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Pulmonary Embolism—Current and Novel Approaches

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: closed (15 January 2026) | Viewed by 10982

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Prof. Dr. Roy Beigel

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Guest Editor

The Cardiovascular Division, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Interests: acute coronary syndrome; myocardial infarction; heart failure; echocardiography; intensive cardiac care; valvular heart disease; clinical cardiology; pulmonary embolism
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Shlomi Matetzky

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Guest Editor

The Cardiovascular Division, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Interests: acute coronary syndrome; myocardial infarction; heart failure; clinical cardiology; pulmonary embolism; intensive cardiac care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, there have been significant advances in our understanding and management of patients with pulmonary embolism, a condition that continues to be a major challenge worldwide. Pulmonary embolism is the third most frequent cause for cardiovascular death and one of the leading causes of in-hospital mortality. In the past decade, there has been tremendous advancement in the field of invasive percutaneous therapeutic options for the treatment of complex cases, providing more specific options for the complex pulmonary embolism patient. Nonetheless, there are still many gaps in our knowledge regarding the optimal use of these novel techniques and their associated outcomes, as well as there still being a need to discuss future perspectives on the topic and unmet needs.

This Special Issue aims to bring focus to the topic of pulmonary embolism from leading scientists and clinicians around the world in order to share their latest insights on the developments, methods for diagnosis, and novel treatments in the field. This issue will include original research and reviews relating to the epidemiology, diagnosis, risk stratification, and treatment of venous thromboembolic disease and specifically pulmonary embolism.

We are pleased to invite you take part in this Special Issue focusing on pulmonary embolism and look forward to receiving your contributions.

Prof. Dr. Roy Beigel
Prof. Dr. Shlomi Matetzky
Guest Editors

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Keywords

pulmonary embolism
treatment
coagulation
venous thrombosis
thrombolysis
anticoagulation
risk stratification

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Published Papers (5 papers)

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Research

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12 pages, 1011 KB

Open AccessArticle

Sex Differences as Predictors of In-Hospital Outcome in Patients with Acute Pulmonary Embolism

by Corina Cinezan and Camelia Bianca Rus

J. Clin. Med. 2026, 15(4), 1576; https://doi.org/10.3390/jcm15041576 - 17 Feb 2026

Viewed by 800

Abstract

Background: Sex-related differences in cardiovascular disease outcomes are well recognized. Their impact on short-term outcomes in acute pulmonary embolism (PE) remains unclear. This study aimed to assess the association between sex and in-hospital outcomes in patients with acute PE. Methods: We performed a retrospective observational cohort study including 322 consecutive adult patients with acute PE admitted to a university hospital. Clinical, hemodynamic, laboratory, and imaging data were collected at presentation. The primary outcome was a composite poor outcome defined as intensive care unit (ICU) admission, systemic thrombolysis, or in-hospital mortality. Multivariable logistic regression analysis was used to evaluate whether sex independently predicted adverse outcomes after adjustment for established prognostic factors. Results: This study included 322 patients with acute pulmonary embolism (mean age 64.4 ± 13.1 years), of whom 50.0% were women. The composite poor outcome occurred more frequently in women than in men (34.0% vs. 22.7%, p = 0.032). Female sex was associated with increased odds of poor outcome in univariate analysis (odds ratio (OR) 1.76; 95% confidence interval (CI) 1.08–2.88). This association remained significant after multivariable adjustment (adjusted OR 1.69; 95% CI 1.02–2.82; p = 0.042). No significant sex differences were observed for individual components of the composite endpoint. Conclusions: Female sex was independently associated with a higher risk of adverse in-hospital outcomes in acute PE, suggesting that sex-specific factors may influence early prognosis and should be considered in future risk stratification models. Full article

(This article belongs to the Special Issue Pulmonary Embolism—Current and Novel Approaches)

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12 pages, 934 KB

Open AccessArticle

Ultra Short Heart Rate Variability as a Prognostic Marker in Pulmonary Embolism: A Retrospective Cohort Study

by Shay Perek, Majd Lahham, Tarek Arraf, Naama Sitry, Khalil Hamati, Yori Gidron and Ayelet Raz-Pasteur

J. Clin. Med. 2026, 15(4), 1488; https://doi.org/10.3390/jcm15041488 - 13 Feb 2026

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Abstract

Background/Objectives: Pulmonary embolism (PE) remains a significant cause of cardiovascular mortality, with risk stratification being critical for optimizing treatment decisions. Heart rate variability (HRV), a measure of autonomic nervous system function, had been explored as a prognostic index in various cardiovascular conditions, yet has received limited investigation regarding PE prognosis. Our objective was to evaluate the prognostic value of ultra-short HRV indices, obtained at the emergency department (ED), in patients presenting with PE. Methods: A retrospective cohort study, conducted at Rambam Health Care Campus, Haifa, Israel. All eligible patients diagnosed with acute PE at the ED, between the years 2010 and 2012 were included. Further, a subgroup analysis was performed to differentiate between oncological (n = 118) and non-oncological (n = 115) patient populations. Ten-seconds electrocardiogram was used to compute ultra-short HRV indices, specifically SDNN (standard deviation of normal-to-normal RR intervals) and RMSSD (root mean square of successive differences). Multivariate logistic regression models were created to assess HRV’s independent predictive value for 30-day and 90-day mortality. In addition, a survival analysis was carried out utilizing Cox regression and Kaplan-Meier curves. Results: 233 patients (42% male; age 65 ± 17) were included in the analysis. Ultra-short HRV indices did not significantly correlate with short-term mortality. However, in non-oncological patients (n = 115), multivariate analysis demonstrated that higher SDNN (as a continuous variable), was independently associated with increased 90-day mortality (AOR 1.018, 95% CI 1.000–1.037; p = 0.044). In contrast, HRV showed no predictive value for mortality in oncological patients. In both the entire cohort and the non-oncological sub-group, Kaplan-Meier plots established statistically significant differences, with lower HRV indices correlating with worse survival. This finding is paradoxical. The issue of context-dependent HRV (i.e., based on ECG obtained during rapid shallow breathing, which reduces HRV on the one hand, but is possibly adaptive during an acute PE, to increase oxygen supply and prevent shock in the short run, on the other hand), may explain these findings. Conclusions: Ultra-short HRV shows some promise in short term risk stratification of non-oncological PE patients. As for oncological patients, HRV was not found to have short term prognostic relevance. Full article

(This article belongs to the Special Issue Pulmonary Embolism—Current and Novel Approaches)

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12 pages, 2783 KB

Open AccessArticle

Echocardiography-Based Pulmonary Artery Pulsatility Index Correlates with Outcomes in Patients with Acute Pulmonary Embolism

by Gassan Moady, Loai Mobarki, Tsafrir Or, Alexander Shturman and Shaul Atar

J. Clin. Med. 2025, 14(8), 2685; https://doi.org/10.3390/jcm14082685 - 14 Apr 2025

Cited by 2 | Viewed by 2043

Abstract

Objectives: The pulmonary artery pulsatility index (PAPI) is a novel hemodynamic parameter that reflects right ventricular (RV) function. PAPI was shown to be useful in predicting outcomes following left ventricular assist device (LVAD) implantation, acute RV infarction, and in patients with chronic RV failure. The standard method to estimate PAPI is during right heart catheterization (RHC); however, echocardiography-based PAPI was also shown to be accurate. In the current study, we evaluated the ability of echocardiography-based PAPI to predict outcomes of patients with acute pulmonary embolism (PE). Methods: A total of 177 patients (mean age 67 ± 15, 54.1% male) with acute PE were included in the study. PAPI was calculated based on measurements from standard transthoracic echocardiography. Results: 27% of patients needed oxygen support, 5.6% were on mechanical ventilation, and 7.3% were on inotropic support. The 30-day mortality rate in the whole cohort was 8.3%. Lower PAPI measurements were associated with increased 30-day mortality (p < 0.05), a higher rate of RV failure (p < 0.001), and the need for inotropic support (p < 0.05). There was no association between PAPI and the need for oxygen support (p = 0.59), mechanical ventilation (0.06), or length of stay (LOS) (p = 0.414). PAPI was superior to tricuspid annular plane systolic excursion (TAPSE) in predicting mortality and RV failure. Conclusions: Echocardiography-derived PAPI is feasible and superior over TAPSE in predicting RV failure and mortality among patients with acute PE. Full article

(This article belongs to the Special Issue Pulmonary Embolism—Current and Novel Approaches)

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Review

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16 pages, 1819 KB

Open AccessReview

The Surgical Management of Chronic Thromboembolic Pulmonary Hypertension

by Kevin C. McGann, Chen Chia Wang, John M. Trahanas, Swaroop Bommareddi, Brian Lima, Awab Ahmad, Clifford W. Chin, Ivan M. Robbins, Meredith E. Pugh, Anna R. Hemnes, Blake Funke, Ashish S. Shah and Aaron M. Williams

J. Clin. Med. 2025, 14(19), 6862; https://doi.org/10.3390/jcm14196862 - 28 Sep 2025

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Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension due to unresolved thromboembolic disease that presents with signs of pulmonary artery obstruction and right heart dysfunction. Pulmonary thromboendoarterectomy (PTE) with deep hypothermic circulatory arrest remains the standard of care for the treatment of CTEPH, with significant improvements in symptoms and functional status after surgery. This review outlines the diagnostic workup, considerations during operative planning, surgical technique, and postoperative management of CTEPH patients. Full article

(This article belongs to the Special Issue Pulmonary Embolism—Current and Novel Approaches)

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37 pages, 1686 KB

Open AccessReview

Intermediate-Risk Pulmonary Embolism: Patients’ Stratification, Prognosis, and Therapeutic Options—Time to Pay Attention to the Middle Child

by Sharon Shalom Natanzon, Mahmoud Mansour, Alexander Fardman, Fernando Chernomordik, Romana Herscovici, Shlomi Matetzky and Roy Beigel

J. Clin. Med. 2025, 14(17), 6215; https://doi.org/10.3390/jcm14176215 - 3 Sep 2025

Cited by 2 | Viewed by 5294

Abstract

Acute pulmonary embolism can range from being completely asymptomatic to causing life-threatening events, which underscores the importance of effective risk stratification. Intermediate-risk patients represent a distinct subgroup characterized by specific clinical, laboratory, and imaging features. Although the majority have favorable outcomes, a significant proportion may still experience adverse events, presenting an ongoing challenge in determining the optimal therapeutic approach. This comprehensive review explores the characteristics of intermediate-risk pulmonary embolism patients, focusing on key diagnostic and prognostic factors, current treatment practices, and the evolving role of novel, specifically catheter-directed interventions. We also provide an overview of current guideline recommendations and discuss recent advancements in the field. Full article

(This article belongs to the Special Issue Pulmonary Embolism—Current and Novel Approaches)

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