Pulmonary Embolism Vascular Segmentation in CT Angiography

2013 ◽  
Vol 380-384 ◽  
pp. 4192-4196
Author(s):  
Qi Xin Gao ◽  
Huai An Li
Keyword(s):  
Pulmonary Embolism ◽  
Quantitative Analysis ◽  
Drug Therapy ◽  
Mortality Rate ◽  
Blood Vessels ◽  
Acute Pulmonary Embolism ◽  
Treatment Strategies ◽  
Edge Point ◽  
Disease Mortality ◽  
Very High

Pulmonary embolism mortality rate is very high disease, especially for acute pulmonary embolism with other disease mortality. Treatment of pulmonary embolism method is mainly to drug therapy. Pulmonary embolism in the acute phase of drug treatment strategies is mainly for anticoagulation and thrombolysis. Through the lungs scanning, decision of thrombolysis success or fail. This paper puts forward a kind of algorithm that analysis quantitatively the degree of thrombolysis by the computer. Firstly, making use of the Hessians eigenvalue and diffuse equation enhance pulmonary embolism vessel, and then pulmonary embolism vessel segmentation based on a LEVEL-SET. At lastly, According to the eigenvalue of blood vessels, remove the blood vessels edge line, and the rest relevant to edge point. According to the each point of eigenvector and eigenvalue, quantitative analysis of the degree of thrombolysis.

scholarly journals Use and clinical outcome of veno-arterial extracorporeal membrane oxygenation in patients with acute pulmonary embolism and cardiopulmonary resuscitation

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
L Hobohm ◽  
I Sagoschen ◽  
T Gori ◽  
FP Schmidt ◽  
T Muenzel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Mortality Rate ◽  
Cardiopulmonary Resuscitation ◽  
Acute Pulmonary Embolism ◽  
Treatment Strategies ◽  
Hospital Death ◽  
Systemic Thrombolysis ◽  
Va Ecmo ◽  
Acute Pe

Abstract Funding Acknowledgements Type of funding sources: None. Background Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with acute pulmonary embolism (PE) and concomitant cardiac arrest with the necessity of cardiopulmonary resuscitation (CPR). Little is known about the use and clinical outcome of veno-arterial (VA)-ECMO and adjunctive treatment strategies in patients with acute PE and CPR. Purpose In this context, we aimed to investigate the use of VA-ECMO alone or after systemic thrombolysis and its impact on in-hospital outcomes of patients with acute PE and CPR. Methods We analyzed data on the characteristics, treatments and in-hospital outcomes for all patients with acute PE (ICD-code I26) and CPR in Germany between the years 2005 and 2018 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2018, own calculations). Results Between 2005 and 2018, 1,172,354 patients with acute PE (53.5% females) were included in this analysis; of those, 77,196 (6.5%) presented with cardiac arrest and CPR. While more than one fourth of those patients were treated with systemic thrombolysis alone (n = 20,839 patients; 27.0%), a minority received a combination of thrombolysis + VA-ECMO (n = 165; 0.2%) or singular approach with VA-ECMO treatment alone (n = 588; 0.8%). The overall in-hospital mortality rate of PE patients with cardiac arrest was high with 83.8%. Non-survivors were considerable older than survivors (74 [IQR 63-81] vs. 69 [58-77]). In patients treated with VA ECMO alone the mortality rate was 71.1% and 69.7% when patients received Thrombolysis + VA-ECMO. Patients, who received thrombolysis without VA-ECMO had a higher mortality rate (83.8%). In order to investigate the impact of those different treatment strategies, a multivariate logistic regression analysis (adjusted for age, sex and comorbidities) demonstrated the lowest risk for in-hospital death in patients, who underwent the combination of Thrombolysis + VA-ECMO (OR, 0.61 [95% CI, 0.43-0.86], P = 0.004) or VA-ECMO alone (OR, 0.70 [0.58-0.84], P < 0.001) compared to patients without VA-ECMO and without thrombolysis. Use of thrombolysis alone in patients with PE and CPR lowering the risk regarding in-hospital death as well (OR, 0.95 [0.91-0.99], P = 0.013). Regarding temporal trends, the annual use of VA-ECMO increased from 0 in the year 2005 to the number of 138 in 2018 (ß 6.13 (4.62-6.76); p < 0.001) as well as for the combined treatment Thrombolysis + VA-ECMO (from 0 to 39 [ß 4.28 (3.68-4.89); p < 0.001]). Conclusion Patients with acute PE and CPR had a very high in-hospital mortality rate. Our data suggest, that VA-ECMO alone or after systemic thrombolysis should be considered as an option in this outstanding life-threatening situation to improve in-hospital outcome. Furthermore, our data highlight a marked increase in the number of PE patients treated with VA-ECMO indicating the structural health care progress between 2005 and 2018.

Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hai Xu ◽  
Angel Martin ◽  
Avneet SINGH ◽  
Mangala Narasimhan ◽  
Joe Lau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Severe Bleeding ◽  
Study Cohort ◽  
D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends

2011 ◽  
Vol 106 (07) ◽  
pp. 83-89 ◽  
Author(s):  
Davide Imberti ◽  
Walter Ageno ◽  
Francesco Dentali ◽  
Roberto Manfredini ◽  
Massimo Gallerani
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Techniques ◽  
Co Morbidity ◽  
Emilia Romagna Region ◽  
Morbidity Index ◽  
Hospital Administrative ◽  
Acute Pe

SummaryThe management of acute pulmonary embolism (PE) is often challenging and requires specific medical expertise, diagnostic techniques and therapeutic options that may not be available in all hospitals throughout the entire week. The aim of our study was to evaluate whether or not an association exists between weekday or weekend admission and mortality for patients hospitalised with acute PE. Using routinely collected hospital administrative data, we examined patients discharged with a diagnosis of PE from the hospitals of the Emilia- Romagna Region in Italy (January 1999-December 2009). The risk of inhospital death was calculated for admissions at the weekend and compared to weekday admissions. Of a total of 26,560 PEs, 6,788 (25.6%) had been admitted during weekends. PE admissions were most frequent on Mondays (15.8%) and less frequent on Saturdays and Sun- days/holidays (12.8%) (p<0.001). Weekend admissions were associated with significantly higher rates of in-hospital mortality than weekday admissions (28% vs. 24.8%) (p<0.001). The risk of weekend admission and in-hospital mortality was higher after adjusting for sender, hospital characteristics, and the Charlson co-morbidity index. In conclusion, hospitalisation for PE on weekends seems to be associated with a significantly higher mortality rate than on weekdays. Further research is needed to investigate the reasons for this observed difference in mortality in order to try and implement future strategies that ensure an adequate level of care throughout the entire week.

scholarly journals MR-proADM and MR-proANP levels in patients with acute pulmonary embolism

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Önsel Öner ◽  
Figen Deveci ◽  
Selda Telo ◽  
Mutlu Kuluöztürk ◽  
Mehmet Balin
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Control Group ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Relationship

Summary Background The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1- and 3-month mortality. Methods 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for MR-proANP and MR-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. Results The mean serum MR-proANP and MR-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with MR-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with MR-proADM ≥ 152.2 pg/mL showed a statistically significant increase. Conclusions This study showed that MR-proANP and MR-proADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

scholarly journals Profil Pasien Stroke Hemoragik yang Dirawat di ICU RSUP Prof. Dr. R.D. Kandou Manado Periode Desember 2014 sampai November 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Maria Estefina Siwi ◽  
Diana Lalenoh ◽  
Harold Tambajong
Keyword(s):  
Mortality Rate ◽  
Blood Vessels ◽  
Medical Record ◽  
Cause Of Death ◽  
Cerebral Edema ◽  
Hemorrhagic Stroke ◽  
Stroke Mortality ◽  
Probability Sampling ◽  
The Brain ◽  
Very High

Abstract: Hermorrhagic stroke is a disease caused by rupture of blood vessels of the brain that causes bleeding intro the brain parenchym tissue, cerebrospinal space around the brain or combination of both. Cause of death from hemorrhagic stroke is presence of complications or other comorbodities, like cerebral edema were reported the highest cause of death of hemorrhagic stroke. This study aimed to determine the profile of patients with hemorrhagic stroke in ICU, using descriptive retropective method. The samples were Prof. Dr. R.D. Kandou Manado ICU’s patients with hemorrhagic stroke based on the data in the medical record from December 2014 – November 2015. Hemorrhagic stroke mortality rate is very high (89%). From total 35 samples were examined, there 4 survivors (11%) and 31 deaths (89%), which consisted of 24 males (69%) and 11 females (31%). Most patients are 45-59 years old.Keywords: hemorrhagic stroke, ICUAbstrak: Stroke hemoragik adalah penyakit yang disebabkan oleh pecahnya pembuluh darah otak yang menyebabkan keluarnya darah ke jaringan parenkim otak, ruang serebrospinalis disekitar otak atau kombinasi keduanya. Penyebab kematian dari stroke hemoragik sendiri adalah adanya komplikasi atau penyakit penyerta lainnya, salah satu contohnya yaitu edema serebri yang dilaporkan merupakan penyebab kematian terbanyak. Penelitian ini bertujuan untuk mengetahui profil pasien stroke hemoragik yang dirawat di ICU RSUP Prof. Dr. R.D. Kandou Manado, menggunakan metode penelitian deskriptif retrospektif. Besar sampel ditentukan dengan metode non probability sampling yaitu purposive sampling. Sampel penelitian adalah pasien ICU RSUP Prof. Dr. R.D. Kandou Manado dengan diagnosa stroke hemoragik berdasarkan data di bagian Rekam Medik periode Desember 2014 sampai November 2015. Angka mortalitas stroke hemoragik sangatlah tinggi (89%). Total 35 sampel yang diteliti dengan 4 orang yang selamat (11%) dan 31 orang meninggal dunia (89%), terdiri dari 24 orang laki-laki (69%) dan 11 orang perempuan (31%). Sebagian besar adalah pasien umur 45-59 tahun.Kata kunci: stroke hemoragik, ruang rawat intensif

scholarly journals Contemporary clinical management of acute pulmonary embolism: the COPE study

2022 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli ◽  
Aldo Pietro Maggioni ◽  
Francesco Dentali ◽  
Andrea Fabbri ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Low Risk ◽  
Contemporary Management ◽  
Secondary Study ◽  
European Society Of Cardiology ◽  
Acute Pe

Abstract Background New management, risk stratification and treatment strategies have become available over the last years for patients with acute pulmonary embolism (PE), potentially leading to changes in clinical practice and improvement of patients’ outcome. Methods The COntemporary management of Pulmonary Embolism (COPE) is a prospective, non-interventional, multicentre study in patients with acute PE evaluated at internal medicine, cardiology and emergency departments in Italy. The aim of the COPE study is to assess contemporary management strategies in patients with acute, symptomatic, objectively confirmed PE concerning diagnosis, risk stratification, hospitalization and treatment and to assess rates and predictors of in-hospital and 30-day mortality. The composite of death (either overall or PE-related) or clinical deterioration at 30 days from the diagnosis of PE, major bleeding occurring in hospital and up to 30 days from the diagnosis of PE and adherence to guidelines of the European Society of Cardiology (ESC) are secondary study outcomes. Participation in controlled trials on the management of acute PE is the only exclusion criteria. Expecting a 10–15%, 3% and 0.5% incidence of death for patients with high, intermediate or low-risk PE, respectively, it is estimated that 400 patients with high, 2100 patients with intermediate and 2500 with low-risk PE should be included in the study. This will allow to have about 100 deaths in study patients and will empower assessment of independent predictors of death. Conclusions COPE will provide contemporary data on in-hospital and 30-day mortality of patients with documented PE as well as information on guidelines adherence and its impact on clinical outcomes. Trail registration NCT number: NCT03631810.

Percutaneous thrombectomy in patients with massive and very high‐risk submassive acute pulmonary embolism

2020 ◽  
Vol 96 (7) ◽  
pp. 1465-1470
Author(s):  
Catalin Toma ◽  
Sameer Khandhar ◽  
Adrian M. Zalewski ◽  
Stephen J. D'Auria ◽  
Thomas M. Tu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acute Pulmonary Embolism ◽  
Percutaneous Thrombectomy ◽  
Very High

scholarly journals Evaluation of Risk Stratification Markers and Models in Acute Pulmonary Embolism: Rationale and Design of the MARS-PE (Mainz Retrospective Study of Pulmonary Embolism) Study Programme

2018 ◽  
Vol 61 (3) ◽  
pp. 93-97 ◽  
Author(s):  
Karsten Keller ◽  
Johannes Beule ◽  
Jörn Oliver Balzer ◽  
Wolfgang Dippold
Keyword(s):  
Pulmonary Embolism ◽  
Retrospective Study ◽  
Risk Stratification ◽  
Case Fatality Rate ◽  
Acute Pulmonary Embolism ◽  
Treatment Strategies ◽  
Case Fatality ◽  
Imaging Procedures ◽  
Hemodynamic Stability ◽  
Study Programme

An acute pulmonary embolism (PE) is a crucial event in patients’ life and connected with serious morbidity and mortality. Regarding a high case-fatality rate, early and accurate risk-stratification is crucial. Risk for mortality and complications are closely related to hemodynamic stability and cardiac adaptations. The currently recommended risk-stratification approach is not overall simple to use and might delay the identification of those patients, who should be monitored more closely and may treated with more aggressive treatment strategies. Additionally, some risk-stratification criteria for the imaging procedures are still imprecise. Summarized, the search for the most effective risk-stratification tools is still ongoing and some diagnostic criteria might have to be refined. In the MAinz Retrospective Study of Pulmonary Embolism (MARS-PE), overall 182 consecutive patients with confirmed PE were retrospectively included over a 5-year period. Clinical, echocardiographic, functional and laboratory parameters were assessed. The study was designed to provide answers to some of the mentioned relevant questions.

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