S24 Incidence of persistent perfusion defects following pulmonary embolism: impact on pulmonary artery systolic pressure at 6 months

ABSTRACT CONTEXT AND OBJECTIVE: The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING: Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS : 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS : Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS : The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.

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A Single Imaging Modality in the Diagnosis, Severity, and Prognosis of Pulmonary Embolism

BioMed Research International ◽

10.1155/2014/470295 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10

Author(s):

Hadice Selimoglu Sen ◽

Özlem Abakay ◽

Mehmet Güli Cetincakmak ◽

Cengizhan Sezgi ◽

Süreyya Yilmaz ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Risk Evaluation ◽

Systolic Pressure ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Risk Of Death ◽

Prediction Of Mortality ◽

Increased Risk ◽

Acute Pe

Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement.Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score.Results. Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r=0.531,P<0.001), PAOI (r=0.296,P<0.001), and pulmonary artery diameter (r=0.659,P<0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death.Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

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Simultaneous Pulmonary Artery Pressure and Left Ventricle Stroke Volume Assessment Predicts Adverse Events in Patients With Pulmonary Embolism

Journal of the American Heart Association ◽

10.1161/jaha.120.019849 ◽

2021 ◽

Vol 10 (18) ◽

Author(s):

Hayaan Kamran ◽

Essa H. Hariri ◽

Jean‐Pierre Iskandar ◽

Aditya Sahai ◽

Ihab Haddadin ◽

...

Keyword(s):

Pulmonary Embolism ◽

Left Ventricle ◽

Adverse Events ◽

Pulmonary Artery ◽

Stroke Volume ◽

Acute Pulmonary Embolism ◽

Systolic Pressure ◽

Severity Index ◽

Pulmonary Artery Systolic Pressure ◽

Advanced Therapies

Background Certain echocardiographic parameters may serve as early predictors of adverse events in patients with hemodynamically compromising pulmonary embolism (PE). Methods and Results An observational analysis was conducted for patients with acute pulmonary embolism evaluated by a Pulmonary Embolism Response Team (PERT) between 2014 and 2020. The performance of clinical prediction algorithms including the Pulmonary Embolism Severity Index and Carl Bova score were compared using a ratio of right ventricle and left ventricle hemodynamics by dividing the pulmonary artery systolic pressure by the left ventricle stroke volume. The primary outcome of in‐hospital mortality, cardiac arrest, and the need for advanced therapies was evaluated by univariate and multivariable analyses. Of the 343 patients meeting the inclusion criteria, 215 had complete data. Pulmonary artery systolic pressure/left ventricle stroke volume was a clear predictor of the primary end point (odds ratio [OR], 2.31; P =0.005), performing as well or better than the Pulmonary Embolism Severity Index (OR, 1.43; P =0.06) or the Bova score (OR, 1.28; P =0.01). Conclusions This study is the first study to demonstrate the utility of early pulmonary artery systolic pressure/left ventricle stroke volume in predicting adverse clinical events in patients with acute pulmonary embolism. Pulmonary artery systolic pressure/left ventricle stroke volume may be a surrogate marker of ventricular asynchrony in high‐risk pulmonary embolism and should be prognostically evaluated.

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Abstract 14176: Pulmonary Effective Artery Elastance as a Novel Predictor of Adverse Events in Patients With Pulmonary Embolism

Circulation ◽

10.1161/circ.142.suppl_3.14176 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Hayaan Kamran ◽

Essa Hariri ◽

Jean-Pierre Iskandar ◽

Aditya Sahai ◽

Ihab haddadin ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Adverse Events ◽

Pulmonary Artery ◽

Troponin T ◽

Systolic Pressure ◽

Composite Endpoint ◽

Severity Index ◽

Pulmonary Artery Systolic Pressure ◽

Hemodynamic Parameters

Introduction: Risk stratification tools including the Pulmonary Embolism Severity Index (PESI) and BOVA rely on complicated calculations that give less attention to hemodynamic parameters predictive of cardiogenic shock in acute pulmonary embolism (PE). We explored the possibility that simultaneous measurement of right sided and left sided non-invasive hemodynamic parameters by echocardiography may predict adverse sequelae in the context of acute PE. Methods: We retrospectively reviewed all Pulmonary Embolism Response Team (PERT) activations between 2014 and 2020. The PESI and BOVA scores were calculated and their performance in predicting adverse events was compared to pulmonary artery elastance (PAE). PAE (mmHg/mL) was calculated by dividing the Pulmonary Artery Systolic pressure (PASP) by the LV Stroke (SV). Blood biomarkers (troponin T, NT-proBNP, and lactate) were recorded. The composite primary outcome was: 1) need for advanced intervention, 2) cardiac arrest, and 3) in-hospital mortality. Multivariate and univariate regression was used to analyze outcomes. Results: 215 of 343 patients met inclusion criteria. Baseline characteristics were similar in patients with PAE <1 and PAE ≥ 1. PAE ≥ 1 was common in intermediate-high risk PE (85.7% vs 63.1%, p <0.001), with greater [NT-proBNP, pg/mL] (3599 vs 1427.5, p=0.001) and [lactate, mM] (2.9 vs 1.8. p=0.003). PAE ≥ 1 predicted the composite endpoint with odds ratio (OR) of 2.31 (95% CI 1.3-4.2, p=0.005), Comparatively BOVA had adjusted OR of 1.3 (95% CI, 1.1-1.6, p = 0.01) and PESI was not significant with OR of 1.4 (95% CI, 1 -2.1, p = 0.055) in predicting composite outcomes. Conclusion: In the context of acute high risk PE, PAE ≥ 1.0 is a novel and independent predictor of adverse cardiovascular events and mortality that should be prospectively validated.

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Hyperlipidemia is associated with a higher pulmonary artery systolic pressure in patients after pulmonary embolism

Thrombosis Research ◽

10.1016/j.thromres.2011.09.018 ◽

2012 ◽

Vol 129 (1) ◽

pp. 86-88 ◽

Cited By ~ 2

Author(s):

Thomas Gary ◽

Ina Starz ◽

Klara Belaj ◽

Karin Steidl ◽

Franz Hafner ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure

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Effects of catheter-directed therapy for pulmonary embolism on pulmonary artery systolic pressure and PaO2/FiO2

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.194 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Muzzio ◽

A Rossini ◽

D Costa ◽

L Garcia Iturralde ◽

C Gonzalez ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Pulmonary Artery ◽

Systolic Pressure ◽

Bleeding Risk ◽

Cardiovascular Death ◽

Pulmonary Artery Systolic Pressure ◽

Systemic Thrombolysis ◽

Funding Sources ◽

High Bleeding Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary embolism (PE) is the third global cause of cardiovascular death. Treatment of high-risk cases and selected intermediate-risk cases is based on systemic thrombolysis, which can be inconvenient in patients with a contraindications for thrombolysis. Catheter-directed therapies are emerging as an alternative for treatment when there is an increased bleeding risk. Methods One-center retrospective study of patients with high or intermediate-high risk PE with contraindications for systemic thrombolysis. Catheter directed rheolytic thrombectomy or mechanical thrombectomy was performed, assessing its effect on clinical variables, pulmonary artery systolic pressure (PASP), PaO2/FiO2, and the occurrence of complications. Results In 12 patients with PE treated with catheter-directed therapy, we observed a mean increase of the PaO2/FiO2 of 62 mm Hg (p = 0.013), as well mean reduction in the PASP of 13 mm Hg (p < 0.001), as can be observed in the figure. As complications, there was one case of hemoptysis, and two of hemolysis, with an in-hospital mortality of 16.7%. Conclusion Catheter-directed therapy in patients with high or intermediate-high risk PE is a feasible option when there are contraindications for thrombolysis or there is a high bleeding risk. It has been shown to improve surrogate endpoints as PASP and right to left ventricle ratio in other studies, although data on mortality from a randomized trial is lacking. Abstract Figure. Gardner-Altman plots.

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Effect of acute lower respiratory tract infection on pulmonary artery pressure in children with post-tricuspid left-to-right shunt

Cardiology in the Young ◽

10.1017/s1047951120004734 ◽

2021 ◽

pp. 1-5

Author(s):

Sakshi Sachdeva ◽

Shyam S. Kothari ◽

Saurabh K. Gupta ◽

Sivasubramanian Ramakrishnan ◽

Anita Saxena

Keyword(s):

Tract Infection ◽

Pulmonary Artery ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Pulmonary Artery Pressure ◽

Lower Respiratory Tract ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Artery Pressure

Abstract We sought to examine the influence of clinically severe lower respiratory tract infection on pulmonary artery pressure in children having CHD with post-tricuspid left-to-right shunt, as it may have physiological and clinical implications. In a prospective single-centre observational study, 45 children with post-tricuspid left-to-right shunt and clinically severe lower respiratory tract infection were evaluated during the illness and 2 weeks after its resolution. Pulmonary artery systolic pressure was estimated non-invasively using shunt gradient by echocardiography and systolic blood pressure measured non-invasively. Median pulmonary artery systolic pressure during lower respiratory tract infection was only mildly (although statistically significantly) elevated during lower respiratory tract infection [60 (42–74) versus 53 (40–73) mmHg, (p < 0.0001)]. However, clinically significant change in pulmonary artery systolic pressure defined as the increase of >10 mmHg was present in only 9 (20%) patients. In the absence of hypoxia or acidosis, only a small minority (9%, n = 4) showed significant pulmonary artery systolic pressure rise >10 mmHg. In the absence of hypoxia or acidosis, severe lower respiratory tract infection in patients with acyanotic CHD results in only mild elevation of pulmonary artery systolic pressure in most of the patients.

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Echocardiographic screening discloses increased values of pulmonary artery systolic pressure in 9 of 68 unselected patients affected with hereditary hemorrhagic telangiectasia

Genetics in Medicine ◽

10.1097/01.gim.0000204463.77319.1c ◽

2006 ◽

Vol 8 (3) ◽

pp. 183-190 ◽

Cited By ~ 33

Author(s):

Carla Olivieri ◽

Lucav Lanzarini ◽

Fabio Pagella ◽

Lucia Semino ◽

Sabrina Corno ◽

...

Keyword(s):

Pulmonary Artery ◽

Hereditary Hemorrhagic Telangiectasia ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure

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Serum-Free Thyroxine Levels Were Associated with Pulmonary Hypertension and Pulmonary Artery Systolic Pressure in Euthyroid Patients with Coronary Artery Disease

International Journal of Endocrinology ◽

10.1155/2017/4832608 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8

Author(s):

Bingjie Wu ◽

Jingjing Jiang ◽

Minghui Gui ◽

Lin Liu ◽

Qiqige Aleteng ◽

...

Keyword(s):

Coronary Artery Disease ◽

Pulmonary Hypertension ◽

Regression Analysis ◽

Coronary Artery ◽

Pulmonary Artery ◽

Systolic Pressure ◽

Free Thyroxine ◽

Pulmonary Artery Systolic Pressure ◽

Serum Free ◽

Artery Disease

The aim of this study was to evaluate the association between thyroid hormone levels, pulmonary hypertension (PH), and pulmonary artery systolic pressure (PASP) in euthyroid patients with coronary artery disease (CAD). A cross-sectional study was conducted in individuals who underwent coronary angiography and were diagnosed as CAD from March 2013 to November 2013. 811 subjects (185 women and 626 men) were included in this study. PASP was measured by transthoracic Doppler echocardiography. 86 patients were diagnosed as PH and had significantly higher free thyroxine (FT4) levels than those without PH. Multiple logistic regression analysis demonstrated an independent association of FT4 levels with PH after adjustment of gender, age, body mass index, systolic blood pressure, left ventricular ejection fraction, hypertension, and medication use of calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, and nitrates. Serum-free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) were not associated with PH. Furthermore, multivariate linear regression analysis showed that FT4 levels emerged as an independent predictor for PASP, while FT3 and TSH levels were not associated with PASP. Our study demonstrated that, in euthyroid patients with CAD, FT4 was an independent risk factor for PH, and FT4 levels were independently associated with PASP.

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Abstract 15388: Persistent Pulmonary Hypertension After Transcatheter Aortic Valve Implantation: Impact on Mortality

Circulation ◽

10.1161/circ.132.suppl_3.15388 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Maria Drakopoulou ◽

Konstantinos Stathogiannis ◽

Konstantinos Toutouzas ◽

George Latsios ◽

Andreas Synetos ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Aortic Stenosis ◽

Pulmonary Artery ◽

Severe Aortic Stenosis ◽

Systolic Pressure ◽

Right Atrial ◽

Pulmonary Artery Systolic Pressure ◽

End Point ◽

The Right ◽

The Impact

Objective: Severe aortic stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of persistent PHT on 2-year all-cause mortality of patients with severe aortic stenosis following TAVI. Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1 cm 2 ) who were scheduled for TAVI with a self-expanding valve at our institution were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as absent if <35 mmHg and persistent if ≥35 mmHg. Primary clinical end-point was 2-year all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2. Results: Hundred and forty patients (mean age: 82±9 years) were included in the study. The primary clinical end point occurred in 17 patients (12%) during a median follow-up period of 2 years. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (45±9 versus 41±6 mmHg, p<0.01). Mortality rate was higher in patients with persistent PHT compared to patients with normal pulmonary artery systolic pressure following TAVI (26% versus 14 %, p<0.01). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (43±9 versus 39±6 mmHg, p=0.02). In multivariate regression analysis, persistence of PHT (OR: 2.51, 95% CI: 1.109-7.224, p=0.01) was an independent predictor of long-term mortality. Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by larger trials.

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