Gender-related differences in clinical presentation, electrocardiography signs, laboratory markers and outcome in patients with acute pulmonary embolism

Background/Aim. Acute pulmonary embolism (PE) is a potentially life threating event, but there are scarce data about genderrelated differences in this condition. The aim of this study was to identify gender-specific differences in clinical presentation, the diagnosis and outcome between male and female patients with PE. Methods. We analysed the data of 144 consecutive patients with PE (50% women) and compared female and male patients regarding clinical presentation, electrocardiography (ECG) signs, basic laboratory markers and six-month outcome. All the patients confirmed PE by visualized thrombus on the multidetector computed tomography with pulmonary angiography (MDCTPA), ECG and echocardiographic examination at admission. Results. Compared to the men, the women were older and a larger proportion of them was in the third tertile of age (66.0% vs 34.0%, p = 0.008). In univariate analysis the men more often had hemoptysis [OR (95% CI) 3.75 (1.16-12.11)], chest pain [OR (95% CI) 3.31 (1.57-7.00)] febrile state [OR (95% CI) 2.41 (1.12-5.22)] and pneumonia at PE presentation [OR (95% CI) 3.40 (1.25-9.22)] and less likely had heart decompensation early in the course of the disease [OR (95%CI) 0.48 (0.24-0.97)]. In the multivariate analysis a significant difference in the rate of pneumonia and acute heart failure between genders disappeared due to strong influence of age. There was no significant difference in the occurrence of typical ECG signs for PE between the genders. Women had higher level of admission glycaemia [7.7 mmol/L (5.5-8.2 mmol/L) vs 6.9 mmol/L (6.3-9.6 mmol/L), p = 0.006] and total number of leukocytes [10.5 x 109/L (8.8-12.7 x 109/L vs 8.7 x 109/L (7.0-11.6 x 109/L)), p = 0.007]. There was a trend toward higher plasma level of brain natriuretic peptide in women compared to men 127.1 pg/mL (55.0-484.0 pg/mL), p = 0.092] vs [90.3 pg/mL (39.2-308.5 pg/mL). The main 6-month outcomes, death and major bleeding, had similar frequencies in both sexes. Conclusion. There are several important differences between men and women in the clinical presentation of PE and basic laboratory findings which can influence the diagnosis and treatment of PE.

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Clinical Presentation of Acute Pulmonary Embolism in Patients with Coronavirus Disease 2019 (COVID-19)

Case Reports in Hematology ◽

10.1155/2020/8855957 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Nonso Osakwe ◽

Douglas Hart

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Distress Syndrome ◽

Clinical Presentation ◽

Clinical Status ◽

Treatment Decision ◽

Laboratory Findings ◽

Anticoagulation Treatment ◽

D Dimer

The clinical management of severely ill patients with COVID-19-related acute respiratory distress syndrome (ARDS) presents significant challenges. Many COVID-19 patients with ARDS also present with laboratory findings significant for derangement in coagulation function. In this report, we describe acute pulmonary embolism in three patients with COVID-19. We assessed the role of D-dimer assay and anticoagulation treatment in these patients. The aim of this case report is to increase awareness about the use of D-dimer in addition to patient’s clinical status for making treatment decision in COVID-19 patients.

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Acute pulmonary embolism: Tell tale signs

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1425 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Mayank Yadav ◽

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Wide Spectrum ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Detailed History ◽

Non Invasive ◽

Asymptomatic Stage ◽

High Degree

Acute Pulmonary embolism is one of the major preventable causes of in hospital mortality. It is commonly seen in ICU setting in chronic bed ridden patients [1]. It has wide spectrum of clinical presentation ranging from asymptomatic stage to severe hemodynamic decompensation so diagnosis requires high degree of suspicion. In majority of cases detailed history and physical examination along with ECG and 2D transthoracic echocardiography is enough the diagnosis. CT pulmonary angiography is done to confirm the diagnosis or when diagnosis is not possible by other non-invasive tests. A 45-year-old army person presented to ER with breathlessness for 3 days. There was no complaint of chest pain, giddiness, palpitation, swelling or pain of legs. Patient does not have any other comorbidities.

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Advances in the diagnosis of acute pulmonary embolism

F1000Research ◽

10.12688/f1000research.21347.1 ◽

2020 ◽

Vol 9 ◽

pp. 44 ◽

Cited By ~ 3

Author(s):

Ella Ishaaya ◽

Victor F. Tapson

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Diagnostic Testing ◽

Lung Imaging ◽

Common Disease ◽

Evidence Based ◽

Imaging Studies ◽

Laboratory Findings

Venous thromboembolism is a common disease which remains underdiagnosed because of nonspecific presentations which can range from asymptomatic incidental imaging findings to sudden death. Symptoms can overlap with comorbid cardiopulmonary disease, and risk factors that offer clues to the clinician are not always present. The diagnostic approach can vary depending on the specific clinical presentation, but ruling in the diagnosis nearly always depends on lung imaging. Overuse of diagnostic testing is another recognized problem; a cautious, evidence-based approach is required, although physician gestalt must be acknowledged. The following review offers an approach to the diagnosis of acute pulmonary embolism based on the assessment of symptoms, signs, risk factors, laboratory findings, and imaging studies.

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Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

TH Open ◽

10.1055/s-0041-1723782 ◽

2021 ◽

Vol 05 (01) ◽

pp. e66-e72

Author(s):

Lisette F. van Dam ◽

Lucia J. M. Kroft ◽

Menno V. Huisman ◽

Maarten K. Ninaber ◽

Frederikus A. Klok

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Reperfusion Therapy ◽

Pulmonary Perfusion ◽

Short Term ◽

Acute Pe ◽

Related Mortality

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

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COVID-19-induced vascular angiopathy: CTPA signs in critically ill patients other than acute pulmonary embolism and high-lung opacity scores

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00491-4 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mohamed Hossameldin khalifa ◽

Ahmed Samir ◽

Ayman Ibrahim Baess ◽

Sara Samy Hendawi

Keyword(s):

Artificial Intelligence ◽

Pulmonary Embolism ◽

Lung Volume ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

Vascular Tree ◽

Ct Pulmonary Angiography ◽

Artificial Intelligence System ◽

Intelligence System ◽

Severity Scores

Abstract Background Vascular angiopathy is suggested to be the major cause of silent hypoxia among COVID-19 patients without severe parenchymal involvement. However, pulmonologists and clinicians in intensive care units become confused when they encounter acute respiratory deterioration with neither severe parenchymal lung involvement nor acute pulmonary embolism. Other radiological vascular signs might solve this confusion. This study investigated other indirect vascular angiopathy signs on CT pulmonary angiography (CTPA) and involved a novel statistical analysis that was performed to determine the significance of associations between these signs and the CT opacity score of the pathological lung volume, which is calculated by an artificial intelligence system. Results The study was conducted retrospectively, during September and October 2020, on 73 patients with critical COVID-19 who were admitted to the ICU with progressive dyspnea and low O2 saturation on room air (PaO2 < 93%). They included 53 males and 20 females (73%:27%), and their age ranged from 18 to 88 years (mean ± SD=53.3 ± 13.5). CT-pulmonary angiography was performed for all patients, and an artificial intelligence system was utilized to quantitatively assess the diseased lung volume. The radiological data were analyzed by three expert consultant radiologists to reach consensus. A low CT opacity score (≤10) was found in 18 patients (24.7%), while a high CT opacity score (>10) was found in 55 patients (75.3%). Pulmonary embolism was found in 24 patients (32.9%); three of them had low CT opacity scores. Four other indirect vasculopathy CTPA signs were identified: (1) pulmonary vascular enlargement (57 patients—78.1%), (2) pulmonary hypertension (14 patients—19.2%), (3) vascular tree-in-bud pattern (10 patients—13.7%), and (4) pulmonary infarction (three patients—4.1%). There were no significant associations between these signs and the CT opacity score (0.3205–0.7551, all >0.05). Furthermore, both pulmonary vascular enlargement and the vascular tree-in-bud sign were found in patients without pulmonary embolism and low CT-severity scores (13/15–86.7% and 2/15–13.3%, respectively). Conclusion Pulmonary vascular enlargement or, less commonly, vascular tree-in-bud pattern are both indirect vascular angiopathy signs on CTPA that can explain the respiratory deterioration which complicates COVID-19 in the absence of severe parenchymal involvement or acute pulmonary embolism.

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P6461The long-term clinical comparisons of symptomatic patients of pulmonary embolism with and those without deep vein thrombosis: from the COMMAND VTE Registry

European Heart Journal ◽

10.1093/eurheartj/ehz746.1053 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Murata ◽

Y Yamashita ◽

T Morimoto ◽

H Amano ◽

T Takase ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Acute Phase ◽

Clinical Presentation ◽

Vein Thrombosis ◽

Significant Difference ◽

Severe Clinical Presentation ◽

Recurrent Vte ◽

Deep Vein

Abstract Background Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), has significant morbidity and mortality. Acute PE, in particular, is fatal if we miss it, and symptomatic patients of PE sometimes have concomitant DVT. Purpose This study compared the risk of mortality in symptomatic patients of PE with and those without DVT in the long term. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. Patients with both PE and DVT (N=1334) were regarded as PE patients, and the current study population consisted of 1715 PE patients and 1312 DVT patients. Results There were 1203 symptomatic patients of PE, including 381 without and 822 with DVT. In our cohort, the mean age was 67.9±14.9 years, 63% was female, 44% had hypertension, 12% diabetes mellitus, 5% history of VTE. There were 20% of active cancer. Baseline characteristics were well matched except for dyslipidemia (18% vs. 23%, p=0.021) and atrial fibrillation (8% vs. 5%, p=0.045). Patients without DVT had a more severe clinical presentation compared to those with DVT, including hypoxemia, shock and arrest. Moreover, Initial parenteral anticoagulation therapy in the acute phase was administered less frequently in patients without DVT (89% vs. 96%, P=0.0001). Two groups received thrombolysis (20% vs. 26%, P=0.18) and mechanical supports (Ventilator 14% vs. 5%, p<0.001, PCPS 5% vs. 3%, p<0.001, respectively). During follow-up, 93 (8%) patients experienced recurrent VTE events and 98 (8%) major bleeding events, and 323 (27%) patients died. The most frequent cause of death was cancer (11%). There were a significant differences in the cumulative incidences of all-cause death between the groups (32% vs. 24%, P=0.006), whereas there was significant difference in VTE-related death (13% vs. 4%, p<0.001). Estimated freedom rates from death for patients of PE without and those with DVT were as follows: 88% vs 99% at 10-day, 86% vs 95% at 1-month, 75% vs 83% at 1-year, and 64% vs 71% at 5-year, respectively. Landmark analysis Conclusions In symptomatic patients of PE, there was a difference in mortality between groups, but no difference in recurrent VTE. Patients without DVT had a more severe clinical presentation compared to those with DVT, and many VTE-related deaths in the acute phase. The one-month mortality rate differed statistically between groups, but there was no significant difference in long-term survival beyond one month. Most of deaths were due to underlying diseases, mainly cancer, and less commonly due to VTE in the long term. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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Usefulness of an imaging tool on CT pulmonary angiography in the prognostic stratification of patients with acute pulmonary embolism

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.08.016 ◽

2021 ◽

Author(s):

Iolanda Enea

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Imaging Tool ◽

Prognostic Stratification

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A visualized pulmonary arterial thrombus by using a new echocardiographic view in an intermediate-risk a cute pulmonary embolism patient: a case report

10.21203/rs.2.19164/v1 ◽

2019 ◽

Author(s):

Guanyu Mu ◽

Feixue Li ◽

Xiaolin Chen ◽

Bo Zhao ◽

Guangping Li ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

Pulmonary Artery ◽

Acute Pulmonary Embolism ◽

Clinical Signs ◽

Signs And Symptoms ◽

Pulmonary Angiography ◽

Normal Blood ◽

Intermediate Risk ◽

Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

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Does Pulmonary Embolism Differ Between Genders in Terms of Clinical, Laboratory Findings, Prognosis and Mortality?

Journal of İzmir Chest Hospital ◽

10.5222/igh.2020.94830 ◽

2020 ◽

Author(s):

Damla Serçe Unat ◽

Aysu Ayrancı ◽

Gulru Polat ◽

Gülistan Karadeniz ◽

Fatma Demirci Üçsular ◽

...

Keyword(s):

Pulmonary Embolism ◽

Clinical Laboratory ◽

Severity Index ◽

Early Mortality ◽

European Respiratory Society ◽

Laboratory Findings ◽

Significant Difference ◽

Male Patients ◽

European Society Of Cardiology

INTRODUCTION: Pulmonary thromboembolism (PTE) is a disease that mortal and hardly diagnosed. Since findings of PTE are nonspesific diagnosed can be so hard sometimes. Major risk factors are malignancy, immobility, previous surgery, thrombophilia, advanced age, and genetic factors. Studies on the relationship between gender and prognosis in PTE have very different results. In this study, we aimed to evaluate gender differences in terms of prognosis, intensive care admission, laboratory, and radiological tests. METHODS: We retrospectively analyzed the data of 348 patients diagnosed with Acute PTE between January 2012 and December 2015. All of these patients were patients who applied to the emergency department of our center, which is a third step chest diseases hospital. We used the PTE guideline jointly designed by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) for prognosis classifications. RESULTS: The mean age of the patients was 62.7, while the male patients were younger. Women's sPESI scores and mean ages were observed higher than men. Although women had more bad prognostic factors, no significant difference was found between both genders in terms of early mortality. DISCUSSION AND CONCLUSION: Although there is a difference between mean age and simplified Pulmonary Embolism Severity Index (sPESI) scores; no difference in early mortality between men and women. Gender studies in PTE are an area that is open to new studies, since the studies conducted on this subject give quite different results and these results may affect the follow-up protocols.

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