Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Author Contributions
Acknowledgments
Conflicts of Interest
References
- Goldhaber, S.Z.; Visani, L.; De Rosa, M. Acute pulmonary embolism: Clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet 1999, 353, 1386–1389. [Google Scholar] [CrossRef]
- Ng, A.C.; Chung, T.; Yong, A.S.; Wong, H.S.; Chow, V.; Celermajer, D.S.; Kritharides, L. Long-term cardiovascular and noncardiovascular mortality of 1023 patients with confirmed acute pulmonary embolism. Circulation 2011, 4, 122–128. [Google Scholar] [CrossRef] [PubMed]
- Wu, A.S.; Pezzullo, J.A.; Cronan, J.J.; Hou, D.D.; Mayo-Smith, W.W. CT pulmonary angiography: Quantification of pulmonary embolus as a predictor of patient outcome-initial experience. Radiology 2004, 230, 831–835. [Google Scholar] [CrossRef] [PubMed]
- Van der Meer, R.W.; Pattynama, P.M.; van Strijen, M.J.; van den Berg-Huijsmans, A.A.; Hartmann, I.J.; Putter, H.; de Roos, A.; Huisman, M.V. Right ventricular dysfunction and pulmonary obstruction index at helical CT: Prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 2005, 235, 798–803. [Google Scholar] [CrossRef]
- Ghaye, B.; Ghuysen, A.; Bruyere, P.J.; D’Orio, V.; Dondelinger, R.F. Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics 2006, 26, 23–39. [Google Scholar] [CrossRef] [PubMed]
- Collomb, D.; Paramelle, P.J.; Calaque, O.; Bosson, J.L.; Vanzetto, G.; Barnoud, D.; Pison, C.; Coulomb, M.; Ferretti, G. Severity assessment of acute pulmonary embolism: Evaluation using helical CT. Eur. Radiol. 2003, 13, 1508–1514. [Google Scholar] [CrossRef]
- Dentali, F.; Riva, N.; Turato, S.; Grazioli, S.; Squizzato, A.; Steidl, L.; Guasti, L.; Grandi, A.M.; Ageno, W. Pulmonary embolism severity index accurately predicts long-term mortality rate in patients hospitalized for acute pulmonary embolism. J. Thromb. Haemost. 2013, 11, 2103–2110. [Google Scholar] [CrossRef] [Green Version]
- Barra, S.N.; Paiva, L.; Providência, R.; Fernandes, A.; Marques, A.L. A review on state-of-the-art data regarding safe early discharge following admission for pulmonary embolism: What do we know? Clin. Cardiol. 2013, 36, 507–515. [Google Scholar] [CrossRef]
- Urbina, T.; Bigé, N.; Nguyen, Y.; Boelle, P.; Dubée, V.; Joffre, J.; Baudel, I.A.J.; Maury, E.; Guidet, B.; Ait-Oufella, H. Tissue perfusion alterations correlate with mortality in patients admitted to the intensive care unit for acute pulmonary embolism: An observational study. Medicine 2018, 97, e11993. [Google Scholar] [CrossRef] [PubMed]
- Bajaj, A.; Saleeb, M.; Rathor, P.; Sehgal, V.; Kabak, B.; Hosur, S. Prognostic value of troponins in acute nonmassive pulmonary embolism: A meta-analysis. Heart Lung 2015, 44, 327–334. [Google Scholar] [CrossRef] [PubMed]
- Lee Chuy, K.; Hakemi, E.U.; Alyousef, T.; Dang, G.; Doukky, R. The long-term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Clin. Cardiol. 2017, 40, 1271–1278. [Google Scholar] [CrossRef] [Green Version]
- Henzler, T.; Roeger, S.; Meyer, M.; Schoepf, U.J.; Nance, J.W., Jr.; Haghi, D.; Kaminski, W.E.; Neumaier, M.; Schoenberg, S.O.; Fink, C. Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. Eur. Respir. J. 2012, 39, 919–926. [Google Scholar] [CrossRef]
- Jaff, M.R.; McMurtry, M.S.; Archer, S.L.; Cushman, M.; Goldenberg, N.; Goldhaber, S.Z.; Jenkins, J.S.; Kline, J.A.; Michaels, A.D.; Thistlethwaite, P.; et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the American Heart Association. Circulation 2011, 123, 1788–1830. [Google Scholar] [CrossRef]
- Mastora, I.; Remy-Jardin, M.; Masson, P.; Galland, E.; Delannoy, V.; Bauchart, J.J.; Remy, J. Severity of acute pulmonary embolism: Evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur. Radiol. 2003, 13, 29–35. [Google Scholar]
- Ji, Y.; Sun, B.; Juggessur-Mungur, K.S.; Li, Z.; Zhang, Z. Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography. Chin. Med. J. 2014, 127, 2025–2029. [Google Scholar]
- Tamizifar, B.; Fereyduni, F.; Esfahani, M.A.; Kheyri, S. Comparing three clinical prediction rules for primarily predicting the 30-day mortality of patients with pulmonary embolism: The "Simplified Revised Geneva Score," the "Original PESI," and the "Simplified PESI". Adv. Biomed. Res. 2016, 5, 137. [Google Scholar] [CrossRef]
- Elias, A.; Mallett, S.; Daoud-Elias, M.; Poggi, J.N.; Clarke, M. Prognostic models in acute pulmonary embolism: A systematic review and meta-analysis. BMJ Open 2016, 6, e010324. [Google Scholar] [CrossRef]
- Ghuysen, A.; Ghaye, B.; Willems, V.; Lambermont, B.; Gerard, P.; Dondelinger, R.; D’Orio, V. Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism. Thorax 2005, 60, 956–961. [Google Scholar] [CrossRef] [Green Version]
- Apfaltrer, P.; Henzler, T.; Meyer, M.; Roeger, S.; Haghi, D.; Gruettner, J.; Süselbeck, T.; Wilson, R.B.; Schoepf, U.J.; Schoenberg, S.O.; et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur. J. Radiol. 2012, 81, 2867–2871. [Google Scholar] [CrossRef]
- Furlan, A.; Aghayev, A.; Chang, C.C.; Patil, A.; Jeon, K.N.; Park, B.; Fetzer, D.T.; Saul, M.; Roberts, M.S.; Bae, K.T. Short-term mortality in acute pulmonary embolism: Clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology 2012, 265, 283–293. [Google Scholar] [CrossRef]
- Attinà, D.; Valentino, M.; Galiè, N.; Modolon, C.; Buia, F.; de Luca, F.; Bacchi-Reggiani, M.L.; Zompatori, M. Application of a new pulmonary artery obstruction score in the prognostic evaluation of acute pulmonary embolism: Comparison with clinical and haemodynamic parameters. Radiol. Med. 2011, 116, 230–245. [Google Scholar] [CrossRef]
- Alonso Martinez, J.L.; Anniccherico Sánchez, F.J.; Urbieta Echezarreta, M.A.; García, I.V.; Álvaro, J.R. Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival. N. Am. J. Med. Sci. 2016, 8, 134–142. [Google Scholar] [CrossRef] [Green Version]
- Bach, A.G.; Nansalmaa, B.; Kranz, J.; Taute, B.M.; Wienke, A.; Schramm, D.; Surov, A. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur. J. Radiol. 2015, 84, 332–337. [Google Scholar] [CrossRef]
- Keller, K.; Beule, J.; Schulz, A.; Coldewey, M.; Dippold, W.; Balzer, J.O. Cardiac troponin I for predicting right ventricular dysfunction and intermediate risk in patients with normotensive pulmonary embolism. Neth. Heart J. 2015, 23, 55–61. [Google Scholar] [CrossRef]
- Keller, K.; Beule, J.; Schulz, A.; Coldewey, M.; Dippold, W.; Balzer, J.O. Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism. Thromb. Res. 2014, 133, 555–559. [Google Scholar] [CrossRef]
- Thieme, S.F.; Ashoori, N.; Bamberg, F.; Sommer, W.H.; Johnson, T.R.; Leuchte, H.; Becker, A.; Maxien, D.; Helck, A.D.; Behr, J.; et al. Severity assessment of pulmonary embolism using dual energy CT—Correlation of a pulmonary perfusion defect score with clinical and morphological parameters of blood oxygenation and right ventricular failure. Eur. Radiol. 2012, 22, 269–278. [Google Scholar] [CrossRef]
- Gul, E.E.; Can, I.; Guler, I.; Yesildag, A.; Abdulhalikov, T.; Kayrak, M.; Ozdemir, K.; Gok, H. Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk. Diagn. Interv. Radiol. 2012, 18, 531–536. [Google Scholar]
- Jeebun, V.; Doe, S.J.; Singh, L.; Worthy, S.A.; Forrest, I.A. Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? QJM 2010, 103, 91–97. [Google Scholar] [CrossRef]
- Klok, F.A.; Mos, I.C.; Huisman, M.V. Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: A systematic review and meta-analysis. Am. J. Respir. Crit. Care Med. 2008, 178, 425–430. [Google Scholar] [CrossRef]
- Vanni, S.; Nazerian, P.; Bova, C.; Bondi, E.; Morello, F.; Pepe, G.; Paladini, B.; Liedl, G.; Cangioli, E.; Grifoni, S.; Jiménez, D. Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: The prognostic role of plasma lactate. Intern. Emerg. Med. 2017, 12, 657–665. [Google Scholar] [CrossRef]
Parameters | Mean ± Standard Deviation | Median | Range |
---|---|---|---|
Wells score | 6.06 ± 1.79 | 6 | 3–10.5 |
Geneva score | 13.61 ± 3.57 | 7 | 0–17 |
D-dimer | 13.10 ± 14.84 | 7.21 | 0.26–128 |
PESI score | 2 ± 1 | 2 | 0–6 |
Troponin | 90.69 ± 141.98 | 55.18 | 3–128 |
BNP | 2112.25 ± 2622.85 | 776.7 | 0–10,445 |
Lactate | 3.48 ± 3.56 | 2.3 | 0.6–23 |
pH | 7.34 ± 0.15 | 7.39 | 6.59–7.53 |
Mastora score | 77.49 ± 26.04 | 82 | 11–137 |
Wells Score | Geneva Score | D-Dimer | PESI Score | BNP | Troponin | Lactate | pH | |
---|---|---|---|---|---|---|---|---|
Mastora Score | ρ = 0.07 | ρ = 0.06 | ρ = 0.15 | ρ = -0.03 | ρ = 0.29 | ρ = 0.08 | ρ = 0.17 | ρ = 0.02 |
p = 0.27 | p = 0.40 | p = 0.09 | p = 0.39 | p = 0.063 | p = 0.29 | p = 0.01 | p = 0.77 |
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Lerche, M.; Bailis, N.; Akritidou, M.; Meyer, H.J.; Surov, A. Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism. J. Clin. Med. 2019, 8, 584. https://doi.org/10.3390/jcm8050584
Lerche M, Bailis N, Akritidou M, Meyer HJ, Surov A. Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism. Journal of Clinical Medicine. 2019; 8(5):584. https://doi.org/10.3390/jcm8050584
Chicago/Turabian StyleLerche, Marianne, Nikolaos Bailis, Mideia Akritidou, Hans Jonas Meyer, and Alexey Surov. 2019. "Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism" Journal of Clinical Medicine 8, no. 5: 584. https://doi.org/10.3390/jcm8050584