Prospective Evaluation of Right Ventricular Function and Functional Status 6 Months After Acute Submassive Pulmonary Embolism

Kline, Jeffrey A.; Steuerwald, Michael; Marchick, Michael R.; Hernandez‐Nino, Jackeline; Rose, Geoffrey

doi:10.1378/chest.08-2988

Cited by 223 publications

(158 citation statements)

References 34 publications

(16 reference statements)

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“…21 In a separate study of 144 anticoagulated submassive PE patients, 27% of patients were found to have higher pulmonary pressures at the 6-month follow up than at the initial presentation. 36 As alluded to above, these physiologic findings may have functional consequences for patients, referred to by some as 'the post-PE syndrome'. 37,38 In one prospective cohort of 109 previously healthy patients who developed acute submassive PE, 41% displayed poor exercise tolerance (assessed using the 6-minute walk test or New York Heart Association (NYHA) status) or persistent RV dysfunction (by echocardiography) 6 months later.…”

Section: Question 3: Can Thrombolytic Therapy Improve Long-term Outcomentioning

confidence: 99%

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

2015

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Submassive pulmonary embolism (PE) remains a vexing entity, and the appropriate use of thrombolytic therapy for this subgroup continues to be actively debated. Catheter-directed thrombolysis has shown efficacy for submassive PE and is gaining momentum because of theoretically improved safety. This review poses and responds to four questions that explore the complex issues surrounding optimal therapy of submassive PE.

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Section: Question 3: Can Thrombolytic Therapy Improve Long-term Outcomentioning

confidence: 99%

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

2015

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“…In an analysis of normotensive PE patients (n = 162) treated with adjunctive fibrinolysis or heparin alone, no patients treated with fibrinolytics had an RV systolic pressure (RVSP) at 6 months' follow-up that was greater than that at diagnosis [35]. In contrast, 27 % of heparin-only patients had worsened RVSP at 6 months, 46 % of which had dyspnea with limited activity or at rest (New York Heart Association C3) or exercise intolerance (6-min walking distance\330 m) [35]. These findings suggest fibrinolysis may reduce the development of CTEPH.…”

Section: Quality Of Lifementioning

confidence: 99%

“…These findings suggest fibrinolysis may reduce the development of CTEPH. When the analysis was limited to those who had RVSP [30 mmHg at baseline, however, only 9 % of heparinmonotherapy patients had an RVSP increase at 6 months [35]. Table 3 also summarizes key safety results, including total major, intracranial, fatal, and minor bleedings, from randomized clinical trials evaluating the use of fibrinolysis in submassive PE.…”

Section: Quality Of Lifementioning

confidence: 99%

Submassive Pulmonary Embolism: Risk Evaluation and Role of Fibrinolysis

Prom

Dull

Kujawski

et al. 2013

Curr Emerg Hosp Med Rep

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Submassive pulmonary embolism (PE) is characterized by hemodynamic stability with evidence of right ventricular dysfunction or myocardial necrosis, and represents a heterogeneous population at risk for adverse outcomes. Although patients with this subtype of PE are at higher risk of death, it is unclear whether escalation of care with fibrinolytic therapy mitigates this risk. The controversial role of fibrinolytic therapy for submassive PE is driven by a paucity of data, conflicting results from clinical trials, and lack of reliable positive predictive markers of mortality in this population. When compared with anticoagulation therapy alone, systemic fibrinolytic therapy leads to a more rapid improvement in pulmonary artery hemodynamics, restoration of right ventricular function, improved lung perfusion, and fewer episodes of clinical deterioration. The clinical significance of these findings remains uncertain because fibrinolytic therapy has not been demonstrated to improve mortality or reduce recurrent PE in patients with submassive PE. However, it is unclear whether this reflects methodological limitations such as small sample size and rescue fibrinolytic therapy in those assigned placebo, the absence of benefit in all patients with submassive PE, or the benefit is limited to an undefined, high-risk subset. The decision to administer adjunctive fibrinolytics in patients with submassive PE should be made on an individual basis, with serious consideration given to those with severe PE-related clinical manifestations and an acceptable risk of bleeding.

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“…Patients with severe tricuspid regurgitation, implying more severe PE and more hemolysis appear to be at the highest risk of acute L-arginine depletion, and persistent right ventricular dysfunction [6,7].…”

Section: Introductionmentioning

confidence: 99%

Development, validation, and comparison of four methods to simultaneously quantify l-arginine, citrulline, and ornithine in human plasma using hydrophilic interaction liquid chromatography and electrospray tandem mass spectrometry

Lai

Kline

Wang

2015

Journal of Chromatography B

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M. (2015). Development, validation, and comparison of four methods to simultaneously quantify l-arginine, citrulline, and ornithine in human plasma using hydrophilic interaction liquid chromatography and electrospray tandem mass spectrometry. ABSTRACT:To understand the role of L-arginine depletion in impaired nitric oxide synthesis in disease, it is important to simultaneously quantify arginine, citrulline, and ornithine in the plasma. Because the three amino acids are endogenous analytes, true blank matrix for them is not available. It is necessary and valuable to compare the performance of different approaches due to lack of regulatory clarity for validation. A two-step sample preparation method using methanol as protein precipitation reagent was developed in this study is used for sample preparation. Because true blank matrix for endogenous analytes is not available, water as blank matrix, 1% BSA in PBS as blank matrix, surrogate analyte, and background subtraction were designed to establish successful quantification methods. Four methods to simultaneously quantify arginine, citrulline, and ornithine in human plasma using hydrophilic interaction liquid chromatography and electrospray tandem mass spectrometry were developed, validated, and compared. The developed two-step sample preparation method using methanol as protein precipitation reagent in this study needs less time and provides higher recovery comparing with other approaches. Three of the four methods, water as blank matrix, 1% BSA in PBS as blank matrix, and surrogate analyte, have been successful in fulfilling all the criteria, while background subtraction has failed. Results of the measured concentrations in 97 human plasma samples using the three methods show that the difference between any two methods or among the three methods presents 100% of samples with less than 20% for all the three amino acids and majority of them are under 10%. The developed two-step sample preparation method using methanol as protein precipitation reagent is simple and convenient. Three of the four methods are fully validated and the validation is successful. The BSA functioned effectively as a blank matrix for these three amino acids, considering cost, data quality, matrix similarity, and practicality.

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Prospective Evaluation of Right Ventricular Function and Functional Status 6 Months After Acute Submassive Pulmonary Embolism

Abstract: Six months after experiencing submassive PE, a significant proportion of patients had echocardiographic and functional evidence of pulmonary hypertension.

Cited by 223 publications

References 34 publications

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

Submassive Pulmonary Embolism: Risk Evaluation and Role of Fibrinolysis

Development, validation, and comparison of four methods to simultaneously quantify l-arginine, citrulline, and ornithine in human plasma using hydrophilic interaction liquid chromatography and electrospray tandem mass spectrometry

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