Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

Plasencia-Martínez, J.M.; Carmona-Bayonas, Alberto; Calvo-Temprano, David; Jiménez‐Fonseca, Paula; Fenoy, Francisco J.; Benegas, Mariana; Sánchez, Marcelo; Font, Carme; Varona, Diego; Haza, David Martinez de la; Pueyo, Jesús C.; Biosca, Mercedes; Antonio, Maite; Beato, Carmen; P, Solís; Faez, L.; Haba, Irma de al; Hernández-Muñiz, Susana; Madridano, Olga; Martín, Mar; Castañón, Eduardo; Ramchandani, Avinash; Marchena, Pablo Javier; Sánchez-Cánovas, Manuel; Vicente, M. A.; Martínez, M.J.; Fernandez-Plaza, Angela; Martinez-Encarnacion, Lourdes; De-la-O, Alejandro; Domínguez, A. Mediero; Rodríguez, Daniel; Marín, Gema; Otero, Remedios; Sánchez-Lasheras, Fernando; Vicente, Vicente

doi:10.1016/j.ejrad.2016.12.010

Cited by 13 publications

(11 citation statements)

References 30 publications

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“…In this registry, incidental or unsuspected events represent approximately half of the diagnoses of cancer-associated thrombosis. This trend is similar to that of other contemporary series [29][30][31], which presumably reflects the increased use of high-resolution CTs to assess tumor response [32]. As for the prognosis of unsuspected PE, our results are compatible with the prospective data yielded by the EPIPHANY study, that proved the influence of clinical severity, and the diagnostic scenario on short-term mortality [33].…”

Section: Discussionsupporting

confidence: 89%

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Carmona-Bayonas

Gómez

Castro

et al. 2020

European Journal of Internal Medicine

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Background: The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. Method: TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. Results: Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. Conclusion: CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.

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Section: Discussionsupporting

confidence: 89%

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Carmona-Bayonas

Gómez

Castro

et al. 2020

European Journal of Internal Medicine

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“…In 2012, researchers found that in the death and survival groups of patients with acute pulmonary embolism, an increase in PAOI was a risk factor for death in patients with acute pulmonary embolism. The negative predictive value of death reached 100% when the PAOI was less than 40% 35 .…”

Section: Discussionmentioning

confidence: 96%

Health risk stratification based on computed tomography pulmonary artery obstruction index for acute pulmonary embolism

Guo

Zhu

Shen

et al. 2018

Sci Rep

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Early effective identification of high-risk patients for acute pulmonary embolism (APE) contributes to timely treatment. The pulmonary artery obstruction index (PAOI) in computed tomography angiography (CTA) is a semi-quantitative observation index, commonly used to evaluate the severity of a patient’s condition. This study explores the ability of PAOI to assess the risk stratification of APE. Thirty patients with APE were analysed. They were classified according to the guidelines, and the PAOI and cardiovascular parameters were measured in CTA. The difference of PAOI between different risk stratification patients was compared, and the predictive value of the PAOI for high-risk stratification was evaluated by the receiver operating characteristic curve. The correlation between PAOI and cardiovascular parameters was also analysed by Spearman correlation analysis. The PAOI in low- and high-risk patients was (33.2 ± 18.6)% and (68.1 ± 11.8)% respectively, and the difference was statistically significant. The PAOI was strongly predictive for high-risk patients. The cut-off value was 52.5%, with a sensitivity of 100% and specificity of 81.0%. The PAOI was correlated with the main cardiovascular parameters. We conclude that the PAOI in CTA is helpful for assessing risk stratification in patients with APE, which contributes to the selection of both the treatment plan and prognostic evaluation.

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“…The Mastora score was not associated with mortality; however, it was correlated with RV/LV ratio. Plasencia‐Martinez et al also showed that right ventricular dysfunction signs in CTPA are more useful than the Qanadli index in predicting the cancer‐related PE outcome. Our results further showed the important value of the clot volume as the index of thrombus burden in the pulmonary bed in the risk stratification of low to high‐risk APE patients.…”

Section: Discussionmentioning

confidence: 99%

Risk stratification of acute pulmonary embolism based on the clot volume and right ventricular dysfunction on CT pulmonary angiography

Shen

Wen

et al. 2019

Clinical Respiratory J

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Objective:To test the feasibility of the clot volume and right ventricular dysfunction for risk stratification of acute pulmonary embolism (APE) patients. Methods: CT pulmonary angiography (CTPA) images of 158 APE patients were collected. After excluding 38 (24.1%) patients due to unsatisfactory quality, 120 APE patients (61 males and 59 females) were divided into high-risk (n = 37) and nonhigh-risk (n = 83) groups. Clot burden was measured by an automated programme (clot volume) and by two semi-quantitative systems (Qanadli and Mastora scores).The ratios of the right ventricular diameter to left ventricular diameter (RVd/LVd) and area (RVa/LVa) were obtained. The correlations amongst the above parameters were analysed. Receiver operating characteristic (ROC) curves were calculated to determine the efficacy of high-risk APE. Multivariate analyses were used to identify the independent predictors. Results: Strong positive correlations were found between the clot volume and both Qanadli score (r 2 = 0.696, P < 0.001) and Mastora score (r 2 = 0.728, P < 0.001), and moderate correlations were found between the clot volume and both RVd/LVd (r 2 = 0.392, P < 0.001) and RVa/LVa (r 2 = 0.389, P < 0.001). The clot volume contributed the highest efficacy (AUC = 0.992) for the identification of high-risk cases, followed by Mastora score (0.968), Qanadli score (0.952), RVa/LVa (0.900) and RVd/LVd (0.892). The clot volume and RVd/LVd were two independent factors of high-risk APE. Conclusions: The clot volume is correlated with semi-quantitative clot burden scores and CT measured cardiac parameters. The clot volume and RVd/LVd were two independent factors of high-risk APE patients. K E Y W O R D Sacute pulmonary embolism, cardiovascular disease, clot burden, CT angiography, risk stratification Bold values indicates significantly different with a P value less than 0.05. Abbreviations: LVa, area of left ventricular; LVd, diameter of left ventricular; RVa, area of right ventricular; RVd, diameter of right ventricular.

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Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

Cited by 13 publications

References 30 publications

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Health risk stratification based on computed tomography pulmonary artery obstruction index for acute pulmonary embolism

Risk stratification of acute pulmonary embolism based on the clot volume and right ventricular dysfunction on CT pulmonary angiography

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