Complications in Patients with Pulmonary Embolism

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (1 March 2025) | Viewed by 1173

Special Issue Editor


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Guest Editor
Department of Clinical Medicine, Department of Anesthesiology and Intensive Care, Aarhus University, Aarhus, Denmark
Interests: acute pulmonary embolism; hemodynamics; right ventricular function; cardiorespiratory interaction; pulmonary hypertension; anesthesia; intensive care medicine

Special Issue Information

Dear Colleagues,

Acute pulmonary embolism is a frequent condition with a large impact on patients’ morbidity and mortality, as well as high costs to health care systems. Complex interactions between the right ventricle and the pulmonary circulation cause V/Q mismatch, hypoxia, and increased pulmonary vascular resistance. In more severe cases, this progresses to right ventricular failure and death, making acute pulmonary embolism the third most common cause of cardiovascular death.

Treatment options span from simple, oral anticoagulation to systemic thrombolysis or advanced therapies including surgical embolectomy, ECMO, or catheter-directed therapies. The latter are especially emerging in recent years. However, such interventions may have side effects or procedural complications. And, among survivors, life may not return to previous standards as patients can suffer from reduced cardiopulmonary capacity with dyspnea and fatigue or psychological late effects. Furthermore, a number of patients will develop chronic thromboembolic pulmonary hypertension, a pathogenesis still not well understood, but which leads to chronic affection of the right ventricular to pulmonary artery coupling.

In this Special Issue, we invite worldwide studies complications to patients with pulmonary embolism, including—but not limited to—studies on pulmonary or cardiac injury, procedure-related complication and therapeutic side effects, challenges in the anesthetic and intensive care managements of patients with pulmonary embolism, and long-term physiological, pathological, and psychological complications. All types of manuscripts are welcome, including full-length original papers, reviews, and preclinical investigations on realistic models deciphering pathophysiological complications to pulmonary embolism.

We look forward to your contributions to this Special Issue on pulmonary embolism.

Dr. Mads Dam Lyhne
Guest Editor

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Keywords

  • right ventricular injury
  • pulmonary vascular injury
  • right ventricle to pulmonary artery uncoupling
  • cardiopulmonary functional impairment
  • ventilatory support/mechanical ventilation
  • anesthetic management
  • CTEPH development
  • bleeding
  • procedure-related complications
  • psychological distress

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Published Papers (1 paper)

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Research

12 pages, 488 KiB  
Article
Pulmonary Artery Pulsatility Index in Acute and Chronic Pulmonary Embolism
by Mads Dam Lyhne, Eugene Yuriditsky, Vasileios Zochios, Simone Juel Dragsbaek, Jacob Valentin Hansen, Mads Jønsson Andersen, Søren Mellemkjær, Christopher Kabrhel and Asger Andersen
Medicina 2025, 61(2), 363; https://doi.org/10.3390/medicina61020363 - 19 Feb 2025
Viewed by 789
Abstract
Background and Objectives: The pulmonary artery pulsatility index (PAPi) is an emerging marker of right ventricular (RV) injury but has not been well investigated in acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to investigate its discriminatory capabilities [...] Read more.
Background and Objectives: The pulmonary artery pulsatility index (PAPi) is an emerging marker of right ventricular (RV) injury but has not been well investigated in acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to investigate its discriminatory capabilities and ability to detect therapeutic effects in acute PE and CTEPH. Materials and Methods: This was a secondary analysis of data from both experimental studies of autologous PE and human studies of acute PE and CTEPH. PAPi was calculated and compared in (1) PE versus sham and (2) before and after interventions aimed at reducing RV afterload in PE and CTEPH. The correlations between PAPi, cardiac output, and RV to pulmonary artery coupling were investigated. Results: PAPi did not differ between animals with acute PE versus sham, nor was it affected by clot burden (p = 0.673) or at a 30-day follow-up (p = 0.242). Pulmonary vasodilatation with oxygen was associated with a reduction in PAPi (4.9 [3.7–7.8] vs. 4.0 [3.2–5.6], p = 0.016), whereas positive inotropes increased PAPi in the experimental PE. In humans, PAPi did not change consistently with interventions. Balloon pulmonary angioplasty did not significantly increase PAPi (6.5 [4.3–10.7] vs. 9.8 [6.8–14.2], p = 0.1) in patients with CTEPH, and a non-significant reduction in PAPi (4.3 ± 1.6 vs. 3.3 ± 1.2, p = 0.074) was observed in patients with acute PE who received sildenafil. PAPi did not correlate well with cardiac output or measures of RV to pulmonary artery coupling in either species. Conclusions: PAPi did not detect acute, experimental PE or changes as a result of therapeutic interventions in patients with hemodynamically stable acute PE or CTEPH. However, it did change with pharmacological interventions in the experimental PE. Further research should establish its utility in detecting and monitoring RV injury in different clinical phenotypes of acute PE and CTEPH. Full article
(This article belongs to the Special Issue Complications in Patients with Pulmonary Embolism)
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