O valor da carga embólica na avaliação de disfunção ventricular direita no tromboembolismo pulmonar agudo: quantificando a causa e clarificando as consequências

Rodrigues, Bruno; Correia, Hildeberto; Figueiredo, Ângela; Delgado, Anne; Moreira, Davide; Santos, Luís; Correia, Emanuel; Pipa, João; Beirão, Ilídio; Santos, Oliveira

doi:10.1016/j.repc.2012.02.020

Cited by 20 publications

(7 citation statements)

References 18 publications

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“…According to Rodrigues et al . , there is a statistically significant correlation between higher values of the Wells score and higher values of the Quanadli index; however, this trial excluded patients with low clinical probability of PE.…”

Section: Discussionmentioning

confidence: 91%

Correlation between the Wells score and the Quanadli index in patients with pulmonary embolism

Obradović

Joves

Karan

et al. 2015

Clinical Respiratory J

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Section: Discussionmentioning

confidence: 91%

Correlation between the Wells score and the Quanadli index in patients with pulmonary embolism

Obradović

Joves

Karan

et al. 2015

Clinical Respiratory J

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“…With the increasing use of the computed tomography (CT) angiography as the main diagnostic method in pulmonary thromboembolism, new approaches for categorizing the severity of pulmonary embolism have been conducted mainly based on thrombus burden and its impact on the right ventricle. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 ] Data from radiographic studies, which used CT angiography to evaluate the prognostic factors associated with pulmonary embolism (such as the relationship between the diameter of the right ventricle and the diameter of the left ventricle, the bowing of the interventricular septum,[ 1 2 3 4 ] the thrombus burden,[ 14 15 16 17 ] the reflux contrast to the cava,[ 18 ] and the diameter of the pulmonary artery regarding the azygos vein) have been studied as prognostic factors of morbidity and mortality in the context of acute pulmonary thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Central versus peripheral pulmonary embolism: Analysis of the impact on the physiological parameters and long-term survival

et al. 2016

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Background:Studies aimed at assessing whether the emboli lodged in the central pulmonary arteries carry a worse prognosis than more peripheral emboli have yielded controversial results.Aims:To explore the impact on survival and long-term prognosis of central pulmonary embolism.Patients and Methods:Consecutive patients diagnosed with acute symptomatic pulmonary embolism by means of computed tomography (CT) angiography were evaluated at episode index and traced through the computed system of clinical recording and following-up. Central pulmonary embolism was diagnosed when thrombi were seen in the trunk or in the main pulmonary arteries and peripheral pulmonary embolism when segmental or subsegmental arteries were affected.Results:A total of 530 consecutive patients diagnosed with pulmonary embolism were evaluated; 255 patients had central pulmonary embolism and 275 patients had segmental or subsegmental pulmonary embolism. Patients with central pulmonary embolism were older, had higher plasma levels of N-terminal of the prohormone brain natriuretic peptide (NT-ProBNP), troponin I, D-dimer, alveolar-arterial gradient, and shock index (P < .001 for each one). Patients with central pulmonary embolism had an all-cause mortality of 40% while patients with segmental or subsegmental pulmonary embolism (PE) had an overall mortality of 27% and odds ratio of 1.81 [confidence interval (CI) 95% 1.16-1.9]. Survival was lower in patients with central PE than in patients with segmental or subsegmental pulmonary embolism, even after avoiding confounders (P = .018).Conclusions:Apart from a greater impact on hemodynamics, gas exchange, and right ventricular dysfunction, central pulmonary embolism associates a shorter survival and an increased long-term mortality.

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“…[ 16 ] On the other hand, PE patients with a CT burden of <40% are unlikely to develop acute RV dysfunction. [ 13 22 33 ] Therefore, the findings of the present study highlighted the clinicoradiological implications of CTPA for the accurate diagnosis and risk stratification of patients with PE.…”

Section: Discussionmentioning

confidence: 59%

“…[ 21 ] Moreover, it facilitates risk stratification of patients based on the degree of vascular obstruction (i.e., clot burden) which could be used as a marker for appropriate selection of treatment. [ 22 ] Apart from the size of embolus, the clinical outcome of patients with PE also depends on various cardiopulmonary measurements (RV, LV, RV/LV ratio, PA, AO diameter, and PA/AO ratio) identified by CTPA.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism

et al. 2016

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INTRODUCTION:Pulmonary embolism (PE) is a serious cardiovascular and pulmonary complication worldwide. We aimed to assess the implications of different computed tomography pulmonary angiography (CTPA) parameters in patients with acute PE.METHODS:A retrospective observational study to include patients presented with clinical suspicious of PE who underwent CTPA was conducted. Patients' demographics, clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed. Computed tomography findings included clot burden (Qanadli score [QS]) and right ventricular dysfunction (RVD) parameters.RESULTS:A total of 45 patients with radiologically confirmed diagnosis of PE were included in the study; of these patients, 8 (17.8%) died during the hospital course. Patients who died were 13 years older than those who survived, and the mortality rate was significantly higher in patients with cancer. The two groups were comparable for cardiovascular parameters. The mean clot burden (QS) was 19.5 ± 11.3 points and 53% of patients had QS >18 points. Obesity (52.4% vs. 12.5%; P = 0.01), hypertension (54.4% vs. 23.8%; P = 0.03), and median D-dimer levels (7.8 vs. 3.4; P = 0.03) were significantly higher in patients with QS >18. Among right ventricular (RV) dysfunction parameters, only higher RV/left ventricular (LV) ratio (P = 0.001) and bowing of interventricular septum (P = 0.001) were associated with higher QS. A significant positive correlation was found between RV short axis (r = 0.499, P = 0.001), RV/LV ratio (r = 0.592, P = 0.001), and pulmonary artery (PA) diameter (r = 0.301, P = 0.04) with the PA clot burden. Receiver operating characteristic curve for clot burden showed a cutoff value of 17.5 points to accurately predict RV dysfunction.CONCLUSIONS:Clot burden >18 is associated with RV dysfunction in patients with acute PE. Echocardiography and RVD parameters showed no correlation with in-hospital deaths. CTPA has clinicoradiological implications for risk stratification in PE patients. As the sample size is small, our findings warrant further larger prospective studies.

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O valor da carga embólica na avaliação de disfunção ventricular direita no tromboembolismo pulmonar agudo: quantificando a causa e clarificando as consequências

Abstract: QS >18 points proved to be an independent predictor of RVD in PE, and correlated linearly with variables associated with higher morbidity and mortality.

Cited by 20 publications

References 18 publications

Correlation between the Wells score and the Quanadli index in patients with pulmonary embolism

Correlation between the Wells score and the Quanadli index in patients with pulmonary embolism

Central versus peripheral pulmonary embolism: Analysis of the impact on the physiological parameters and long-term survival

Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism

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