Acute pulmonary embolism in hospitalized patients with SARS-CoV-2-related pneumonia: multicentric experience from Italian endemic area

Ippolito, Davide; Giandola, Teresa; Maino, Cesare; Pecorelli, Anna; Capodaglio, Carlo; Ragusi, Maria; Porta, M Della; Gandola, Davide; Masetto, Alessandro; Drago, Silvia Girolama; Allegranza, P.; Corso, Rocco; Franzesi, Cammillo Talei; Sironi, Sandro

doi:10.1007/s11547-020-01328-2

Cited by 32 publications

(27 citation statements)

References 29 publications

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“…In 28 out of the 61 patients in the investigated group, the pulmonary artery CTA scan demonstrated the presence of pulmonary embolism (45.9%), which confirms the weight of the problem in patients hospitalized with diagnosed COVID-19. Similar percentages of pulmonary embolism were reported by researchers from Italy (44.7%) [ 27 ] and London (46.2%) [ 28 ] for their respective groups. Right ventricular failure is one of the main problems in this patient group.…”

Section: Discussionsupporting

confidence: 86%

Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19

Truszkiewicz¹,

Poręba

et al. 2021

JCM

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The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with two cut-off points: ≥0.9 and ≥1.0. Heart silhouette enlargement was found when CTR on the chest radiograph in the projection AP > 0.55. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05, respectively. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥ 0.9 or RV/LV ≥ 1.0. Heart silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had a significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE−) (RV/LV: PE+ 1.08 ± 0.24, PE− 0.82 ± 0.12; CTR: PE+ 0.60 ± 0.05, PE− 0.54 ± 0.04; p < 0.05). The correlation analysis showed a statistically significant positive correlation between the RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥ 0.9 or RV/LV ≥ 1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 were 0.412, 0.963, and 0.656, respectively, while those of the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 were 0.488, 0.833, and 0.590, respectively. In summary, in patients with suspected pulmonary embolism during COVID-19, the radiographic cardiothoracic ratio can be considered as a prognostic factor for right ventricular enlargement, especially as a negative predictor of right ventricular enlargement in the case of lower CTR values.

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Section: Discussionsupporting

confidence: 86%

Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19

Truszkiewicz¹,

Poręba

et al. 2021

JCM

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“…PE is a common complication in patients with SARS-CoV-2 pneumonia [42]. The triggering cause of PE following an acute infection, especially in the respiratory tract, would be due to local inflammation causing the local activation of coagulation and vasoconstriction.…”

Section: Covid-19 Pneumoniamentioning

confidence: 99%

“…Ippolito et al observed that 76/170 (44.7%) patients with SARS-CoV-2 developed PE without having higher risk factors for venous thromboembolism [42]. In addition, PE-positive patients showed slightly longer hospitalization times than PE-negative patients, with a mortality rate among PE-positive patients of 54.2% at three months [42]. Moreover, in the study by Masselli et al, 26/60 (40%) patients with SARS-CoV-2 were found to be positive for PE at CTPA.…”

Section: Covid-19 Pneumoniamentioning

confidence: 99%

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

et al. 2022

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Computed Tomography Pulmonary Angiography (CTPA) is considered the gold standard diagnostic technique in patients with suspected acute pulmonary embolism in emergency departments. Several studies have been conducted on the predictive value of CTPA on the outcomes of pulmonary embolism (PE). The purpose of this article is to provide an updated review of the literature reporting imaging parameters and quantitative CT scores to predict the severity of PE.

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“…Recent retrospective studies have found a significant prevalence of VTE, which often leads to pulmonary embolism (PE) thus contributing to a high mortality rate [ 2 – 6 ]. However, the performance of repeated computed tomography pulmonary angiography (CTPA) may not be sustainable in the context of a pandemic, where emergency departments and ICUs are frequently overwhelmed [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

et al. 2022

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Purpose To evaluate the usefulness of compressive ultrasound (CUS) for the diagnosis of deep vein thrombosis (DVT) in patients with SARS-CoV-2-related infection. Methods 112 hospitalized patients with confirmed SARS-CoV-2 infection were retrospectively enrolled. CUS was performed within 2 days of admission and consisted in the assessment of the proximal and distal deep venous systems. Lack of compressibility, or direct identification of an endoluminal thrombus, were the criteria used for the diagnosis of DVT. Pulmonary embolism (PE) events were investigated at computed tomography pulmonary angiography (CTPA) within 5 days of follow-up. Logistic binary regression was computed to determine which clinical and radiological parameters were independently associated with PE onset. Results Overall, the incidence of DVT in our cohort was about 43%. The most common district involved was the left lower limb (68.7%) in comparison with the right one (58.3%) while the upper limbs were less frequently involved (4.2% the right one and 2.1% the left one, respectively). On both sides, the distal tract of the popliteal vein was the most common involved (50% right side and 45.8% left side). The presence of DVT in the distal tract of the right popliteal vein (OR = 2.444 95%CIs 1.084–16.624, p = 0.038), in the distal tract of the left popliteal vein (OR = 4.201 95%CIs 1.484–11.885, p = 0.007), and D-dimer values (OR = 2.122 95%CIs 1.030–5.495, p = 0.003) were independently associated with the onset on PE within 5 days. Conclusions CUS should be considered a useful tool to discriminate which category of patients can develop PE within 5 days from admission.

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Acute pulmonary embolism in hospitalized patients with SARS-CoV-2-related pneumonia: multicentric experience from Italian endemic area

Cited by 32 publications

References 29 publications

Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19

Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

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