Right ventricular strain in patients with pulmonary embolism and syncope

Mohebali, Donya; Heidinger, Benedikt H.; Feldman, Stephanie; Matos, Jason; DaBreo, Dominique; McCormick, Ian; Litmanovich, Diana; Manning, Warren J.; Carroll, Brett J.

doi:10.1007/s11239-019-01976-w

Cited by 15 publications

(12 citation statements)

References 21 publications

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“…Prior studies report about half of the patients with PE have some degree of right ventricular compromise( 25 ) and increased right heart strain is associated with PE and syncope as well as higher mortality. ( 26 ) Among 31 PE positive patients with COVID-19 with available echocardiography, right heart strain was associated with higher embolic burden. Since an estimated 25% of the pulmonary vasculature needs to be occluded to result in pulmonary hypertension, and acute right heart failure requires more than 50% occlusion ( 27 ), it is not surprising to see higher rates of RV strain in these patients whose pulmonary vasculature is already compromised by infection.…”

Section: Discussionmentioning

confidence: 97%

Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter Study

et al. 2021

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Section: Discussionmentioning

confidence: 97%

Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter Study

et al. 2021

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“…Reduced RV GLS has been demonstrated as a bad prognostic factor in patients with pulmonary embolism, pulmonary hypertension, and acute respiratory distress syndrome [20-22]. In COVID-19 patients, RV GLS alteration could be explained by RV inflammation and overload due to pulmonary embolism [23].…”

Section: Discussionmentioning

confidence: 99%

Mid-term subclinical myocardial injury detection in patients recovered from COVID-19 according pulmonary lesion severity

Chamtouri

Kaddoussi

Abroug

et al. 2022

Preprint

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) may cause damage of the cardiovascular system during the acute phase of infection. However, Recent studies described a mid and long-term subtle cardiac injuries after recovery from acute Coronavirus disease 19 (COVID-19).The aim of this study was to determine the relationship between the severity of chest computed tomography (CT) lesions and the persistence of subtle myocardial injuries at mid-term follow-up of patients recovered from COVID-19 infection. Methods All COVID-19 patients were enrolled prospectively in this study. Sensitive troponin T (hsTnT) and chest CT scan was performed in all patients at the acute phase of Covid-19 infection. At the mid-term follow up, conventional transthoracic echocardiograph and global longitudinal strain (GLS) of left and right ventricles (LV and RV) were determined and compared between patients with chest CT scan lesions less than 50% (Group 1) and those with severe chest CT scan greater or equal to 50% (Group 2). Results The mean age was 55 more or less than 14 years. Both LV GLS and RV GLS were significantly decreased in the group 2 (p=0.013 and p=0.011, respectively). LV GLS value more than -18% was noted in 43% of all the patients and RV GLS value more than -20% was observed in 48% of them. The group with severe chest CT scan lesions included more patients with reduced LV GLS and reduced RV GLS than the group with mild chest CT scan lesions (G1:29% vs. G2:57%, p=0.002) and (G1:36% vs. G2:60 %, p=0.009) respectively). Conclusion Patients with severe chest CT scan lesions are more likely to develop subclinical myocardial damage. TTE could be recommended in patients recovering from COVID-19 to detect subtle LV and RV lesions.

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“…Syncope is a known predictor of adverse events in unselected ED patients with acute PE, as it correlates with a higher prevalence of hemodynamic instability and right ventricular dysfunction at the time of PE presentation and confers a higher risk for adverse outcomes. 8,26 But the correlation between syncope and adverse outcomes has disappeared in some studies when patients presenting with hypotension were removed from the cohort, according to the results of a recent 29-study meta- CI, confidence interval; CTPA, computed tomography pulmonary angiography; PE, pulmonary embolism. * Includes non-rebreather mask, non-invasive ventilation, and endotracheal intubation with mechanical ventilation †Proximal emboli were clearly lobar or more proximal, whereas distal emboli were "segmental or lobar" or more distal.…”

Section: Discussionmentioning

confidence: 99%

Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism

Vinson

Engelhart

Bahl

et al. 2020

WestJEM

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Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither. Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013-April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission. Conclusion: Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making. [

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Right ventricular strain in patients with pulmonary embolism and syncope

Cited by 15 publications

References 21 publications

Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter Study

Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter Study

Mid-term subclinical myocardial injury detection in patients recovered from COVID-19 according pulmonary lesion severity

Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism

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