Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Chen, Yu Lin; Wright, Colin M.; Pietropaoli, Anthony P.; Elbadawi, Ayman; Delehanty, Joseph M.; Barrus, Bryan; Gošev, Igor; Trawick, David R.; Patel, Dina; Cameron, Scott J.

doi:10.1007/s11239-019-01922-w

Cited by 21 publications

(21 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Besides, in a retrospective analysis of confirmed PE patients presenting to the emergency department, the authors observed an underestimation of PE-related mortality using existing PE prognostic models. [ 42 ] Therefore, the utility of age or chronic cardiopulmonary disease in PE prognostic models may need further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Hariharan¹,

Giordano²,

Muzikansky³

et al. 2021

International Journal of Cardiology

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Hariharan¹,

Giordano²,

Muzikansky³

et al. 2021

International Journal of Cardiology

View full text Add to dashboard Cite

“…PESI has been used for the risk stratification of right ventricular dysfunction and for prediction of short-term mortality after acute PE. 38,39 Therefore, there may be an alternative factor that attenuates the effect of OSA on the mortality and additional adverse outcomes. We speculate that one such potential mechanism could be a phenomenon termed ischemic preconditioning.…”

Section: Discussionmentioning

confidence: 99%

Acute pulmonary embolism in patients with obstructive sleep apnea: frequency, hospital outcomes, and recurrence

Seckin

Helmi

Weister

et al. 2020

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: The objectives of this study were to assess the effect of obstructive sleep apnea (OSA) on the risk of acute pulmonary embolism (PE), hospital outcomes including mortality, and PE recurrence. Methods: We retrospectively enrolled adult patients, admitted to Mayo Clinic Hospital in Rochester, Minnesota, within a 5-year period (2009)(2010)(2011)(2012)(2013). We compared frequency of PE, hospital mortality, and secondary outcomes in patients with OSA versus patients without OSA. We assessed risk of PE recurrence in relation to compliance with OSA therapy. Results: Of 25,038 patients, 3,184 (13%) had OSA and 283 (1.1%) experienced PE. Frequency of PE in patients with and without OSA was 2.4% versus 0.9% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.9-3.3; P < .001). OSA was independently associated with increased risk of PE after adjusting for demographics and comorbidities (OR, 1.44; 95% CI, 1.07-1.9; P =.017). Adjusted hospital mortality was increased in patients with PE (OR, 2.88; 95% CI, 1.7-4.9; P <.001) but not in patients with OSA (OR, 0.98; 95% CI, 0.7-1.4, P =.92). OSA was not a significant determining factor for mortality in patients who experienced a PE (OR, 0.56; 95% CI, 0.1.1-2.78; P =.47), adjusting for demographics, PE severity, and Charlson comorbidity index. Adjusted risk of PE recurrence was greater in patients with OSA compared with patients without OSA (OR, 2.21; 95% CI, 1.05-4.68; P < .04). The patients compliant with OSA therapy had a lower rate of PE recurrence (16% vs 32%; P = not significant). Conclusions: Although OSA significantly increases risk of acute PE occurrence and recurrences, related hospital mortality was not greater in patients with OSA compared with those without OSA. OSA therapy might have a modifying effect on PE recurrence.

show abstract

“…The right ventricular dysfunction on echocardiogram has an important role for prognosis as seen in different studies that show a correlation between adverse outcomes and right ventricular dysfunction in pulmonary embolism [ 22 ]. Although in our study we did not study the correlation of RV dysfunction with adverse outcomes, it can however be used to risk-stratify patients with acute PE [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study

Khan

Javed

Mohsin

et al. 2020

Cureus

View full text Add to dashboard Cite

Background There is an increasing need to explore other non-invasive techniques for the diagnosis of pulmonary embolism in resource-limited countries. Objective To assess the validity of elevated D-dimer levels and right ventricular (RV) dysfunction on echocardiography in predicting definite massive pulmonary embolism among patients diagnosed with massive pulmonary embolism using computed tomography (CT) pulmonary angiography as the gold standard. Methods The patients with acute massive pulmonary embolism on CT pulmonary angiography were included. The participants underwent 12-lead electrocardiography, assessment of D-dimer levels, and bedside echocardiography to determine right ventricular dysfunction. The data were recorded on a proforma and analyzed using IBM SPSS software version 26.0 (IBM Corp., Armonk, NY). Results There were 160 patients in the study. The mean age was 49.19 ± 14.89 years. Elevated D-dimer levels were seen in 80.60% of the patients whereas ventricular dysfunction on echocardiography was seen in 90.00% of the patients. The sensitivity and specificity of elevated D dimer levels were 78.99% and 14.60%, respectively. The positive predictive values (PPV) and negative predictive values (NPV) for elevated D-dimer levels were 72.87% and 19.35%, respectively. In contrast, the sensitivity of ventricular dysfunction was 94.96% and specificity 24.39%. PPV was found to be 78.47% and NPV was 62.50%. Conclusion Positive D-dimer levels and ventricular dysfunction on echocardiography are sensitive enough to consider the diagnosis of massive pulmonary embolism but lack adequate specificity, thus, necessitating the presence of other noninvasive tests.

show abstract

Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Cited by 21 publications

References 34 publications

Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Acute pulmonary embolism in patients with obstructive sleep apnea: frequency, hospital outcomes, and recurrence

Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study

Contact Info

Product

Resources

About