Prediction of right ventricular dysfunction from radiographic estimates of right descending pulmonary artery in hemodynamically stable pulmonary embolism patients

Background: The evaluation of right ventricular (RV) dysfunction by echocardiography isone of the most important established determinants of the prognosis of acute pulmonary embolism.The aim of the study was to investigate possible association between diameter of rightdescending pulmonary artery on chest X-rays and RV dysfunction by echocardiography inhemodynamically stable pulmonary embolism patients.Methods: Eighty-nine patients with the diagnosis of hemodynamically stable pulmonaryembolism were included.Results: The frequency of RV dysfunction was signifi cantly higher in patients with anenlarged right descending pulmonary artery on chest X-rays (p = 0.001). There wasa signifi cant positive correlation between the diameter of the right descending pulmonary arteryon postero-anterior chest X-rays and the diameter of the RV (r = 0.469; p = 0.002). Diameterof right descending pulmonary artery on chest X-rays was also found as a signifi cant predictorof RV dysfunction besides the troponin-T levels and systolic pulmonary arterial pressure (p < 0.05).Conclusions: Diameter of right descending pulmonary artery on chest X-rays may provideinformation about the risk for pulmonary embolism patients and may be used as a prognosticradiological parameter for the appropriate management of acute pulmonary embolism

Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism

Background: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus. Methods: This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality. Results: Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups. Conclusions: The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.

Chronic thromboembolic pulmonary hypertension: Medical treatment

WOS: 000209981500006PubMed: 24015333Chronic thromboembolic pulmonary hypertension (CTEPH) is responsible for significant levels of morbidity and mortality. the estimated cumulative incidence of CTEPH is 2-4% among patients presenting with acute pulmonary thromboembolism. Currently, at the time of CTEPH diagnosis, 37.9% of the patients in an international registry were receiving at least one pulmonary arterial hypertension ( PAH)-targeted therapy. Advanced medical therapy is considered in patients with inoperable disease, as a bridge to pulmonary endarterectomy or in those with persistent or recurrent pulmonary hypertension. PAH-specific medical therapies include endothelin receptor antagonists, phosphodiesterase inhibitors, and prostacyclin analogues. the present article will focus on recent developments in the pharmacological treatment of CTEPH

Syncope as a subject of the risk assessment of pulmonary thromboembolism to be used for: A cross-sectional study

WOS: 000437844500017PubMed: 29498800IntroductionSyncope is infrequent in pulmonary thromboembolism (PTE) yet might be indicative of haemodynamic instability. the prognostic role of syncope in PTE has not been well documented. ObjectivesIn this study, the association between risk classification of the European Society of Cardiology and syncope was investigated in the normotensive PTE patients. MethodsWe retrospectively screened electronic medical records of patients who were admitted in 2 tertiary care hospital and diagnosis of PTE with computed tomography pulmonary angiography. Patients with hypotension (high risk) at the time of admission were excluded from the study. ResultsOf 5% patients (16/322) had syncope with the proportion of 81.3% (13/16) in the intermediate high risky group, 18.7% (3/16) in intermediate low risk group and 0% in low risk group. Mortality rate was higher in subjects with syncope (25% vs 11.1%) although it was not it was not statistically significant (P=NS). in those with syncope, the central venous thrombus was more frequent than those without it (78.6% vs 30.1%, P=.008). Only heart rate and intermediate high-risk group were retained as independent predictors of syncope selection in the multivariate logistic regression. ConclusionAlthough syncope is positively correlated with the severity of PTE, it does not predict the prognosis alone. Nonetheless, syncope in patients with PTE can be considered as an important alarming stimulus for clinical course

Combination and comparison of two models in prognosis of pulmonary embolism: Results from TUrkey Pulmonary Embolism Group (TUPEG) study

WOS: 000335910900010PubMed ID: 24690480Background: Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. Methods: This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30 days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding. Results: Of the 1078 study patients, 95 (8.8%) diedwithin 30 days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P = NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%. Conclusions: The sPESI andthe ESCmodel showed a similar performance regarding 30-daymortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE. (C) 2014 Elsevier Ltd. All rights reserved