Acute Pulmonary Embolism

2019 ◽  
Author(s):  
Brett J Carroll ◽  
Eric A Secemsky
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Risk Stratification ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Integrated Approach ◽  
Initial Management ◽  
Right Ventricular Strain ◽  
Thromboembolic Pulmonary Hypertension ◽  
Short And Long Term

Pulmonary embolism (PE) is a frequently encountered clinical condition with both short- and long-term adverse consequences. An integrated approach to diagnosis is important to maximize early diagnosis but also to minimize the unnecessary utilization of diagnostic imaging. Comprehensive risk stratification with clinical features and assessment of right ventricular strain by diagnostic imaging and cardiac biomarker results are essential to guide initial management decisions. There is a growing treatment arsenal for acute PE, including increased anticoagulation and advanced therapeutic options such as catheter-based therapy.  Despite such advances, mortality remains high, particularly among those who present critically ill with PE, and long-term physical and psychological effects can persist in many patients for years after the initial diagnosis. This review contains 7 figures, 6 tables, and 69 references. Key Words: anticoagulation, catheter-directed therapy, chronic thromboembolic pulmonary hypertension pulmonary embolism, computed tomography, echocardiography, fibrinolysis, risk stratification, venous thromboembolism

Acute Pulmonary Embolism

2019 ◽  
Author(s):  
Brett J Carroll ◽  
Eric A Secemsky
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Risk Stratification ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Integrated Approach ◽  
Initial Management ◽  
Right Ventricular Strain ◽  
Thromboembolic Pulmonary Hypertension ◽  
Short And Long Term

Pulmonary embolism (PE) is a frequently encountered clinical condition with both short- and long-term adverse consequences. An integrated approach to diagnosis is important to maximize early diagnosis but also to minimize the unnecessary utilization of diagnostic imaging. Comprehensive risk stratification with clinical features and assessment of right ventricular strain by diagnostic imaging and cardiac biomarker results are essential to guide initial management decisions. There is a growing treatment arsenal for acute PE, including increased anticoagulation and advanced therapeutic options such as catheter-based therapy.  Despite such advances, mortality remains high, particularly among those who present critically ill with PE, and long-term physical and psychological effects can persist in many patients for years after the initial diagnosis. This review contains 7 figures, 6 tables, and 69 references. Key Words: anticoagulation, catheter-directed therapy, chronic thromboembolic pulmonary hypertension pulmonary embolism, computed tomography, echocardiography, fibrinolysis, risk stratification, venous thromboembolism

Large-bore Aspiration Thrombectomy for Acute Venous Thromboembolism

2021 ◽  
Vol 39 ◽  
Author(s):  
Andy Sohn ◽  
◽  
James Hu ◽  
Jennifer Colnick ◽  
Justin George ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Short Term ◽  
Aspiration Thrombectomy ◽  
Acute Setting ◽  
Submassive Pulmonary Embolism ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Venous Thromboembolism

Pulmonary embolism can occur following dislodgement of deep venous thrombosis into the pulmonary artery circulation, which results in obstruction of the pulmonary artery system and can be fatal. The consequences of pulmonary embolism include hypotension, right heart strain, and hypoxia. In the long term, pulmonary embolism may lead to Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Patients who develop hypotensive massive and submassive pulmonary embolism can be treated with large-bore aspiration thrombectomy. In the acute setting, this improves short-term outcomes by decreasing the ICU stay. It can also reduce the risk of CTEPH. Options for large-bore aspiration thrombectomy include the FlowTriever™ system (Inari Medical, Irvine, CA) and the Lightning 12 vascular thrombectomy system (Penumbra Inc., Alameda, CA). This review discusses the pathophysiology of pulmonary embolism, management, and options for large-bore aspiration thrombectomy.

scholarly journals From pulmonary embolism to chronic thromboembolic pulmonary hypertension: risk factors

2021 ◽  
Vol 25 (3) ◽  
pp. 11
Author(s):  
O. Ya. Vasiltseva ◽  
A. G. Edemskiy ◽  
D. S. Grankin ◽  
E. N. Kliver ◽  
A. M. Chernyavskiy
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Right Heart Failure ◽  
Recurrence Risk ◽  
National Guidelines ◽  
Thromboembolic Pulmonary Hypertension

<p>Chronic thromboembolic pulmonary hypertension is a long-term consequence of acute pulmonary embolism. Gradual obstruction of the pulmonary arteries and secondary changes in the pulmonary microcirculation over time cause progressive increases in pulmonary vascular resistance and pulmonary artery pressure that can result in severe right heart failure. This article provides an overview of pulmonary embolism and chronic thromboembolic pulmonary hypertension scientific literature and national guidelines. We focus on disease and recurrence risk factors and outline future directions of research to improve short- and long-term patient outcomes.</p><p>Received 17 January 2021. Revised 1 March 2021. Accepted 19 April 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: A.M. Chernyavskiy, A.G. Edemskiy, D.S. Grankin, E.N. Kliver<br />Drafting the article: O.Ya. Vasiltseva<br />Critical revision of the article: E.N. Kliver<br />Final approval of the version to be published: O.Ya. Vasiltseva, A.G. Edemskiy, D.S. Grankin, E.N. Kliver, A.M. Chernyavskiy</p>

scholarly journals Copeptin as a non-invasive biomarker in chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.D Kriechbaum ◽  
F Rudolph ◽  
L Scherwitz ◽  
L Scheche ◽  
C.F Lippert ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Strong Predictor ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Therapy Response ◽  
Cardiac Biomarkers ◽  
Funding Source ◽  
Thromboembolic Pulmonary Hypertension

Abstract Introduction Copeptin is the C-terminal fragment of the precursor protein of vasopressin. In acute pulmonary embolism, copeptin has been suggested to be a strong predictor of outcome and to provide additional predictive value to the established cardiac biomarkers high-sensitivity cardiac troponin and N-terminal pro-brain natriuretic peptide (NT-proBNP). Chronic thromboembolic pulmonary hypertension (CTEPH) is diagnosed in about 5% of patients who survive acute pulmonary embolism. Individualized risk stratification remains a challenge in the work-up of CTEPH patients. Purpose The current study investigated whether copeptin has the potential to aid the stratification of patients who have experienced pulmonary embolism and CTEPH patients. We examined the baseline (BL) levels and dynamics of copeptin during therapy in CTEPH patients who underwent balloon pulmonary angioplasty (BPA) or pulmonary endarterectomy (PEA). Moreover, the study compared copeptin levels between patients with or without therapy response. Methods The study included a total of 125 CTEPH patients scheduled for treatment. A total of 78 underwent staged BPA and 64 underwent PEA. In accordance with recent studies from our group, therapy success was defined as a decrease in meanPAP ≥25% and PVR ≥35% or a normalization below the thresholds defining pulmonary hypertension. Blood samples were collected at BL, prior to each BPA session in the BPA cohort, and at follow-up (FU) 6 months after BPA or 12 months after PEA. Copeptin was measured in thawed serum aliquots by an immunochemical method. Results The 78 patients in the BPA cohort underwent a mean of 6 BPA procedures each; there were a total of 413 interventions. The hemodynamic clinical and functional status the CTEPH patients improved after BPA and PEA therapy: meanPAP (BL: 43±9 mmHg vs. FU: 27±9 mmHg; p&lt;0.001); PVR (BL: 7.6±3.4 WU vs. FU: 3.8±2.0 WU; p&lt;0.001); RAP (BL: 7.9±5.8 mmHg vs. FU: 5.4±2.7 mmHg; p&lt;0.001); WHO functional class [BL: I:0 / II:25 / III:80 / IV:20 vs. FU: I:56 / II:57 / III:10 / IV:2]; 6-minute-walk distance (BL: 405±99 m vs. FU: 456±112 m; p&lt;0.001). The median serum levels of copeptin [BL 7.7 (4.6–14.2) pmol/L vs. FU 6.3 (3.9–12.5); p=0.009] and NT-proBNP [BL: 811 (157–1857) ng/L vs. FU: 142 (72–335) ng/L p&lt;0.001] decreased significantly after therapy. The copeptin levels did not correlate with hemodynamics at BL: PVR (rrs=0.02; p=0.79) and meanPAP (rrs=0.03; p=0.75). The copeptin levels at BL (AUC=0.61) and the relative change (AUC=0.53) did not predict the endpoint of therapy response. Conclusions Copeptin levels are elevated in CTEPH patients compared with normal values in the literature. Although copeptin is known to provide additional value in the context of risk stratification in acute pulmonary embolism, it failed to provide additional diagnostic benefit in CTEPH in the current study. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): SFB 1213 area CP01

scholarly journals Follow-up after acute Pulmonary Embolism

2018 ◽  
Vol 38 (01) ◽  
pp. 22-32 ◽  
Author(s):  
Stefano Barco ◽  
Frederikus Klok
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Functional Limitations ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Increased Risk ◽  
Recurrent Venous Thromboembolism ◽  
Thromboembolic Pulmonary Hypertension ◽  
Potential Benefits ◽  
Definition Of

SummaryIn addition to among others major bleeding from anticoagulant therapy and recurrent venous thromboembolism (VTE), patients who survived acute pulmonary embolism (PE) face an increased risk of chronic functional limitations and decreased quality of life. In recent years, this latter complications have been better framed within the evolving definition of “post-PE syndrome” of which chronic thromboembolic pulmonary hypertension (CTEPH) represents the most extreme presentation. The post-PE syndrome in all its aspects is a frequent and clinically relevant long-term complication of PE but -except for CTEPH- has been largely understudied. There is great need to better define and understand the natural course of acute PE, to predict the development of the post-PE syndrome and to evaluate the potential benefits evolving treatments such as cardiopulmonary rehabilitation.

scholarly journals Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism

2018 ◽  
Vol 52 (1) ◽  
pp. 1702611 ◽  
Author(s):  
Ludo F.M. Beenen ◽  
Patrick M.M. Bossuyt ◽  
Jaap Stoker ◽  
Saskia Middeldorp
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Pulmonary Trunk ◽  
Computed Tomography Pulmonary Angiography ◽  
Short And Long Term ◽  
Recurrent Vte

The value of various computed tomography parameters for prognosis and risk stratification in acute pulmonary embolism is controversial. Our objective was to evaluate the impact of specific cardiovascular computed tomography pulmonary angiography parameters on short- and long-term clinical outcomes.We analysed radiological and clinical data of 1950 patients with acute pulmonary embolism who participated in an international randomised clinical trial on anticoagulants. Parameters included right/left ventricular ratio, septal bowing, cardiothoracic ratio, diameters of pulmonary trunk and aorta, and intrahepatic/azygos vein contrast medium backflow. Associations with mortality, recurrent venous thromboembolism (VTE), hospitalisation, bleeding and adverse events were assessed over the short term (1 week and 1 month) and long term (12 months).Pulmonary trunk enlargement was the only parameter significantly associated with mortality over both the short and long term (OR 4.18 (95% CI 1.04–16.76) at 1 week to OR 2.33 (95% CI 1.36–3.97) after 1 year), as well as with recurrent VTE and hospitalisation.Most of the evaluated radiological parameters do not have strong effects on the short- or long-term outcome in patients with acute pulmonary embolism. Only an enlarged pulmonary trunk diameter carries an increased risk of mortality and recurrent VTE up to 12 months, and can be used for risk stratification.

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