Prospective Study of Pulmonary Embolism Presenting as Syncope

Pop, Călin; Ianos, R; Matei, Claudia; Mercea, Delia; Todea, Bogdan; Dicu, Daniela; Tarus, Mariana; Filip, Dan; Kozma, G; Cotoraci, Coralia; Petriş, Antoniu; Țînț, Diana

doi:10.1097/mjt.0000000000000825

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…Our study has demonstrated that the prevalence of PE is low in patients presenting with syncope using a large nationwide database compared to the recently published report [5] and similar to other studies [13,14]. Our study also showed that a majority of patients had at least one syncope associated diagnosis at index admission, and one should consider PE as an etiology if syncope is unexplained [15]. More recently, Costantino et al have shown a similar low prevalence rate of PE of less than 3% in hospitalized patients and less than 1% within 90 days of follow-up [16].…”

Section: Discussionsupporting

confidence: 89%

“…These results warrant a prospective investigation regarding relevant workup for PE in patients admitted for syncope, which might include using pretest probability score like PERC Rule or Wells Criteria, appropriate use of D-dimer testing and considering further imaging based on the results [19][20][21]. It might be more reasonable to consider VTE work up in syncope patients with hemodynamic instability [15,22].…”

Section: Discussionmentioning

confidence: 97%

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Thirty-day readmissions due to Venous thromboembolism in patients discharged with syncope

et al. 2020

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A recent study found that approximately 1 in every 6 patients hospitalized for the 1st episode of syncope had an underlying pulmonary embolism (PE). As current guidelines do not strongly emphasize evaluation for PE in the workup of syncope, we hypothesize that there might be a higher rate of 30-day readmission due to untreated venous thromboembolism (VTE). The objective of this study is to measure the 30-day readmission rate due to VTE and identify predictors of 30-day readmission with VTE among syncope patients. We identified patients admitted with syncope with ICD9 diagnoses code 780.2 in the Nationwide Readmission Database (NRD-2013), Healthcare Cost and Utilization Project (HCUP). The 30-day readmission rate was calculated using methods described by HCUP. Logisticregression was used to identify predictors of 30-day readmission with VTE. Discharge weights provided by HCUP were used to generate national estimates. In 2013, NRD included 207,339 eligible patients admitted with syncope. The prevalence rates of PE and DVT were 1.1% and 1.4%, respectively. At least one syncope associated condition was present in 60.9% of the patients. Among the patients who were not diagnosed with VTE during index admission for syncope (N = 188,015), 30-day readmission rate with VTE was 0.5% (0.2% with PE and 0.4% with DVT). In conclusion, low prevalence of VTE in patients with syncope and extremely low 30-day readmission rate with VTE argues against missed diagnoses of VTE in index admission for syncope. These results warrant further studies to determine clinical impact of work up for PE in syncope patients without risk factors.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 97%

Thirty-day readmissions due to Venous thromboembolism in patients discharged with syncope

et al. 2020

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“…However, perfusion or ventilation abnormalities caused by hypoxemia might be significantly involved in the development of syncopes. Due to transient depressions in cardiac output, main pulmonary or lobar artery obstructions can also be associated with syncope [ 22 , 23 ]. In intermediate-risk PE patients with right ventricular involvement, the presence of syncopes is associated with a more complicated in-hospital course [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Short-term prognostic value of clinical data in hospitalized patients with intermediate-risk acute pulmonary embolism

Liu

Zhang

et al. 2022

BMC Cardiovasc Disord

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Background Intermediate-risk acute pulmonary embolism (APE) patients are usually defined as hemodynamically stable, comprehending a great therapeutic dilemma. Although anticoagulation therapy is sufficient for most intermediate-risk APE patients, some patients can deteriorate and eventually require a systemic fibrinolytic agent or thrombectomy. Hence, this study aimed to evaluate the predictive value of differences in clinical data for the short-term prognosis of intermediate-risk APE patients. Methods A retrospective cohort of 74 intermediate-risk APE patients confirmed by computed tomography pulmonary angiography was analyzed in the present study. Adverse clinical event outcomes included PE-related in-hospital deaths, critical systolic blood pressure consistently under 90 mmHg, refractory to volume loading and vasopressor infusion requirements, mechanical ventilation, and cardiopulmonary resuscitation. The APE patients were stratified into two groups: adverse outcome (n = 25) and control (n = 49) groups. Then, the clinical data of the two groups were compared. Receiver operating characteristic (ROC) curves were used to explore the predictive value of white blood cell (WBC) counts and the right to left ventricular short-axis (RV/LV) ratio. Model calibration was assessed using the Hosmer–Lemeshow goodness-of-fit statistic. Results The brain natriuretic peptide, WBC count, and the RV/LV ratio were higher in patients with adverse outcomes compared to controls. The APE patients with adverse outcomes presented significantly higher rates of syncope, Negative T waves (NTW) in V1–V3, intermediate-high risk, thrombolytic therapy, and low arterial oxygen saturation (SaO2) compared to controls. In the multivariate logistic regression analysis, the SaO2 < 90%, [odds ratio (OR) 5.343, 95% confidence interval (CI) 1.241–23.008; p = 0.024], RV/LV ratio (OR 7.429, 95% CI 1.145–48.209; p = 0.036), Syncope (OR 12.309, 95% CI 1.702–89.032; p = 0.013), NTW in V1–V3 (OR 5.617, 95% CI 1.228–25.683; p = 0.026), and WBC count (OR 1.212, 95% CI 1.035–1.419; p = 0.017) were independent predictors of in-hospital adverse outcomes among APE patients. The ROC curve analysis indicated that the RV/LV ratio can be used to predict adverse outcomes (AUC = 0.748, p < 0.01) and calibration (Hosmer–Lemeshow goodness of fit test, p = 0.070). Moreover, an RV/LV ratio > 1.165 was predictive of adverse outcomes with sensitivity and specificity of 88.00 and 59.20%, respectively. The WBC counts were also able to predict adverse outcomes (AUC = 0.752, p < 0.01) and calibration (Hosmer–Lemeshow goodness of fit test, p = 0.251). A WBC count > 9.05 was predictive of adverse outcomes with sensitivity and specificity of 68.00 and 73.50%, respectively. Conclusion Overall, a SaO2 < 90%, RV/LV ratio, Syncope, NTW in V1–V3, and WBC counts could independently predict adverse outcomes in hospitalized intermediate-risk APE patients.

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“…Syncope in PE patients may be caused by cerebral hypoperfusion due to reduced cardiac output, arrhythmias due to hemodynamic instability, or neurogenic syncope (Keller et al, 2018;Siddappa Malleshappa et al, 2020). Inadequate oxygen supply due to hypoxemia is also a cause of syncope (Keller et al, 2018;Pop et al, 2019). In the emergency department, 2.2% of syncope patients were eventually diagnosed with PE (deSouza, 2020).…”

Section: Discussionmentioning

confidence: 99%

A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China

Shou

et al. 2022

Front. Neuroinform.

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IntroductionPulmonary embolism (PE) is a common thrombotic disease and potentially deadly cardiovascular disorder. The ratio of clinical misdiagnosis and missed diagnosis of PE is very large because patients with PE are asymptomatic or non-specific.MethodsUsing the clinical data from the First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China), we proposed a swarm intelligence algorithm-based kernel extreme learning machine model (SSACS-KELM) to recognize and discriminate the severity of the PE by patient’s basic information and serum biomarkers. First, an enhanced method (SSACS) is presented by combining the salp swarm algorithm (SSA) with the cuckoo search (CS). Then, the SSACS algorithm is introduced into the KELM classifier to propose the SSACS-KELM model to improve the accuracy and stability of the traditional classifier.ResultsIn the experiments, the benchmark optimization performance of SSACS is confirmed by comparing SSACS with five original classical methods and five high-performance improved algorithms through benchmark function experiments. Then, the overall adaptability and accuracy of the SSACS-KELM model are tested using eight public data sets. Further, to highlight the superiority of SSACS-KELM on PE datasets, this paper conducts comparison experiments with other classical classifiers, swarm intelligence algorithms, and feature selection approaches.DiscussionThe experimental results show that high D-dimer concentration, hypoalbuminemia, and other indicators are important for the diagnosis of PE. The classification results showed that the accuracy of the prediction model was 99.33%. It is expected to be a new and accurate method to distinguish the severity of PE.

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Prospective Study of Pulmonary Embolism Presenting as Syncope

Cited by 7 publications

References 17 publications

Thirty-day readmissions due to Venous thromboembolism in patients discharged with syncope

Thirty-day readmissions due to Venous thromboembolism in patients discharged with syncope

Short-term prognostic value of clinical data in hospitalized patients with intermediate-risk acute pulmonary embolism

A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China

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