scholarly journals Fibrinogen and the prediction of residual obstruction manifested after pulmonary embolism treatment

2018 ◽  
Vol 52 (5) ◽  
pp. 1801467 ◽  
Author(s):  
Benjamin Planquette ◽  
Olivier Sanchez ◽  
James J. Marsh ◽  
Peter G. Chiles ◽  
Joseph Emmerich ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Predictive Model ◽  
Clinical Characteristics ◽  
Goodness Of Fit ◽  
Acute Pulmonary Embolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Information Criterion ◽  
Related Data ◽  
Chi Squared ◽  
Best Fit

Residual pulmonary vascular obstruction (RPVO) and chronic thromboembolic pulmonary hypertension (CTEPH) are both long-term complications of acute pulmonary embolism, but it is unknown whether RPVO can be predicted by variants of fibrinogen associated with CTEPH.We used the Akaike information criterion to select the best predictive models for RPVO in two prospectively followed cohorts of acute pulmonary embolism patients, using as candidate variables the extent of the initial obstruction, clinical characteristics and fibrinogen-related data. We measured the selected models’ goodness of fit by analysis of deviance and compared models using the Chi-squared test.RPVO occurred in 29 (28.4%) out of 102 subjects in the first cohort and 46 (25.3%) out of 182 subjects in the second. The best-fit predictive model derived in the first cohort (p=0.0002) and validated in the second cohort (p=0.0005) implicated fibrinogen Bβ-chain monosialylation in the development of RPVO. When the derivation procedure excluded clinical characteristics, fibrinogen Bβ-chain monosialylation remained a predictor of RPVO in the best-fit predictive model (p=0.00003). Excluding fibrinogen characteristics worsened the predictive model (p=0.03).Fibrinogen Bβ-chain monosialylation, a common structural attribute of fibrin, helped predict RPVO after acute pulmonary embolism. Fibrin structure may contribute to the risk of developing RPVO.

scholarly journals Acute Pulmonary Embolism: Clinical Characteristics and Outcomes in a University Teaching Hospital

2010 ◽  
Vol 68 (3) ◽  
pp. 140 ◽  
Author(s):  
Jin Nyeong Chae ◽  
Won-Il Choi ◽  
Jie Hae Park ◽  
Byung Hak Rho ◽  
Jae Bum Kim
Keyword(s):  
Pulmonary Embolism ◽  
Teaching Hospital ◽  
Clinical Characteristics ◽  
Acute Pulmonary Embolism ◽  
University Teaching

Active search for chronic thromboembolic pulmonary hypertension does not appear indicated after acute pulmonary embolism

2010 ◽  
Vol 125 (5) ◽  
pp. e202-e205 ◽  
Author(s):  
Sulaiman Surie ◽  
Nadine S. Gibson ◽  
Victor E.A. Gerdes ◽  
Berto J. Bouma ◽  
Berthe L.F. van Eck – Smit ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Acute Pulmonary Embolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Active Search ◽  
Thromboembolic Pulmonary Hypertension

scholarly journals Accurate and efficient non-invasive strategy for early identification of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism (InShape II study)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Klok ◽  
G.J.A.M Boon ◽  
Y.M Ende-Verhaar ◽  
R Bavalia ◽  
M Delcroix ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Delay ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Funding Source ◽  
Total Period ◽  
Life Years ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Pe

Abstract Background The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) is unacceptably long exceeding 1 year, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies to diagnose CTEPH earlier are lacking. Importantly, performing echocardiography in all PE patients for this purpose has a low diagnostic yield, is associated with overdiagnosis and is not cost-effective. Moreover, expertise in performing high-quality PH-dedicated echocardiograms may not be available outside expert centers. Aim To validate a simple screening strategy aimed at identifying CTEPH early in the course after acute PE, avoiding echocardiography if possible (Figure 1). Methods In this prospective, international, multicenter management study, consecutive PE survivors were managed according to the predefined algorithm starting three months after acute PE. All were followed for a total period of two years. The study protocol was approved by all local IRBs and all patients provided informed consent. Results 424 patients were included across three European countries (Table 1). Following the algorithm, CTEPH was considered excluded in 343 (81%) patients based on clinical pre-test probability assessment by the “CTEPH prediction score”, evaluation of symptoms and application of the “CTEPH rule-out criteria” (Figure 1); only 19% was subjected to echocardiography. Only 1 of 343 patients managed without echocardiography was diagnosed with CTEPH, 10 months after initial PE, for a failure rate of 0.29% (95% CI 0–1.6%). Overall, 13 patients were diagnosed with CTEPH (incidence 3.1%), of whom 10 within 4 months after PE diagnosis. Conclusions The algorithm accurately ruled out CTEPH and avoided echocardiography in 81% of patients. The vast majority of CTEPH cases were identified early in the course of acute PE which is a considerable improvement compared to current clinical practice with an economic use of healthcare resources. Figure 1. Study flowchart Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study was supported by unrestricted grants from Bayer/Merck Sharp & Dohme (MSD) and Actelion Pharmaceuticals Ltd. F.A. Klok and G.J.A.M. Boon were supported by the Dutch Heart Foundation (2017T064).

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