen ◽

Farhad Waziri ◽

Jacob Gammelgaard Schultz ◽

Sarah Holmboe ◽

Søren Warberg Becker ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

High Risk ◽

Cardiac Index ◽

Oral Dose ◽

Right Ventricular ◽

Single Oral Dose ◽

Ventricular Function ◽

Right Ventricular Function ◽

Pulmonary Vasodilation

Abstract Background: To investigate if acute pulmonary vasodilation by sildenafil improves right ventricular function in patients with acute intermediate-high risk pulmonary embolism (PE).Methods: Patients with PE were randomized to a single oral dose of sildenafil 50mg (n=10) or placebo (n=10) as add-on to conventional therapy. Right ventricular function was evaluated immediately before and shortly after (0.5-1.5h) randomization by right heart catheterization (RHC), trans-thoracic echocardiography (TTE), and cardiac magnetic resonance (CMR). The primary efficacy endpoint was cardiac index measured by CMR.Results: Patients had acute intermediate-high risk PE verified by computed tomography pulmonary angiography, systolic blood pressure of 135 ± 18 (mean ± SD) mmHg, increased right ventricular/left ventricular ratio 1.1 ± 0.09 and increased troponin T 167 ± 144 ng/L. Sildenafil treatment did not improve cardiac index compared to baseline (0.02 ± 0.36 l/min/m2, p=0.89) and neither did placebo (0.00 ± 0.34 l/min/m2, p=0.97).Conclusion: A single oral dose of 50 mg sildenafil did not improve cardiac index but lowered systemic blood pressure in patients with acute intermediate-high risk PE.Trial Registration: The trial was retrospectively registered at www.clinicaltrials.gov (NCT04283240) February 2nd 2020, https://clinicaltrials.gov/ct2/show/NCT04283240?term=NCT04283240&draw=2&rank=1

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Novel CT-derived parameter is associated with low cardiac index in acute pulmonary embolism

Thrombosis Research ◽

10.1016/j.thromres.2021.03.014 ◽

2021 ◽

Vol 202 ◽

pp. 105-107

Author(s):

Yevgeniy Brailovsky ◽

Dalila Masic ◽

Sorcha Allen ◽

Vladimir Lakhter ◽

Riyaz Bashir ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Index ◽

Acute Pulmonary Embolism

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Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

Journal of Intensive Care Medicine ◽

10.1177/0885066619828959 ◽

2019 ◽

Vol 35 (12) ◽

pp. 1426-1433 ◽

Cited By ~ 6

Author(s):

Alessandro Sionis ◽

Mercedes Rivas-Lasarte ◽

Alexandre Mebazaa ◽

Tuukka Tarvasmäki ◽

Jordi Sans-Roselló ◽

...

Keyword(s):

Cardiac Index ◽

Pulmonary Artery ◽

Cardiogenic Shock ◽

Pulmonary Artery Catheter ◽

Risk Score ◽

Stroke Volume Index ◽

Volume Index ◽

Propensity Score Matching Analysis ◽

Net Reclassification Improvement ◽

Life Threatening

Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices ( P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.

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Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism (CAPE) score

ERJ Open Research ◽

10.1183/23120541.00879-2020 ◽

2021 ◽

pp. 00879-2020

Author(s):

Kevin Solverson ◽

Christopher Humphreys ◽

Zhiying Liang ◽

Graeme Prosperi-Porta ◽

James E. Andruchow ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Score ◽

Acute Pulmonary Embolism ◽

Primary Outcome ◽

Wide Spectrum ◽

External Validation ◽

Left Ventricular ◽

Adverse Outcomes ◽

C Statistic ◽

Acute Pe

BackgroundAcute pulmonary embolism (PE) has a wide spectrum of outcomes but the best method to risk stratify normotensive patients for adverse outcomes remains unclear.MethodsA multicenter retrospective cohort study of acute PE patients admitted from emergency departments in Calgary, Canada, between 2012–2017 was used to develop a refined acute PE risk score. The composite primary outcome of in-hospital PE-related death or hemodynamic decompensation. The model was internally validated using bootstrapping and the prognostic value of the derived risk score was compared to the Bova score.ResultsOf 2067 patients with normotensive acute PE, the primary outcome (hemodynamic decompensation or PE related death) occurred in 32 patients (1.5%). In sPESI high-risk patients (n=1498, 78%), a multivariable model used to predict the primary outcome retained computed tomography (CT) right-left ventricular diameter ratio ≥1.5, systolic blood pressure 90–100 mmHg, central pulmonary artery clot, & heart rate ≥100 BMP with a C-statistic of 0.89 (95%CI, 0.82–0.93). Three risk groups were derived using a weighted score (score, prevalence, primary outcome event rate): group 1 (0–3, 73.8%, 0.34%), group 2 (4–6, 17.6%, 5.8%), group 3 (7–9, 8.7%, 12.8%) with a C-statistic 0.85 (95%CI, 0.78–0.91). In comparison the prevalence (primary outcome) by Bova risk stages (n=1179) were: stage I, 49.8% (0.2%); stage II, 31.9% (2.7%); and stage III, 18.4% (7.8%) with a C-statistic 0.80 (95%CI, 0.74–0.86).ConclusionsA simple 4-variable risk score using clinical data immediately available after CT diagnosis of acute PE predicts in-hospital adverse outcomes. External validation of the CAPE score is required.

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