Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism

Meyer, Guy; Collignon, Marie‐Anne; Guinet, F.; Jeffrey, Andrew A.; Barritault, L.; Sors, H.

doi:10.1007/bf01268022

Cited by 79 publications

(65 citation statements)

References 14 publications

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“…The percentage of vascular obstruction by perfusion scanning (PVOs) was then calculated as: PVOs (%) = (1-overall perfusion score) ×100 and a PVOs ≥50% was defined as severe PE. 18 The relation of the ECG and ECHO findings with age, the presence of syncope and PVOs was assessed in a subgroup analysis.…”

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confidence: 99%

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Differences in Clinical Presentation of Pulmonary Embolism in Older vs Younger Patients

Köktürk

Oğuzülgen

Demir

et al. 2005

Circ J

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ulmonary embolism (PE) is a major health problem associated with a significant morbidity and mortality particularly in older patients. The overall annual incidence is approximately more than 1 case per 1,000 person-years, 1 but this increases markedly with advancing age. [1][2][3][4] The incidence is distributed extremely unevenly over the ages: 1 case per 1,000,000 person-years for children aged less than 15 years, 72.4 cases per 100,000 person-years for adults aged 40-54 years and 2.8 cases per 1,000 personyears for those aged 85-89 years. 2,3,5 Autopsy series have shown that PE is responsible for, or at least accompanies, approximately 12% of inhospital deaths and this rate increases to 20% for the patients aged 70 years and over. 6,7 Kniffin et al reported a 1-year mortality for PE of 39% in patients older than 65 years, 3 and Sakuma et al reported that the relative risk of mortality from PE was 417.76 for the patients aged over 79 years. 8 The high incidence of PE requires physicians to maintain a high level of suspicion in order to make a prompt diagnosis and initiate appropriate treatment, which is even more important for elderly patients who have higher mortality rates. On the other hand, physicians have to deal with the challenge of diagnosing suspected PE in elderly because older patients with PE may present with atypical clinical features in the absence of the usual indices. However, the clinical presentation of PE in the elderly population has not been extensively investigated. In the present study, the Circulation Journal Vol.69, August 2005hospital records of patients with documented PE were analyzed according to age, and risk factors, presenting symptoms and signs, arterial blood gas (ABG) analysis, electrocardiographic (ECG) and echocardiographic (ECHO) findings and, pulmonary vascular obstruction scores (PVOs) as a marker of severity of the disease, were compared for a better definition of the disease characteristics in the older population. Methods Study Population and DesignThe study was carried out at Gazi University, a large teaching hospital in Ankara. Hospital records between 1998 to 2003 from the Chest Department's database were used to identify patients who had received a final diagnosis of PE, which was established according to the protocol previously published by Prospective Investigation of Pulmonary Embolism Diagnosis investigators. 9 Patients diagnosed with pneumonia were not included in the study.Patients who met the entry criteria were stratified into 2 groups as older (≥65 years old) or younger (<65 years old) patients. The risk factors for PE were defined as follows: 10,11 immobilization (at least 2 days' bed rest in the 2 weeks prior to admission), pregnancy (includes postpartum period within the 3 months prior to admission), estrogen or oral contraceptive use, stroke, obesity (body mass index >27 kg/m 2 ), trauma (within past 3 months), recent operation (within past 6 weeks), malignancy, recent history of long travel (>6 h within 1 week), chronic obstructive lung disease (COPD...

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confidence: 99%

“…18 Briefly, each lobe was assigned a weight based on the regional distribution of pulmonary blood flow while in the supine position. For each lobe, a semi-quantitative perfusion score from 0 to 1 (0, 0.25, 0.5, 0.75 and 1) was estimated.…”

mentioning

confidence: 99%

Differences in Clinical Presentation of Pulmonary Embolism in Older vs Younger Patients

Köktürk

Oğuzülgen

Demir

et al. 2005

Circ J

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“…In this study, PVOs were used to assess the severity of PTE, which was found to be a reliable method of assessing the per cent of pulmonary vascular obstruction [6]. It was found that patients with PVOs w50% had significantly higher concentrations of factor VIIIc.…”

Section: Discussionmentioning

confidence: 99%

“…The method used to calculate this percentage has been described previously by MEYER et al [6]. Each lobe was assigned a weight based on the regional distribution of pulmonary blood flow in the supine position: right lower lobe 25%, right middle lobe 12%, right upper lobe 18%, left lower lobe 20%, lingual 12%, and left upper lobe 13%.…”

Section: Assessment Of Pulmonary Vascular Obstructionmentioning

confidence: 99%

The role of thrombophilic risk factors in the severity of pulmonary thromboembolism

Oğuzülgen¹,

Ekim²,

Akar³

et al. 2002

Eur Respir J

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The role of thrombophilic risk factors in the severity of pulmonary thromboembolism. I.K. Oguzulgen, N.N. Ekim, N. Akar, K. Demirel, M. Kitapci. #ERS Journals Ltd 2002. ABSTRACT: High plasma factor-VIIIc concentration, presence of factor-V 1691 G-A (FVL) and prothrombin 20210A (PT 20210A ) mutations were shown to be significant risk factors for venous thromboembolism (VTE) and recurrent VTE. The objective of this study was to investigate the role of these thrombotic risk factors in the severity of pulmonary thromboembolism (PTE).The plasma concentrations of factor VIIIc, presence of FVL and PT 20210A mutations were studied in 32 patients with PTE. Eleven of the patients had documented recurrent VTE. Lung perfusion scans were scored according to the percentage of vascular obstruction. Patients who had a pulmonary vascular obstruction score (PVOs) w50% were compared to those with PVOsv50%.There was no significant difference between the patients with PVOs w50% and those with PVOsv50%, with regard to the presence of FVL and PT 20210A mutation. However, patients with PVOs w50% had a significantly higher factor-VIIIc concentration than those with PVOs v50% (factor-VIIIc levels were 253.3¡29.1 International Units (IU)?dL -1 and 138.5¡16.2 IU?dL -1 , respectively; pv0.005). Factor-VIIIc concentrations were significantly correlated with PVOs (r=0.52, pv0.005). Patients with recurrent VTE had significantly higher factor-VIIIc concentrations than those in which it occurred for the first time (factor-VIIIc concentrations were 232.6¡30.9 IU?dL -1 and 158.3¡20.6 IU?dL -1 , respectively; pv0.05). The authors conclude that in addition to being a risk factor for venous thromboembolism, high factor-VIIIc concentration is an important factor in the severity of pulmonary thromboembolism.

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“…Six-view perfusion lung scans were obtained, and the defects were scored by use of an anatomic reference chart. 11,12 With this score, each lobe is assigned a weight based on the regional distribution of pulmonary blood flow. An estimation of remaining perfusion is made for each lobe from 0.0 (no perfusion), to 0.25, 0.50, 0.75, to 1.0 (normal perfusion).…”

Section: Primary Outcome Assessmentmentioning

confidence: 99%

Treatment of Proximal Deep Vein Thrombosis With a Novel Synthetic Compound (SR90107A/ORG31540) With Pure Anti–Factor Xa Activity

2000

Circulation

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Background —Patients with venous thromboembolism require initial treatment with an immediate-acting anticoagulant, low-molecular-weight heparin. We evaluated a novel synthetic factor Xa inhibitor (SR90107a/ORG31540) as an alternative treatment. Methods and Results —A randomized-parallel-group, phase II trial to assess the efficacy and safety of SR90107a/ORG31540 (5, 7.5, or 10 mg once daily) relative to low-molecular-weight heparin (dalteparin, 100 IU/kg twice daily) in symptomatic proximal deep vein thrombosis. The primary outcome measure was the change in thrombus mass, assessed by ultrasonography of the leg veins and perfusion lung scintigraphy, performed at baseline and day 7±1. A positive outcome was defined as improvement of the ultrasound and/or perfusion scan result without deterioration of either test. Other outcome measures included symptomatic, recurrent venous thromboembolism and major bleeding for a period of 3 months. All outcomes were interpreted with the observer unaware of treatment allocation. A positive primary outcome was observed in 46 of 100 (46%), 52 of 108 (48%), 48 of 115 (42%), and 56 of 115 (49%), respectively, of the subjects given 5, 7.5, or 10 mg SR90107a/ORG31540 or dalteparin. There were 8 recurrent thromboembolic complications (2.4%) in the 334 patients treated with SR90107a/ORG31540 and 6 (5.0%) in the 119 dalteparin patients, a difference of 2.6% in favor of SR90107a/ORG31540 (95% CI −2.1% to 10.1%). The incidence of bleeding was low and was similar among the groups. Conclusions —The factor Xa inhibitor SR90107a/ORG31540 appears to be an effective and safe treatment for patients with deep vein thrombosis across a wide range of doses. This synthetic compound merits evaluation in phase III studies.

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Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism

Cited by 79 publications

References 14 publications

Differences in Clinical Presentation of Pulmonary Embolism in Older vs Younger Patients

Differences in Clinical Presentation of Pulmonary Embolism in Older vs Younger Patients

The role of thrombophilic risk factors in the severity of pulmonary thromboembolism

Treatment of Proximal Deep Vein Thrombosis With a Novel Synthetic Compound (SR90107A/ORG31540) With Pure Anti–Factor Xa Activity

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