Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism

Keller, Karsten; Beule, Johannes; Schulz, Andreas; Coldewey, Meike; Dippold, Wolfgang; Balzer, J. O.

doi:10.1016/j.thromres.2014.01.010

Cited by 21 publications

(38 citation statements)

References 31 publications

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“…and Ozsu et al . (each with 0.01 ng/mL) reported similar low cut‐off values for prediction of in‐hospital death and death in the first 30 days after a PE event …”

Section: Discussionmentioning

confidence: 87%

Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism

Keller

Geyer

Beule³

et al. 2015

Thoracic Cancer

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BackgroundDeep vein thrombosis (DVT) and pulmonary embolism (PE) are connected with a poor outcome in cancer patients. We aimed to investigate the impact of cancer on the effectiveness of cardiac Troponin I (cTnI) to predict right ventricular dysfunction (RVD) in acute PE.MethodsWe retrospectively analyzed the data of 182 patients with confirmed PE. PE patients were subdivided into two groups: (i) with concomitant active cancer disease or history of cancer, and (ii) without known cancer. Receiver operating characteristic (ROC) curves with area under the curve (AUC) was calculated for cTnI predicting RVD and related cut-off levels for both groups.ResultsThirty-seven PE patients (20.3%) had an active cancer disease or a history of cancer. In contrast, 145 (79.7%) of the included PE patients did not have a known cancer disease or a history of cancer. In the PE group with cancer, analysis of the ROC curve showed an AUC of 0.76 for cTnI predicting RVD with an optimal cut-off value of 0.04 ng/mL; the risk of misclassification was 25.0%. In the PE group without cancer, AUC was 0.81 for cTnI predicting RVD with an optimal cut-off value of 0.015 ng/mL; the risk of misclassification was 24.9%.ConclusionscTnI is effective for predicting RVD in PE patients with and without cancer. However, the effectiveness of cTnI to predict RVD was higher in PE patients without cancer than in those with cancer or a history of cancer.

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“…and Ozsu et al . (each with 0.01 ng/mL) reported similar low cut‐off values for prediction of in‐hospital death and death in the first 30 days after a PE event …”

Section: Discussionmentioning

confidence: 87%

Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism

Keller

Geyer

Beule³

et al. 2015

Thoracic Cancer

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“…The mentioned echocardiographic measures and findings all evaluate RV dysfunction, and in most clinical trials, several indices need to be present simultaneously before RV dysfunction is considered. Despite this array of echocardiographic measures, only low TAPSE and short pulmonary artery acceleration time have been shown to be independent prognostic markers of mortality, whereas the presence of a thrombus in the RV or right atrium did not aid in prediction of mortality beyond standard risk stratification indices…”

Section: Pulmonary Embolismmentioning

confidence: 99%

When appearances deceive: Echocardiographic changes due to common chest pathology

et al. 2018

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Most indications for performing echocardiography focus on the evaluation of properties intrinsic to the heart. However, numerous extra‐cardiac conditions indirectly convey changes to the echocardiographic appearance through alterations in the governing physiology. Pulmonary embolism increases pulmonary arterial pressure if a sufficient cross‐sectional area of the pulmonary vascular bed is occluded. This may result in dilatation of the right ventricle and, in severe cases, concomitant early diastolic septal collapse into the left ventricle. Acute respiratory failure has been shown to yield a similar echocardiographic appearance in experimental conditions due to the resultant pulmonary vasoconstriction. Echocardiography in the presence of pulmonary disease can reveal underlying cardiac pathologies such as pulmonary hypertension that contribute to the clinical severity of respiratory distress. Positive pressure ventilation affects preload, afterload, and compliance of both ventricles. The echocardiographic net result cannot be uniformly anticipated, but provides information on the deciding physiology or pathophysiology. Mediastinal pathology including tumors, herniation of abdominal content, and pleural effusion can often be visualized directly with echocardiography. Mediastinal pathologies adjacent to the heart may compress the myocardium directly, thus facilitating echocardiographic and clinical signs of tamponade in the absence of pericardial effusion. In conclusion, many pathologies of extra‐cardiac origin influence the echocardiographic appearance of the heart. These changes do not reflect properties of the myocardium but may well be mistaken for it. Hence, these conditions are essential knowledge to all physicians performing echocardiography across the spectrum from advanced cardiological diagnostics to rapid point‐of‐care focused cardiac ultrasonography.

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“…Als Signifikanzschwelle wurde ein Wert von p = 0,05 festgesetzt. [6,10,16,18,20,27,31,32,36,37,42]. Neben einer RVD ist auch ein erhöhtes kardiales Troponin (cTn) mit einer erhöhten Mortalitäts-und Komplikationsrate verbunden [6, 10, 11, 13, 16, 20, 22, 27, 31, 32, 35-37, 42, 46].…”

Section: Statistische Auswertung ▼unclassified

Geschlechtsspezifische Unterschiede bei hämodynamisch stabilen Patienten mit akuter Lungenarterienembolie

Keller

Beule

Schulz

et al. 2014

Dtsch med Wochenschr

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Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism

Cited by 21 publications

References 31 publications

Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism

Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism

When appearances deceive: Echocardiographic changes due to common chest pathology

Geschlechtsspezifische Unterschiede bei hämodynamisch stabilen Patienten mit akuter Lungenarterienembolie

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