Pulmonary embolism causes endomyocarditis in the human heart

Begieneman, Mark P.V.; Goot, F.R.W. van der; Bilt, Ivo A.C. van der; Noordegraaf, A. Vonk; Spreeuwenberg, Marieke; Paulus, Walter J.; Hinsbergh, Victor W.M. van; Visser, Frans C.; Niessen, Hans W.M.

doi:10.1136/hrt.2007.118638

Cited by 69 publications

(54 citation statements)

References 30 publications

(23 reference statements)

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“…However, in patients suffering from acute pulmonary embolism, comparable observations of selective RV inflammation were reported in a postmortem study, 18 and similar findings were observed in experimentally induced acute pulmonary embolism. 28 The mechanistic importance of RV inflammation was demonstrated because suppression of the inflammatory response after acute pulmonary embolism limited RV damage and prevented right heart failure.…”

Section: Worsened Survival After Training Associated With Enhanced Rvsupporting

confidence: 63%

Opposite Effects of Training in Rats With Stable and Progressive Pulmonary Hypertension

et al. 2009

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Background-Exercise training in pulmonary arterial hypertension (PH) is a promising adjunct to medical treatment.However, it is still unclear whether training is beneficial for all PH patients. We hypothesized that right ventricular adaptation plays a pivotal role in the response to training. Methods and Results-Two different dosages of monocrotaline were used in rats to model stable PH with preserved cardiac output and progressive PH developing right heart failure. Two weeks after injection, PH was confirmed by echocardiography, and treadmill training was initiated. Rats were trained for 4 weeks unless manifest right heart failure developed earlier. At the end of the study protocol, all rats were functionally assessed by endurance testing, echocardiography, and invasive pressure measurements. Lungs and hearts were further analyzed in quantitative histomorphologic analyses. In stable PH, exercise training was well tolerated and markedly increased exercise endurance (from 25Ϯ3.9 to 62Ϯ3.9 minutes; PϽ0.001). Moreover, capillary density increased significantly (from 1.21Ϯ0.12 to 1.51Ϯ0.07 capillaries per cardiomyocyte; PϽ0.05). However, in progressive PH, exercise training worsened survival (hazard ratio, 2.7; 95% confidence interval, 1.1 to 14.2) and increased pulmonary vascular remodeling. In addition, training induced widespread leukocyte infiltration into the right ventricle (from 135Ϯ14 to 276Ϯ18 leukocytes per 1 mm 2 ; PϽ0.001). Conclusions-In our rat model, exercise training was found to be beneficial in stable PH but detrimental in progressive PH. Future studies are necessary to address the clinical implications of our findings. Key Words: capillaries Ⅲ exercise Ⅲ hypertension, pulmonary Ⅲ inflammation Ⅲ pulmonary heart disease P ulmonary arterial hypertension (PH) is characterized by progressive pulmonary vascular remodeling, which importantly increases right ventricular (RV) afterload, eventually leading to right heart failure and premature death. 1 Traditionally, PH patients were advised to limit physical activity because of risk of fatal cardiovascular compromise. 2 Clinical Perspective on p 49Recent developments, however, have challenged this view. 3 First, the prognosis of PH patients improved with the introduction of various potent PH-specific medications in the last decades. 4 Second, several studies have demonstrated beneficial effects of training in patients with chronic obstructive pulmonary disease and with congestive heart failure, and training was beneficial even for the most severely affected patients (GOLD IV, New York Heart Association class IV) often suffering from secondary PH. 5,6 Finally, in a recent clinical trial of 30 stable PH patients under optimized medical treatment, Mereles et al 7 reported marked improvement in exercise capacity and quality of life after exercise training.Although training might be a promising adjunct to medical treatment in PH, it remains to be elucidated whether exercise training is beneficial for all PH patients and what its effect is on RV function and remo...

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Section: Worsened Survival After Training Associated With Enhanced Rvsupporting

confidence: 63%

Opposite Effects of Training in Rats With Stable and Progressive Pulmonary Hypertension

et al. 2009

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“…The relationship between elevated WBC count and left ventricular dysfunction in patients with acute coronary syndrome and the various potential mechanisms of myocardial injury mediated by leukocytes have been described in detail [3]. There is growing evidence from animal and autopsy studies that acute PE with at least moderately severe pulmonary hypertension results in right ventricular myocyte lysis and infiltration by neutrophils, macrophages, and lymphocytes in humans and rats [12][13][14][15]17] and that this inflammation independently amplifies injury [25]. Therefore, an elevated WBC count may indicate PE-related right heart dysfunction, a known factor for adverse prognosis in patients with PE [11].…”

Section: Discussionmentioning

confidence: 99%

“…Early death after PE is strongly associated with right ventricular dysfunction [11]. Animal and autopsy studies demonstrated that neutrophils are not only involved in the development of venous thrombosis but that an influx of neutrophils and other WBCs may contribute to right ventricular dysfunction following PE [12][13][14][15][16][17]. Moreover, the WBC count also correlates with levels of fibrinogen, factor VII, and factor VIII and thus, may be a marker for hypercoagulability [18].…”

Section: Introductionmentioning

confidence: 99%

White blood cell count and mortality in patients with acute pulmonary embolism

et al. 2013

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Although associated with adverse outcomes in other cardiovascular diseases, the prognostic value of an elevated white blood cell (WBC) count, a marker of inflammation and hypercoagulability, is uncertain in patients with pulmonary embolism (PE). We therefore sought to assess the prognostic impact of the WBC in a large, state‐wide retrospective cohort of patients with PE. We evaluated 14,228 patient discharges with a primary diagnosis of PE from 186 hospitals in Pennsylvania. We used random‐intercept logistic regression to assess the independent association between WBC count levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient and hospital characteristics. Patients with an admission WBC count <5.0, 5.0–7.8, 7.9–9.8, 9.9–12.6, and >12.6 × 109/L had a cumulative 30‐day mortality of 10.9%, 6.2%, 5.4%, 8.3%, and 16.3% (P < 0.001), and a readmission rate of 17.6%, 11.9%, 10.9%, 11.5%, and 15.0%, respectively (P < 0.001). Compared with patients with a WBC count 7.9–9.8 × 109/L, adjusted odds of 30‐day mortality were significantly greater for patients with a WBC count <5.0 × 109/L (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14–2.03), 9.9–12.6 × 109/L (OR 1.55, 95% CI 1.26–1.91), or >12.6 × 109/L (OR 2.22, 95% CI 1.83–2.69), respectively. The adjusted odds of readmission were also significantly increased for patients with a WBC count <5.0 × 109/L (OR 1.34, 95% CI 1.07–1.68) or >12.6 × 109/L (OR 1.29, 95% CI 1.10–1.51). In patients presenting with PE, WBC count is an independent predictor of short‐term mortality and hospital readmission. Am. J. Hematol. 88:677–681, 2013. © 2013 Wiley Periodicals, Inc.

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“…Обнаружение массивных инфильтратов в миокарде ПЖ у больных, умерших от острой ТЭЛА в течение 48 ч, можно объяснить высо ким уровнем адреналина, который высвобождается при развитии миокардита, вызванного ТЭЛА [74]. Воспалительный ответ также может быть обусловлен и вторичной гемодинамической нестабильностью, которая иногда развивается в течение 24-48 ч после острой ТЭЛА, хотя в некоторых случаях альтерна тивным объяснением могут служить ранние рециди вы ТЭЛА [75].…”

Section: течениеunclassified

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данных Клинических рекомендациях суммированы все современные доказательства по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). В отличие от предыдущей версии рекомендаций, в данном документе представлены упрощенные варианты клинических прогностических шкал, подробно рассмотрена стратификация риска летального исхода, включая промежуточные степени риска, представлены новые подходы к АКТ, в т. ч. системному тромболизису и катетерным методам лечения, терапии антагонистом витамина К, определено место новых пероральных антикоагулянтов в терапии ТЭЛА. Ключевые слова: рекомендации, тромбоэмболия легочной артерии, венозный тромбоз, шок, гипотензия, торакалгия, одышка, сердеч ная недостаточность, диагностика, антикоагулянты, тромболизис. SummaryThese clinical recommendations summarized currently available evidence on diagnosis and management of patients with pulmonary embolism. When compared to previous version of recommendations, this document has introduced simplified clinical prognostic scales and a new risk stratifi cation system including intermediate risk. Novel approach to anticoagulant therapy have been also reviewed including systemic thrombolysis, catheter directed treatment, vitamin K antagonists and new oral anticoagulants. Key words: recommendations, pulmonary embolism, venous thromboembolism, shock, hypotension, chest pain, dyspnea, heart failure, diagnosis, anticoagulants, thrombolysis.Тромбоэмболия легочной артерии: клинические рекомендации Европейского общества кардиологов (2014) 526Пульмонология. 2015; 25 (5): 525-552 возникавших в ходе работы над Рекомендациями, надлежало информировать ЕОК и вносить соответ ствующие поправки. Финансирование Рабочей груп пы проводилось за счет средств ЕОК полностью, без участия представителей медицинской промышлен ности.Комитетом ЕОК по Практическим рекомендаци ям проведены наблюдение за процессом подготовки новых Клинических рекомендаций и его координа ция. Члены Комитета также несли ответственность за утверждение новых Клинических рекомендаций. Клинические рекомендации ЕОК активно проана лизированы Комитетом по Практическим рекомен дациям и внешними экспертами. После соответст вующих поправок Рекомендации были одобрены всеми экспертами Рабочей группы. Окончательный документ был утвержден Комитетом по Практичес ким рекомендациям для публикации в журнале European Heart Journal.Задача написания Клинических рекомендаций ЕОК заключается не только в объединении результа тов исследований последних лет, но также и в разра ботке образовательных методик и программ внедре ния Рекомендаций в практическое здравоохранение.Для практического использования Рекоменда ций готовится их краткая («карманная») версия, а также слайды, буклеты с ключевыми положения ми, листовки для неспециалистов и электронная версия для смартфонов и других гаджетов (сокра щенные варианты); с полным текст Рекомендаций опубликован на сайте ЕОК и находится в свободном доступе. Национальным обществам рекомендуется утверждать, переводить на национальные языки и внедрять Клинические рекоме...

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Pulmonary embolism causes endomyocarditis in the human heart

Cited by 69 publications

References 30 publications

Opposite Effects of Training in Rats With Stable and Progressive Pulmonary Hypertension

Opposite Effects of Training in Rats With Stable and Progressive Pulmonary Hypertension

White blood cell count and mortality in patients with acute pulmonary embolism

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

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