Combined risk stratification with computerized tomography /echocardiography and biomarkers in patients with normotensive pulmonary embolism

Özsu, Savaş; Karaman, Kayıhan; Menteşe, Ahmet; Ozsu, Asiye; Karahan, Süleyman Caner; Durmuş, İsmet; Öztuna, Funda; Koşucu, Polat; Bülbül, Yılmaz; Özlü, Tevfik

doi:10.1016/j.thromres.2010.08.021

Cited by 49 publications

(58 citation statements)

References 30 publications

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“…In our study, the overall mortality rate was around 13%, and no change was observed in the mortality rate over the years. The mortality rate was found to be 13% in our two prospective studies between 2008 and 2009 and between 2012 and 2014 [5,6]. However, while the PTErelated mortality rate was 5.6% in our first study, it was 4.4% in the other one.…”

Section: Discussioncontrasting

confidence: 54%

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Özsu¹,

Durmuş²,

Coşkuner³

et al. 2017

Turk Thorac J

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OBJECTIVES:In the last 20 years, with the use of computed tomography (CT) angiography, the number of patients diagnosed with pulmonary thromboembolism (PTE) has increased. At the same time, data show that pulmonary embolism mortality has also reduced in this duration. MATERIAL AND METHODS:In this study, we analyzed records of patients with PTE (using ICD's) in the hospital automation system from 2001 to 2013. Data regarding age, sex, date of diagnosis, diagnosis of cancer, hemodynamic status, initial and maintenance treatment, hospital length of stay, and hospital mortality were recorded. Primary endpoints of the study were hospital length of stay and all-cause hospital mortality. RESULTS:The total number of patients included in the study was 1185. The median age was 61 years in 2001 and 71 years in 2013. The number of patients who were diagnosed using CT increased from 10% to 92.8%. Between 2001 and 2013, the number of patients diagnosed with PTE increased, and of all patients with PTE, 13.7% was diagnosed in 2009. The hospital length of stay of 13 days declined to 9 days. The use of a vena cava filter in 2007 was 1.1% and that in 2013 was 4.6%. Mortality rate was 15%, however hospital mortality did not significantly differ over the years but varied between 9.4% and 18.8%. Increased use of thrombolytics in patients with massive PTE has been observed over the years. Massive PTE ratio in 2006 was 8.5% and thrombolytic use was 5.8%, however in 2013, these ratios were 2.6%, 6% respectively (p=0.017). CONCLUSION:Finally, despite the increased number of patients diagnosed with PTE over the years, the mortality rate was not observed to have changed from 2001 to 2013. KEYWORDS:Pulmonary thromboembolism, heparin, thrombolytic, mortality, incidence INTRODUCTIONPulmonary thromboembolism (PTE) is an important public health concern that causes mortality and morbidity. Its non-specific symptoms and findings lead to difficulties in confirming its diagnosis. However, with the use of computed tomography (CT) angiography in recent years, an important step has been taken in the diagnosis of PTE. Moreover, improvements, such as the development of new anticoagulants and mechanical interventions, have occurred in the treatment of PTE. In parallel with all these improvements, data on the incidence and outcomes of the disease seems to be restricted.In a study conducted in USA the incidence of PTE was reported to increase from 23/100,000 to 65/100,000 [1]. On the other hand, in a study conducted in Canada, no significant change was observed in the incidence of PTE in the last decade [2]. A study was conducted on 60853 patients in Italy, and an increase was found in the incidence of PTE in the last 10 years [3]. In our study, the data of patients diagnosed with PTE between 2001 and 2013 were obtained from hospital recordings and were analyzed. MATERIAL AND METHODSIn our study, the records of patients diagnosed with PTE between 2001 and 2013 were obtained from the hospital's automations system (with the International Classification of Di...

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Section: Discussioncontrasting

confidence: 54%

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Özsu¹,

Durmuş²,

Coşkuner³

et al. 2017

Turk Thorac J

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“…Although Kostrubiec et al (21) reported correlation between N-terminal pro-BNP (NT-proBNP) and RVD, there was no correlation between cTn-T and RVD in that study. Bova et al (26) did not find any differences in RVD between patients with positive and negative cTn-T levels. Moreover, in patients with acute PE and normal cTn-T level, the prevalence of RVD was noted as 15 to 28% (27,28).…”

Section: Discussionmentioning

confidence: 83%

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study

Özsu¹,

Kırış²,

Bülbül³

et al. 2012

Anadolu Kardiyol Derg

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Objective: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. Methods: Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7 th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. Results: The mean of the RV Tei index was 0.46±0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40±20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved. Conclusion: RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE. Yöntemler: Prospektif gözlemsel bu çalışmaya, bilgisayarlı spiral tomografik pulmoner anjiyografi ile tanısı konulan 38 PE hastası dahil edildi. Tüm çalışma popülâsyonuna, hastaneye kabulün ilk 12 saati içinde, doku Doppler görüntülemeyi içeren kapsamlı bir ekokardiyografik inceleme yapıldı. cTn-T seviyesi hastaneye kabulde ölçüldü. Hastanedeki tedavinin yedinci gününde rutin olarak takip ekokardiyografisi yapıldı. SV Tei indeksinde düzelme olmayan hastaların ekokardiyografisi doksanıncı günde tekrarlandı. Başlangıç ve takip değerleri dağılıma uygun olarak bağımsız örneklem t-testi veya Wilcoxon test ile değerlendirildi. Bulgular: Ortalama SV Tei indeksi 0.46±0.14 ve ortalama sistolik pulmoner arter basıncı (sPAP) 40±20 mmHg idi. Hastaların %37'sinde artmış cTn-T düzeyi saptandı (normal değer 0.01< ng/mL). SV Tei indeksi, sPAP ve cTn-T düzeyi arasında anlamlı korelasyon gözlendi (r=0.467 ve r=0.468, p<0.001,

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“…24 In 108 consecutive patients, Ozsu et al showed the correlation of biomarkers and right/left ventricular dimension ratio ≥1.1 on CTPA with mortality. 26 Several limitations in our study warrant consideration. First, its retrospective design prevented us from producing correlations with findings of other diagnostic clinical parameters.…”

Section: Figure4mentioning

confidence: 91%

Correlation of Computerized Tomography Angiographic Pulmonary Artery Obstruction Score with Hematologic Outcome and Mortality in Patients with Acute Pulmonary Embolism

Yesildag¹,

Keskin²,

Güler³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of this study was to determine the relationship between the computed tomography obstruction score and radiological parameters, biochemical parameters, and mortality. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : During an 8-month period (January 2011-August 2011), 326 patients with clinically suspected pulmonary embolism (PE) were examined by computerized tomography pulmonary angiography (CTPA). Of these patients, only 95 (49 men and 46 women) were diagnosed with PE. Computerized tomography images were retrieved from the picture archiving and communication system (PACS) for the determination of right ventricle/left ventricle (RV/LV) shortaxis ratio, maximum diameter of the pulmonary artery, and vascular obstruction score according to Qanadli method. We investigated the correlation between continuous values of the Qanadli scoring system and mortality, and determined whether there was a significant difference between mortality and CTPA parameters. The values derived from the morphologic changes in the CTPA, hematological findings and gender where then assessed with respect to their impacts on mortality. R Re es su ul lt ts s: : There was a significant correlation between the PE obstruction score and RV/LV short-axis ratio (r=0.58, p<0.001), RV/LV short-axis ratio, and neutrophil to lymphocyte ratio (NLR) (r=0.21, p=0.035). Survivors and non-survivors had a statistically significant difference in the NLR and midplatelet volume (MPV) (p<0.05). The mortality incidence in patients with an increased MPV (odds ratio 1.689; 95% confidence interval (CI) 1.06-2.67; p=0.025) and older female patients (odds ratio 3.732; 95% CI 1.02-13.65; p=0.04) was higher. C Co on nc cl lu us si io on n: : Our results suggest that in patients with acute PE, NLR and MPV may be of value for the estimation of mortality.K Ke ey y W Wo or rd ds s: : Pulmonary embolism; multidetector computed tomography Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı, bilgisayarlı tomografi obstrüksiyon skoru ile radyolojik, biyokimyasal parametreler ve mortalite arasındaki ilişkiyi belirlemektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Sekiz aylık periyotta (Ocak 2011-Ağustos 2011), klinik olarak pulmoner emboli kuşkulu 326 hasta bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ile incelendi. Bunların sadece 95'i (49 erkek, 46 kadın) pulmoner emboli tanısı aldı. Bilgisayarlı tomografi imajları sağ ventrikül/sol ventrikül kısa aks oranlarını, pulmoner arter maksimum çapını ve Qanadli obstrüksiyon skorunu saptamak için gö-rüntü saklama ve iletişim sisteminden çağrıldı. Qanadli obstrüksiyon skoru ile mortalite arasındaki ilişki incelendi. Mortalite ve bilgisayarlı tomografi pulmoner anjiyografi parametreleri arasında anlamlı farklılık olup olmadığı araştırıldı. Bilgisayarlı tomografi pulmoner anjiyografideki morfolojik değişikliklerden elde edilen değerler, hematolojik bulgular, cinsiyet ve bunların mortalite üzerin-deki etkileri değerlendirildi. B Bu ul lg gu ul la ar r...

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Combined risk stratification with computerized tomography /echocardiography and biomarkers in patients with normotensive pulmonary embolism

Cited by 49 publications

References 30 publications

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study

Correlation of Computerized Tomography Angiographic Pulmonary Artery Obstruction Score with Hematologic Outcome and Mortality in Patients with Acute Pulmonary Embolism

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