Detection of Residual Pulmonary Vascular Obstruction by Ventilation-Perfusion Lung Scan Late After a First Pulmonary Embolism

Chopard, Romain; Genet, Bruno; Ecarnot, Fiona; Chatot, Marion; Napporn, Gabriel; Hyvert, Agnes; Didier-Petit, Katy; Schiele, François; Méneveau, Nicolas

doi:10.1016/j.amjcard.2017.03.002

Cited by 16 publications

(13 citation statements)

References 19 publications

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“…Sensitivity analyses were performed on the association between RPO and recurrent VTE (Table ). These analyses confirmed the association between recurrent VTE and RPO ( a ) on lung scan regardless of the methods used for RPO assessment, ( b ) in studies assessing RPO at least 3 months after acute PE (significant heterogeneity observed in the analysis of studies assessing RPO at 3 months or earlier after acute PE was mainly related to the study of Chopard et al), ( c ) after the exclusion of asymptomatic recurrence of VTE, ( d ) in patients treated for a first PE, ( e ) in high‐quality studies, and ( f ) in studies with a fixed duration of anticoagulant treatment regardless of the presence or absence of RPO.…”

Section: Resultssupporting

confidence: 54%

“…Overall, 192 of 1294 patients with RPO had recurrent VTE (14.8%; 95% CI 13.0‐16.8), as compared with 176 of 2178 without RPO (8.1%; 95% CI 7.0‐9.3). The presence of RPO, either on CT angiography or on lung scan, was associated with an increased risk of recurrent VTE without significant heterogeneity (16 studies; 3472 patients; OR according to the random‐effects model, 2.22; 95% CI 1.61‐3.05; I 2 = 26%) (Figure ) . The association was confirmed after amending for zero cells (OR 2.13; 95% CI 1.56‐2.90) and after excluding from the analysis the study by Meneveau et al, in which RPO was assessed at an early stage (OR 2.11; 95% CI 1.52‐2.93).…”

Section: Resultsmentioning

confidence: 82%

“…The association between RPO and recurrent VTE was confirmed in studies assessing RPO on lung scan (11 studies; 2916 patients; OR 2.21; 95% CI 1.63‐3.01; I 2 = 16%), but not in studies assessing RPO on CT angiography, although there was significant heterogeneity (five studies; 556 patients; OR according to the random‐effects model, 2.56; 95% CI 0.82‐7.94; I 2 = 52%) …”

Section: Resultsmentioning

confidence: 95%

“…Death occurred in 22 of 217 patients with RPO (10%; 95% CI 6.1‐14.2) and in 44 of 695 patients without RPO (6.3%; 95% CI 4.5‐8.1). The presence of RPO was not associated with an increased risk of all‐cause death (OR 1.61; 95% CI 0.65‐3.98; I 2 = 42% according to the random‐effects model) (Figure B) …”

Section: Resultsmentioning

confidence: 98%

“…Overall, 538 papers were found, of which 16 met the inclusion criteria (the flow diagram is shown in Figure S1). In one study, the numbers of patients with or without RPO who had recurrent VTE events were obtained after the authors had been contacted . The agreement between reviewers for study selection was good (kappa statistic of 0.85).…”

Section: Resultsmentioning

confidence: 99%

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Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Becattini

Giustozzi

Cerdà

et al. 2019

Journal of Thrombosis and Haemostasis

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Debated is the role of residual pulmonary obstruction (RPO) in predicting venous thromboembolism. Whether right ventricular dysfunction (RVD) predicts recurrent venous thromboembolism is unknown. 15 studies on RPO and 4 on RVD and venous thromboembolism were included in this meta‐analysis. RPO is a predictor of recurrent venous thromboembolism when assessed by perfusion lung scan. RVD after acute pulmonary embolism is not associated with recurrent venous thromboembolism. Background There is conflicting evidence regarding the role of residual pulmonary obstruction (RPO) or persistent right ventricular dysfunction (RVD) after pulmonary embolism (PE) as a predictor of recurrent venous thromboembolism (VTE). The aim of this study was to assess whether RPO or persistent RVD after PE is associated with recurrent VTE. Methods MEDLINE and EMBASE were searched through December 2018. Studies reporting on (a) RPO either on computed tomography (CT) angiography or perfusion lung scan, or RVD on echocardiography or CT angiography, after therapeutic anticoagulation for the acute PE, and (b) recurrent VTE, were included in this meta‐analysis. Results RPO was associated with an increased risk of recurrent VTE (16 studies; 3472 patients; odds ratio [OR] 2.22; 95% confidence interval [CI] 1.61‐3.05; I2 = 26%); the association was statistically significant for lung scan–detected RPO (11 studies; 2916 patients; OR 2.21; 95% CI 1.63‐3.01) but not for CT angiography–detected RPO (five studies; 556 patients; OR 2.56; 95% CI 0.82‐7.94). No significant association was found between persistent RVD and recurrent VTE (four studies; 852 patients; OR 1.62; 95% CI 0.63‐4.17). Conclusions RPO is a predictor of recurrent VTE after a first acute PE, mainly when assessed by perfusion lung scan.

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Section: Resultssupporting

confidence: 54%

Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Becattini

Giustozzi

Cerdà

et al. 2019

Journal of Thrombosis and Haemostasis

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Reduced fibrin clot permeability on admission and elevated E-selectin at 3 months as novel risk factors of residual pulmonary vascular obstruction in patients with acute pulmonary embolism

Stępień,

Ząbczyk,

Kopytek

et al. 2023

J Thromb Thrombolysis

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Background Residual pulmonary vascular obstruction (RPVO) is common following pulmonary embolism (PE) but its association with fibrin clot properties is poorly understood. We investigated whether prothrombotic state and hypofibrinolysis markers can identify patients with RPVO. Methods In 79 normotensive noncancer patients (aged 56 ± 13.3 years) with acute PE, we determined fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), fibrinolysis proteins, oxidative stress markers, and E-selectin on admission before initiation of anticoagulant therapy, after 5–7 days, and 3 months of anticoagulation. RPVO was diagnosed using computed tomography angiography 3–6 months since PE. Results Patients with RPVO (n = 23, 29.1%) had at baseline higher simplified Pulmonary Embolism Severity Index (sPESI) (P = 0.004), higher N-terminal brain natriuretic propeptide (P = 0.006) and higher D-dimer (P = 0.044). Patients with versus without RPVO had lower Ks (P < 0.001) and longer CLT (P < 0.05), both at baseline and 5–7 days since admission, but not at 3 months. Patients with RPVO showed 40.6% higher E-selectin (P < 0.001) solely at 3 months. By multivariable logistic regression, baseline Ks (odds ratio [OR] 0.010, 95% confidence interval [CI] 0.001–0.837, P = 0.042, per 10− 9 cm2), baseline D-dimer (OR 1.105, 95% CI 1.000-1.221, P = 0.049, per 100 ng/ml), and E-selectin levels after 3 months (OR 3.874, 95% CI 1.239–12.116, P = 0.020, per 1 ng/ml) were associated with RPVO. Conclusions RPVO patients despite anticoagulation characterize with the formation of denser fibrin clots on admission and higher E-selectin at 3 months. Those parameters could be the potential novel RPVO risk factors that warrant further evaluation in an independent cohort. Graphical Abstract

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Changes in Lung Perfusion in Patients Treated with Percutaneous Mechanical Thrombectomy for Intermediate-Risk Pulmonary Embolism

Gayen¹,

Upadhyay²,

Kumaran³

et al. 2022

The American Journal of Medicine

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Detection of Residual Pulmonary Vascular Obstruction by Ventilation-Perfusion Lung Scan Late After a First Pulmonary Embolism

Cited by 16 publications

References 19 publications

Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Reduced fibrin clot permeability on admission and elevated E-selectin at 3 months as novel risk factors of residual pulmonary vascular obstruction in patients with acute pulmonary embolism

Changes in Lung Perfusion in Patients Treated with Percutaneous Mechanical Thrombectomy for Intermediate-Risk Pulmonary Embolism

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