Is there a link between lung parenchyma lesions , BMI , CRP , D-dimer and acute pulmonary embolism in patients infected with COVID-19 ?

Introduction: ince the outbreak of the COVID-19 pandemic , increasing suggests that infected patients present a high incidence of venous thromboembolic events (VTE). The main objective of this retrospective study was to evaluate the prevalence of acute pulmonary embolism (PE) on pulmonary computer tomography angiograms (CTPA) in patients classified as COVID-19 infection. The second objective was to determine if there is a link between D-dimer levels, serum C-reactive protein (CRP ), body mass index (BMI) , the lung parenchyma lesions (LPL) and acute pulmonary embolism (PE) in these patients. Material and Methods: 120 patients with mean age 65 ±14.5 years infected with COVID- 19 underwent in our institution a CTPA for suspected PE .Thirty four were in intensive care units (ICU). A COVID-19 diagnosis was made by transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest CT images. Demographics and co-morbidities characteristics were collected . Laboratory parameters were automatically extracted from our heath information system. When PE was suspected a CTPA were acquired after injection of high concentration iodine contrast media .The criterion of suspected PE were based on the clinical respiratory deterioration , with an increased need for oxygen. A venous duplex ultrasound (DU) test of lower limbs was performed on admission. Results: CTPA showed 24 acute PE (20%) , of which 11 primary and 13 associated with deep venous thrombosis diagnosed on DU .Eleven of the 24 (45.8 %)had PE despite preventive and therapeutic anticoagulation with low molecular weight heparin with Enoxaparin (7 with preventive anticoagulation and 4 had therapeutic dose), of them 8 (72.7%) with risk factors for VTE .Acute PE was not significantly associated with CRP and LPL. However , we found a significant association between acute PE and BMI (mean 32.41±5.90 versus 27.1± 5.2 kg/m2, p 0.0007) or D-dimer Levels (mean 6040±5068 versus 3396.7±5361.5 ng/ml ,p <0.0001). Conclusions: Hospitalized patients infected with COVID-19 in conventional units or ICU have a high frequency of PE justifying preventive anticoagulation. For those who have a risk factors for VTE a therapeutic anticoagulation may be indicated.

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Safety and Clinical Utility of Four Clinical Decision Rules In the Diagnostic Management of Acute Pulmonary Embolism – the Prometheus Diagnosis Study

Blood ◽

10.1182/blood.v116.21.3186.3186 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3186-3186

Author(s):

Inge CM Mos ◽

Renée A Douma ◽

Petra MG Erkens ◽

Tessa AC Nizet ◽

Marc F Durian ◽

...

Keyword(s):

Pulmonary Embolism ◽

Clinical Utility ◽

Acute Pulmonary Embolism ◽

Decision Rules ◽

Clinical Decision ◽

Clinical Decision Rules ◽

Wells Rule ◽

Revised Geneva Score ◽

Acute Pe ◽

D Dimer

Abstract Abstract 3186 Background Several clinical decision rules (CDRs) are available for the exclusion of acute pulmonary embolism (PE). This prospective multi-center study compared the safety and clinical utility of four CDRs (Wells rule, revised Geneva score, simplified Wells rule and simplified revised Geneva score) in excluding PE in combination with D-dimer testing. Methods Clinical probability of patients with suspected acute PE was assessed using a computerized based “black box”, which calculated all CDRs and indicated the next diagnostic step. A “PE unlikely” result according to all CDRs in combination with a normal D-dimer result excluded PE, while patients with “PE likely” according to at least one of the CDRs or an abnormal D-dimer result underwent CT-scanning. Patients in whom PE was excluded were followed for three months. Results 807 consecutive patients were included and PE prevalence was 23%. The number of patients categorized as “PE unlikely” ranged from 62% (simplified Wells rule) to 72% (Wells rule). Combined with a normal D-dimer level, the CDRs excluded PE in 22–24% of patients. The total failure rates of the CDR-D-dimer combinations were similar (1 failure, 0.5– 0.6%, upper 95% CI 2.9– 3.1%). Despite 30% of the patients had discordant CDR outcomes, PE was missed in none of the patients with discordant CDRs and a normal D-dimer result. Conclusions All four CDRs show similar safety and clinical utility for exclusion of acute PE in combination with a normal D-dimer level. With this prospective validation, the more straightforward simplified scores are ready for use in clinical practice. Disclosures: No relevant conflicts of interest to declare.

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Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01757-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Limin Zhang ◽

Yunqiu Chen ◽

Wenjuan Liu ◽

Xinzhuo Wang ◽

Shuang Zhang ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Cesarean Section ◽

Diagnostic Imaging ◽

Pregnant Women ◽

Cesarean Delivery ◽

High Sensitivity ◽

Imaging Results ◽

Acute Pe ◽

D Dimer

Abstract Background Acute pulmonary embolism (PE) is one of the leading causes of maternal mortality, and cesarean section is an established independent risk factor for PE. The diagnostic utility of D-dimer for PE in non-pregnant women has been well-established, but its role in women with suspected PE after cesarean section is unclear. Furthermore, the optimal threshold level in this patient population is unknown. Traditional D-dimer levels have low diagnostic specificity, resulting in many pregnant women being exposed to potentially harmful radiation despite negative diagnostic imaging results. This research aimed to optimize the clinical threshold for D-dimer to improve specificity while ensuring high sensitivity and to identify risk factors for PE after cesarean section. Methods This retrospective study of 289 women who underwent diagnostic imaging (ventilation/perfusion [V/Q] or computed tomographic pulmonary angiography [CTPA]) for suspected acute PE after cesarean delivery from 2010 to 2021 was conducted. Clinical data and laboratory indicators within 24 h postpartum including D-dimer levels were collected for analyses. Results The final analysis included 125 patients, among whom 33 were diagnosed with acute PE (incidence of 11.42%, 95% confidence interval 7.7–15.1). The receiver operating characteristic curve analysis suggested that a D-dimer cut-off value of 800 ng/mL had specificity of 25.26% and sensitivity of 100% for detecting PE. The cut-off value was adjusted to 1000 ng/mL with a specificity of 34.74% and a sensitivity of 96.67%. Using a D-dimer cut-off value of 800 ng/mL (instead of the conventional value of 500 ng/mL) increased the number of patients excluded from suspected PE from 9.6 to 18.4% without additional false-negative results. Of note, a history of known thrombophilia was significantly more common in patients with PE than in those without (P < 0.05). No other independent risk factors were noted in our study. Conclusions The D-dimer cut-off value of 800 ng/mL ensures high sensitivity and increases specificity compared to the conventional threshold of 500 ng/mL. Utilizing this higher threshold can reduce the number of unnecessary CT and subsequently unnecessary radiation exposure, in women after cesarean delivery. Prospective studies should also be conducted to verify these results.

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Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

10.21203/rs.3.rs-82135/v1 ◽

2020 ◽

Author(s):

Marta Alfageme ◽

Jorge González Plaza ◽

María Luisa Collado ◽

Santiago Méndez ◽

Juan A. Gómez Patiño ◽

...

Keyword(s):

Pulmonary Embolism ◽

Respiratory Failure ◽

Critically Ill ◽

Doppler Ultrasound ◽

Acute Pulmonary Embolism ◽

Anticoagulation Therapy ◽

Lower Limbs ◽

Severe Respiratory Failure ◽

Asymptomatic Patients ◽

D Dimer

Abstract BackgroundCOVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE).MethodsThe purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n=23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU).ResultsDVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. CTPA was performed in 6 patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy.ConclusionIn critically COVID 19 ill ICU patients with severe respiratory failure y elevated D-dimer the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulated these patients.

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Venous Doppler ultrasound in critically Ill COVID-19 patients: game changer in anticoagulation therapy

The Ultrasound Journal ◽

10.1186/s13089-020-00201-7 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Marta Alfageme ◽

Jorge González Plaza ◽

Santiago Méndez ◽

Juan A. Gómez Patiño ◽

María L. Collado ◽

...

Keyword(s):

Pulmonary Embolism ◽

Respiratory Failure ◽

Critically Ill ◽

Doppler Ultrasound ◽

Acute Pulmonary Embolism ◽

Anticoagulation Therapy ◽

Lower Limbs ◽

Severe Respiratory Failure ◽

Asymptomatic Patients ◽

D Dimer

Abstract Background COVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE). Methods The purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n = 23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU). Results DVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. Computed Tomography Pulmonary Angiography (CTPA) was performed in six patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy. Conclusion In critically COVID-19 ill ICU patients with severe respiratory failure and elevated D-dimer, the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulate these patients.

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Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Medical Principles and Practice ◽

10.1159/000497436 ◽

2019 ◽

Vol 28 (3) ◽

pp. 264-272 ◽

Cited By ~ 2

Author(s):

Valdis Ģībietis ◽

Dana Kigitoviča ◽

Barbara Vītola ◽

Sintija Strautmane ◽

Andris Skride

Keyword(s):

Pulmonary Embolism ◽

Glomerular Filtration Rate ◽

Filtration Rate ◽

Acute Pulmonary Embolism ◽

All Cause Mortality ◽

Acute Pe ◽

D Dimer ◽

Active Cancer ◽

Long Term Mortality

Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

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Safety and Efficiency of the YEARS Diagnostic Algorithm for Pregnant Patients with Clinically Suspected Acute Pulmonary Embolism —the Artemis Study

Blood ◽

10.1182/blood-2018-99-113336 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 419-419

Author(s):

Liselotte M. Van Der Pol ◽

Cecile Tromeur ◽

Ingrid Bistervels ◽

Thomas van Bemmel ◽

Francis Couturaud ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pregnant Women ◽

Failure Rate ◽

Acute Pulmonary Embolism ◽

Diagnostic Algorithm ◽

Ct Scanning ◽

Ct Scans ◽

Acute Pe ◽

D Dimer

Abstract Background Acute pulmonary embolism (PE) is the leading cause of maternal mortality in Western countries, accounting for 20 to 30% of all maternal deaths. Therefore, the threshold to test for PE during pregnancy is low. Because evidence regarding the safety of ruling out PE with clinical decision rules and D-dimer tests in pregnant women is unavailable, all women with a suspected PE need to undergo an imaging test, with potential harm to patient and fetus by exposure to ionizing radiation. In the present international, multicenter, prospective management study, we evaluated the safety and efficiency of the YEARS diagnostic algorithm for ruling out PE in pregnant patients with clinically suspected PE (Netherlands Trial Registry number 5913). YEARS is a simple diagnostic algorithm designed to reduce the number of required computed tomography (CT) scans in the diagnostic work-up of PE in non-pregnant patients, and was recently shown to be as safe as conventional algorithms but associated with a significant absolute 14% reduction in the number of CT scans (van der Hulle et al., Lancet 2017). Methods The Artemis study was performed in 11 Dutch hospitals, 8 French hospitals and 1 Irish hospital. Consecutive pregnant patients with suspected acute PE were included. Exclusion criteria were treatment with therapeutically dosed anticoagulants >24 hours or contraindications for CT. The YEARS algorithm was slightly adjusted for application during pregnancy (figure 1): in patients with signs of deep vein thrombosis (DVT), compression ultrasonography was obligatory before CT scanning was considered. In patients with proven DVT, anticoagulant treatment was initiated and no further diagnostic tests were undertaken. In patients with no YEARS items (Figure 1), a D-dimer threshold of <1.0 µg/ml was sufficient to rule out PE. In the remaining patients D-dimer threshold was <0.5 µg/mL. CT scanning was only performed in patients with a D-dimer level above the threshold. Anticoagulant therapy was withheld if PE was excluded. The primary safety endpoint was the occurrence of symptomatic venous thromboembolism during 3 months of follow-up, the primary efficiency endpoint was the proportion of patients in whom CTPA could be avoided. All safety endpoints were adjudicated by an independent committee. Assuming a 1.0% diagnostic failure rate and defining a maximum acceptable failure rate of 2.7%, a total study population of 472 patients was required (one-sided alpha 0.05, beta 80%). Results and conclusion: The last patient was included in May 2018. At baseline, 48% of pregnant women with suspected acute PE had no YEARS item and a D-dimer threshold of 1.0 µg/mL was applied. A total of 42% had a D-dimer level below the relevant threshold and were managed without CT scanning. Follow-up and endpoint adjudication was not completed at the abstract submission deadline; full study results will be presented at the ASH meeting. Disclosures Couturaud: Pfizer: Research Funding; Bayer: Honoraria, Other: Travel Support; AstraZeneca: Honoraria; Actelion: Other: Travel Support; Intermune: Other: Travel Support; Leo Pharma: Other: Travel Support; Daiichi Sankyo: Other: Travel Support.

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High D-dimer is a predictor for short-term mortality in patients with active cancer and acute pulmonary embolism

10.22514/sv.2021.083 ◽

2021 ◽

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Performance Status ◽

Tertiary Care ◽

Eastern Cooperative Oncology Group ◽

Care Hospital ◽

Ecog Performance Status ◽

Acute Pe ◽

D Dimer ◽

Active Cancer

Objectives: Acute pulmonary embolism (PE) is the main cause of death in cancer patients, but there are limited prognostic tools for the patients with active cancer and acute PE. We aimed to identify prognostic factors of 30-day mortality in patients with active cancer and acute PE. Methods: This retrospective observational study included all adult patients aged ≥18 years with active cancer and acute PE from February 2017 to February 2019 at the emergency department in tertiary care hospital, Seoul, Korea. The primary outcome is 30-day mortality. Results: A total of 178 patients were included with a mean age of 63.9 years (SD 10.4) and males of 52.8%. The overall 30-day mortality rate was 30.9%. In a multivariable logistic analysis, high D-dimer, defined as ≥median value of 14.7 µg/mL, with odds ratio (OR) 2.47 (95% confidence interval [CI], 1.15–5.33), high Pulmonary Embolism Severity Index (PESI) scores with OR 2.95 (95% CI, 1.21–7.75) for class IV and OR 2.90 (95% CI, 1.06–7.90) for class V, and Eastern Cooperative Oncology Group (ECOG) performance status 3/4 with OR 3.22 (95% CI, 1.18–8.76) were independent predictors of 30-day mortality. Conclusion: High D-dimer values, high PESI scores, and poor ECOG performance status may be reliable predictors of mortality in patients with active cancer and acute PE.

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Higher Incidence of Chronic Thromboembolic Pulmonary Hypertension After Acute Pulmonary Embolism in Asians Than in Europeans: A Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.721294 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wenyi Pang ◽

Zhu Zhang ◽

Zenghui Wang ◽

Kaiyuan Zhen ◽

Meng Zhang ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Hypertension ◽

Cohort Studies ◽

Sample Size ◽

Acute Pulmonary Embolism ◽

Meta Analysis ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Venous Thromboembolic Events ◽

Thromboembolic Pulmonary Hypertension ◽

Acute Pe

Aim: To summarize the incidence of right heart catheter diagnosed chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) in a meta-analysis.Methods: Cohort studies reporting the incidence of CTEPH after acute PE were identified via search of Medline, Embase, China National Knowledge Infrastructure and WanFang databases.Results: Twenty-two cohort studies with 5,834 acute PE patients were included. Pooled results showed that the overall incidence of CTEPH was 2.82% (95% CI: 2.11–3.53%). Subgroup analyses showed higher incidence of CTEPH in Asians than Europeans (5.08 vs. 1.96%, p = 0.01), in retrospective cohorts than prospective cohorts (4.75 vs. 2.47%, p = 0.02), and in studies with smaller sample size than those with larger sample size (4.57 vs. 1.71%, p < 0.001). Stratified analyses showed previous venous thromboembolic events and unprovoked PE were both significantly associated with increased risk of CTEPH (OR = 2.57 and 2.71, respectively; both p < 0.01).Conclusions: The incidence of CTEPH after acute PE is ~3% and the incidence is higher in Asians than Europeans. Efforts should be made for the early diagnosis and treatment of CTEPH in PE patients, particularly for high-risk population.

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P5017Factors associated with a negative D-dimer test in patients diagnosed with acute symptomatic pulmonary embolism

European Heart Journal ◽

10.1093/eurheartj/ehz746.0195 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Barco ◽

M Russo ◽

F A Klok ◽

S V Konstantinides

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

False Negative ◽

Diagnostic Strategy ◽

Inverse Association ◽

Symptomatic Pulmonary Embolism ◽

Post Hoc ◽

Acute Pe ◽

D Dimer

Abstract Background The recommended diagnostic strategy for suspected acute pulmonary embolism (PE) combines the assessment of pre-test probability, D-dimer level, and -if indicated- computed tomography pulmonary angiography. Purpose To evaluate the frequency and potential explanations for negative D-dimer tests in patients diagnosed with acute PE. Methods The multicentre Follow-up of Acute Pulmonary Embolism (FOCUS) cohort study prospectively enrolled 1,100 consecutive patients diagnosed with acute symptomatic PE; two-year follow-up is ongoing. The items of the Simplified revised Geneva Score and the D-dimer levels at diagnosis have been prospectively collected, but they did not necessarily guide management decisions. Quantitative D-dimer was measured on admission either by quantitative latex-based assays or enzyme-linked immunosorbent assays. A negative D-dimer was defined by fixed (0.50 μg/mL) or age-adjusted (age*0.01 μg/mL if age>50) cut-off. Results Using the fixed cut-off, a negative D-Dimer was detected in 17 of 773 patients with ultimately diagnosed PE (miss rate 2.2% [95% CI 1.4–3.5]); using the age-adjusted cut-off, the test was discordant with the PE diagnosis in 24 patients (3.1% [2.1–4.6]). In Figure 1, red dots indicate negative D-dimer test by fixed cut-off and blue dots indicate additional negative D-dimer tests by age-adjusted cut-off. In 448 (59%) patients post-hoc classified as PE-unlikely, 11 (2.5% [1.4–4.3]) and 14 (3.1% [1.9–5.2]) patients had a negative D-dimer using the two different cut-offs, respectively. Haemoptysis on admission, V/Q scan-based diagnosis, and chronic lung disease were associated with a discordant D-dimer, while an inverse association existed for concomitant DVT. In 7 (29%) PE cases with normal D-dimer, PE was verified to be subsegmental also in a post-hoc evaluation. Another seven (29%) patients were receiving anticoagulation at the time of D-dimer assessment. Figure 1 Conclusions Our results show that the frequency of discordance between a normal D-dimer test and the diagnosis of acute PE is low, but not negligible. One third of discordant findings were related to subsegmental PE. Physicians should be aware that the risk of obtaining a false-negative D-dimer might be higher in specific subgroups of patients. Acknowledgement/Funding The sponsor (University Medical Center of the Johannes Gutenberg University, Mainz) has obtained grants from Bayer Vital GmbH and Bayer Pharma AG

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Clinical and anamnestic characteristics and risk factors in patients with acute pulmonary embolism among residents of Kharkiv

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.3.2021.234810 ◽

2021 ◽

Vol 17 (3) ◽

pp. 58-63

Author(s):

V.Y. Tseluyko ◽

L.M. Yakovleva ◽

S.M. Sukhova ◽

K.Yu. Kinoshenko ◽

O.V. Radchenko ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Varicose Veins ◽

Pulmonary Arteries ◽

Lower Extremities ◽

Right Ventricular Dysfunction ◽

Early Death ◽

City Council ◽

Acute Pe

Background. The purpose was the analysis of the features of the course and the leading factors in the development of pulmonary embolism. Materials and methods. During the period from November 1, 2019, to December 2020, inclusive, 188 patients with acute pulmonary embolism (PE), aged 46 to 80 years old, were hospitalized at the City Clinical Hospital 8 of the Kharkiv City Council; the average age was 62.9 ± 16.7 years. In-hospital mortality was 12.2 % (23 patients). The criterion for inclusion in the study was acute PE, which was diagnosed based on the results of multislice computed tomographic angiography of the pulmonary arteries (MCT angiography of the pulmonary arteries). All patients underwent a general clinical examination, the risk and prognosis were assessed based on the generally accepted scales, standard transthoracic echocardiography (EchoCG), and Doppler ultrasound examination of the veins of the lower extremities were performed. Results. The disease was diagnosed with the same frequency in men and women; there was no difference in age. Among the most significant and important risk factors for the development of pulmonary embolism are the history of venous thrombosis/embolism and active malignant oncological disease (43 and 35 %, respectively), while the less significant ones were advanced age, varicose veins of the lower extremities and arterial hypertension 47.9, 31.4 and 52.1 %, respectively. The vast majority (57.4 %) had a combination of 2 or more risk factors. Signs of right ventricular dysfunction according to MCT angiography of the pulmonary arteries and/or echocardiography were recorded in 45.7 % of patients. A high and medium-high risk of early death associated with acute PE was found in a significant percentage (71.8 %) of patients, which required the inclusion of a thrombolytic agent in the treatment strategy.

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