scholarly journals A Novel Predictive Method Incorporating Parameters of Main Pulmonary Artery Bifurcation for Short-Term Prognosis in Non-high-risk Acute Pulmonary Embolism Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Dong Jia ◽  
Xue-Lian Li ◽  
Gang Hou ◽  
Xiao-Ming Zhou
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Main Pulmonary Artery ◽  
Short Term ◽  
Predictive Method

scholarly journals Elevated gamma glutamyl transferase levels are associated with the location of acute pulmonary embolism. Cross-sectional evaluation in hospital setting

2015 ◽  
Vol 133 (6) ◽  
pp. 488-494 ◽  
Author(s):  
Ozge Korkmaz ◽  
Hasan Yucel ◽  
Ali Zorlu ◽  
Ocal Berkan ◽  
Hakki Kaya ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Main Pulmonary Artery ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Gamma Glutamyl Transferase ◽  
Cross Sectional ◽  
Gamma Glutamyl ◽  
Glutamyl Transferase

ABSTRACT CONTEXT AND OBJECTIVE: The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING: Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS : 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS : Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS : The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.

scholarly journals Does Baseline BUN Have an Additive Effect on the Prediction of Mortality in Patients with Acute Pulmonary Embolism?

2020 ◽  
Author(s):  
Yaser Jenab ◽  
Ali-Mohammad Haji-Zeinali ◽  
Mohammad Javad Alemzadeh-Ansari ◽  
Shapour Shirani ◽  
Mojtaba Salarifar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Cardiac Biomarkers ◽  
Operating Characteristics ◽  
Short Term ◽  
Prediction Of Mortality ◽  
Short Term Mortality ◽  
Acute Pe

Background: In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE). Methods: Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology’s risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk). Results: Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43–19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01–5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01–1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008). Conclusion: An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group.

scholarly journals Risk management in acute pulmonary embolism: correlation between right heart dysfunction, pulmonary clots distribution, biomarkers and prognosis

2013 ◽  
pp. 23-29
Author(s):  
Luca Masotti ◽  
Fabio Antonelli ◽  
Elio Venturini ◽  
Giancarlo Landini
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Troponin I ◽  
Main Pulmonary Artery ◽  
Shock Index ◽  
Right Heart ◽  
Heart Dysfunction ◽  
Right Heart Dysfunction ◽  
D Dimer

BACKGROUND Right heart dysfunction (RHD) is related to adverse outcomes in acute pulmonary embolism (PE). AIM OF THE STUDY To evaluate the relation between RHD, pulmonary clots distribution and biomarkers and prognosis of patients with PE. METHODS We analysed echocardiographic data of 70 patients with diagnosis of PE confirmed by pulmonary computer tomography, hCT. We considered the enddiastolic right/left ventricles ratio > 1 as index of RHD; echocardiographic data were compared with clots distribution in pulmonary vascular tree such as hCT findings and biomarkers. For each patient we calculated the shock index (heart rate/systolic blood pressure ratio, shock defined as ratio ≥ 1). RESULTS Hospital mortality was 8.5%. Mean age of dead patients was significantly higher compared to alive (85.67 vs 71.57 years, p < 0.05). 41% of patients revealed unilateral PE, 59% had bilateral. In 10% of patients main pulmonary artery was interested by clot, 48% of patients had involved one of the main branches, 90% had involved at least one of the lobar branches, 59% one of segmental branches of pulmonary arteries. 52% of patients had RHD. Mortality in RHD patients was 14.8% vs 8% in no RHD, p < 0.05. Mean values of troponin I and D-dimer were significantly higher in RHD patients. Shock index was ≥ 1 in 37.5% of RHD and 20% in no RHD. RHD patients showed significantly higher involvement of main pulmonary artery and its branches and higher bilateral involvement. CONCLUSIONS RHD is related to proximal and bilateral pulmonary clots distribution and troponin I and D-dimer values and poorer prognosis.

scholarly journals Clinical significance of peculiarities of the lesions of the vascular bed associated with pulmonary thromboembolism

2017 ◽  
Vol 95 (5) ◽  
pp. 394-397
Author(s):  
M. A. Bachurina ◽  
V. V. Mazur ◽  
E. S. Mazur
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Clinical Manifestations ◽  
Pulmonary Angiography ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Risk Patients ◽  
Vascular Obstruction

Aim. To study effect of the level of vascular obstruction on the clinical manifestations of pulmonary embolism (PE). Material and methods. 63 patients with PE were included in this study. PE was verified by multidetector computed tomography (MSCT) with pulmonary angiography. 43 patients with high-risk PE survived the first week of the disease. In the remaining 20 patients with community-acquired pneumonia PE was diagnosed using MSCT pulmonary angiography in the first week of illness. Results. Obstruction of the trunk of the pulmonary artery or its lobar branches was detected in 34 (79.1%) patients with a high risk of PE and in only 2 (10%) ones with low-risk PE (p <0,001). The development of pneumonia complicated the course of the disease in 14 (32.6%) patients with a high risk of pulmonary embolism. The clots in the segmental branches of the pulmonary artery were identified in 9 (64.3%) patients with pneumonia. In high-risk patients with PE without pneumonia the lesion of segmental branches was detected only in 1 (3.4%) case (p <0,001). In patients with pneumonia at low risk of PE, the obstruction segmental branches was detected in 17 (85%) cases. Conclusion. The development of obstructive shock in PE is associated with a trunk embolism and/or the main pulmonary artery branches embolism. Infarction pneumonia is associated with the lesions of segmental branches of the pulmonary artery.

scholarly journals Association of Admission Glucose Level and Improvement in Pulmonary Artery Pressure in Patients with Submassive-type Acute Pulmonary Embolism

2018 ◽  
Vol 57 (5) ◽  
pp. 647-654
Author(s):  
Masaomi Gohbara ◽  
Keigo Hayakawa ◽  
Azusa Hayakawa ◽  
Yusuke Akazawa ◽  
Yukihiro Yamaguchi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Glucose Level ◽  
Acute Pulmonary Embolism ◽  
Artery Pressure ◽  
Admission Glucose

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

TH Open ◽  
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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