Tromboembolismo pulmonar en pacientes con COVID-19: estudio de prevalencia en un hospital terciario

Adams²,

2021

Eur Radiol

Purpose To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA). Methods A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models. Results Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0–23.8%), 23.9% (95% CI: 15.2–32.7%), and 48.6% (95% CI: 41.0–56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0–70.1%] vs. 32.9% [95% CI: 26.7–39.0%]; OR = 3.540 [95% CI: 2.308–5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844–1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 μg/L. Conclusion The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 μg/L. Key Points • The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. • PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. • D-dimer levels are significantly higher in patients with COVID-19 who have PE. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08003-8.

Section: Discussionmentioning

confidence: 81%

Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis

Adams²,

2021

Eur Radiol

“…Next to GGO, the usually evaluated parameters in chest CT scans are: increased opacity of the lung, with preservation of bronchial and vascular margins, consolidation, crazy-paving pattern, cavity and bronchial dilatation [ 150 , 151 ]. Vascular involvement is indicated by vessel dilatation, an increased vessel diameter within or near opacifications, larger compared to vessels in healthy lung tissue [ 150 ].…”

Section: Chest Computerized Tomography In Covid-19mentioning

confidence: 99%

“…On the contrary, chronic PE can manifest as complete occlusive disease in vessels smaller than adjacent patent ones. Other CTPA findings in chronic PE include webs or flaps, recanalization and partial filling defects [ 151 , 157 , 158 ].…”

Section: Chest Computerized Tomography In Covid-19mentioning

confidence: 99%

Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

et al. 2021

Coronavirus Disease 2019 (COVID-19) has been a pandemic challenge for the last year. Cardiovascular disease is the most described comorbidity in COVID-19 patients, and it is related to the disease severity and progression. COVID-19 induces direct damage on cardiovascular system, leading to arrhythmias and myocarditis, and indirect damage due to endothelial dysfunction and systemic inflammation with a high inflammatory burden. Indirect damage leads to myocarditis, coagulation abnormalities and venous thromboembolism, Takotsubo cardiomyopathy, Kawasaki-like disease and multisystem inflammatory syndrome in children. Imaging can support the management, assessment and prognostic evaluation of these patients. Ultrasound is the most reliable and easy to use in emergency setting and in the ICU as a first approach. The focused approach is useful in management of these patients due its ability to obtain quick and focused results. This tool is useful to evaluate cardiovascular disease and its interplay with lungs. However, a detailed echocardiography evaluation is necessary in a complete assessment of cardiovascular involvement. Computerized tomography is highly sensitive, but it might not always be available. Cardiovascular magnetic resonance and nuclear imaging may be helpful to evaluate COVID-19-related myocardial injury, but further studies are needed. This review deals with different modalities of imaging evaluation in the management of cardiovascular non-ischaemic manifestations of COVID-19, comparing their use in emergency and in intensive care.

“…Next to GGO, the usually evaluated parameters in chest CT scans are: increased opacity of the lung, with preservation of bronchial and vascular margins, consolidation, crazy-paving pattern, cavity, and bronchial dilatation [126,127]. Vascular involvement is indicated by vessel dilatation, an increased diameter of vessel within or near opacifications clearly larger compared to vessels of the same generation in healthy lung tissue [126].…”

Section: Chest Computerized Tomography In Covid-19 Emergencymentioning

confidence: 99%

“…Chronic PE can manifest as complete occlusive disease in vessels that are smaller than adjacent patent vessels. Other CTPA findings in chronic PE include: evidence of recanalization, webs or flaps, and partial filling defects that form obtuse angles with the vessel wall [127,134,135]. Embolism (Circles) is not related to site of pneumonia but to endotheliitis and not to pulmonary phlogosis (Triangles).…”

Section: Chest Computerized Tomography In Covid-19 Emergencymentioning

confidence: 99%

Cardiovascular Imaging Evaluation in COVID-19 Heart and Vascular Non-Ischaemic Involvement

Cicco¹,

Vacca²,

Cariddi³

et al. 2021

Preprint

Coronavirus Disease 2019 (COVID-19) is the pandemic challenge of the last year. Cardiovascular involvement is one of the main characteristics of this disease. Due to endothelial damage, consequent phlogosis may increase a thrombosis risk. Cardiac injury may occur in different ways. However, an ischemic involvement of the cardiovascular system is rarely implied. In this regard, direct and indirect effects of COVID-19 are described. Nonetheless, the possible evaluation of the cardiovascular system may require different modalities. The cardiovascular evaluation may be different in emergency compared to critical care, requiring different tools for each setting. The aim of this review is to explore these modalities according to the different involvement of the cardiovascular system..