scholarly journals Thrombolytic Therapy in Normotensive Patients with Pulmonary Embolism (Data from the Retrospective Study)

2020 ◽  
Vol 16 (5) ◽  
pp. 742-748
Author(s):  
N. A. Сherepanova ◽  
I. S. Mullova ◽  
A. R. Kiselev ◽  
T. V. Pavlova ◽  
S. M. Khokhlunov ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Troponin I ◽  
Varicose Veins ◽  
Right Ventricular Dysfunction ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Background. The thrombolytic therapy is absolutely recommended for patients in shock or hypotension because the benefits are clearly outweighing the risks. However, in hemodynamically stable patients, including those with acute right ventricular dysfunction and/or myocardial damage, thrombolysis has a significantly lower evidence level.Aim. To study the criteria based on which doctors decide to conduct thrombolytic therapy in normotensive patients in real clinical practice according to the retrospective data.Material and methods. A single-center retrospective cohort study analyzed medical records of patients hospitalized in 2006-2017 with a verified diagnosis of pulmonary embolism (PE) and who had a systolic blood pressure >90 mm Hg at the time of admission.Results. The present study population included 299 patients with a verified diagnosis of PE from 2006 to 2017 years. Patients were divided into two groups: with thrombolysis (group 1) and without thrombolysis (group 2). Logistic regression analysis showed that age younger than 60 years, the presence of varicose veins of the lower extremities, skin cyanosis, syncope in the debut of PE were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis. Increased troponin I, right ventricular dysfunction, and the severity of PE according to the PESI score showed no significant impact on this decision. In-hospital mortality in the group 2 was 1.9% (5 patients), while there were no deaths in the group 1. But the analysis of the association of thrombolysis with survival was difficult to perform due to the low incidence of deaths and the small number of patients in the group with thrombolysis (odds ratio 0.34; 95% confidence interval 0.03-8.18; р=0.856). No major bleeding was registered in any group.Conclusion. We were not able to clearly identify independent clinical or instrumental factors that influence the decision to perform thrombolysis in patients with PE outside the framework of evidence-based medicine. Further research is needed.

scholarly journals Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism

2015 ◽  
Vol 6 (5) ◽  
pp. 584-588 ◽  
Author(s):  
Karsten Keller ◽  
Martin Geyer ◽  
Johannes Beule ◽  
Meike Coldewey ◽  
Jörn Oliver Balzer ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Cardiac Troponin ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Troponin I ◽  
Right Ventricular Dysfunction ◽  
Cardiac Troponin I

scholarly journals Prognostic roles of obstructive sleep apnea syndrome and right ventricular dysfunction in heart failure patients with preserved ejection

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
E Grakova ◽  
AV Yakovlev ◽  
SN Shilov ◽  
AT Teplyakov ◽  
NF Yakovleva ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Sleep Apnea Syndrome ◽  
Right Ventricular Dysfunction ◽  
Preserved Ejection Fraction ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Objective. To study the prognostic roles of obstructive sleep apnea syndrome (OSAS) and right ventricular dysfunction in the development of heart failure (HF) progression in patients with preserved ejection fraction (HFpEF) during the 12-month follow-up period. Methods. The severity of obstructive breathing disorders during sleep was assessed by the apnea/hypopnea index (AHI). A total of 86 men, median age of 62.0 (41.0; 78.0) years with moderate and severe OSAS (with AHI > 15 per hour) and HF of NYHA class I-III with baseline LVEF of 60% [52; 65]% were enrolled in the study. All patients had the abdominal obesity (WC > 92 cm), body mass index exceeded 30 kg/m2. Serum levels of NT-proBNP were measured using ELISA at baseline. Two-dimensional transthoracic echocardiography with assessment of right ventricular function and 6-minute walk test were performed at baseline and at 12 months. Results. At 12 months of follow-up period all patients were divided into 2 groups: group 1 (n = 33) comprised patients with HF progression, group 2 (n = 53) without it. The concentration of NT-proBNP at baseline was higher by 18% in group 1 than in group 2 (p = 0.024; 338 [168; 678] vs. 278 [177; 815] pg/mL, respectively). The median values of AHI (p < 0.0001) were 46.0 [20.6; 85] per hour in group 1 and 24.0 [21.0; 28.0] per hour in group 2. In group 1 than in group 2 fractional change in the area of the right ventricle (ΔSRV) was less by 9.1% (p = 0.031; 40 [35; 47] vs. 44 [40; 47]%, respectively) and right ventricular myocardial function index (RVSWI, Tey index) was less by 8% (p = 0.022; 0.23 [0.22; 0.25] vs. 0.25 [0.24; 0.26], respectively). Based on ROC-analysis, AHI ≥33.5 episodes per hour (sensitivity 75.8%, specificity 67.9%, AUC = 0.732; p < 0.0001), ΔSRV ≤18.6% (sensitivity 75.8%, specificity 54.7%, AUC = 0.62; p = 0.047) and NT-proBNP ≥311 pg/mL (sensitivity 63.6%, specificity 73.6%, AUC = 0.645; p < 0.0001) were identified as a cut-off values predicting the development of HF progression. The combined evaluation of NT-proBNP and AHI increased the predictive value of the analysis (sensitivity of 82.6%, specificity of 77.1%, and AUС of 0.821; p < 0.0001). Conclusion. Our data suggest that NT-proBNP, AHI and ΔSRV may be used as a diagnostic biomarker for HF progression in patients with preserved ejection fraction (HFpEF) during the 12-month follow-up period. The combined use of NT-proBNP and AHI demonstrated higher diagnostic sensitivity and specificity for prediction of unfavorable course of HF.

Shape-based analysis of right ventricular dysfunction associated with acute pulmonary embolism

2012 ◽  
Author(s):  
Nima Tajbakhsh ◽  
Wenzhe Xue ◽  
Hong Wu ◽  
Jianming Liang ◽  
Eileen M. McMahon ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction
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