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Background Acute pulmonary embolism (PE) is a life-threatening disease and an early diagnosis and herapy are crucial. Several parameters for risk stratification have been evaluated and it's important to assess their impact on clinical practice. Objective We assessed four different parameters (clinical, echocardiographic, analytical and anatomical imaging parameters) - PESI class; PESI-Echo score; lactate and troponin I values and central or peripheral thrombi location. We determined a composite outcome of adverse events: shock, acute ventilatory failure, severe bleeding events or in-hospital mortality. Methods Retrospective single center analysis including 131 patients admitted for PE. Results Mean age of 67.6 ± 15.3 years-old and 71% patients were female. Eighty patients (63.4%) had arterial hypertension, 27.4% had a recent hospitalization or surgery and 16% an active neoplasm disease. According to the PESI classification, 29.8% of the patients were in class V, 26.7% in class III and 17.6% in class II. This classification had a weak positive correlation with the outcome (P < 0.001; r = 0.37) as PESI-Echo score (p 0.018; r = 0.36). The majority (72.2%) of the in-hospital adverse events occurred in PESI class V patients. Analytic parameters determined at hospital admission had a good discriminative power to predict the outcome, mainly lactate value (AUC 0.864; P < 0.001). PESI-Echo score presented the best discriminative power (AUC 1.0), followed by PESI class (AUC 0.925) and lactate (AUC 0.856). The cut-off value for PESI-Echo was 211. Conclusion The association of clinical and echocardiographic parameters was superior as a predictor of adverse events when compared with their isolated use.

Background Acute pulmonary thromboembolism (PE) is a life-threatening disease. Cardiac biomarkers like lactate, NT-proBNP and troponin I have been reported to predict prognosis of acute PE however, the prognostic importance of these factors on long-term mortality is not known. Objectives To assess the prognostic role of biomarkers lactate, NT-proBNP and troponin I in acute PE. Methods: We retrospectively assessed 131 consecutive patients diagnosed with acute PE. Prognostic impact of both lactate, NT-proBNP and troponin was assessed. Results Out of 131 patients with acute PE, the median age was 67.6 ± 15.3 years and 71.0% were female. Mean follow-up was 44.8 ± 37.3 months. Overall in-hospital mortality was 8.4%, 30-day mortality 13.0% and 1-year mortality 20.6%. Twenty-six patients (19.8%) had a recent hospitalization and 21 (16.0%) a medical history of active cancer. ROC curves shown that lactate has a good discriminatory power for in-hospital mortality, with an area under the curve (AUC) of 0.84 and p-value 0.001, unlike NT-proBNP (AUC 9.45, p-value 0.76) and troponin (AUC 0.64, p-value 0.12). Serum lactate equal or superior to 2.05 mmol/L were associated with higher in-hospital mortality (odds ratio [OR] 23.1, 95% confidence interval (CI) 2.8–187.7), when compared with lower levels. The impact of this parameter was independent of hypotension, tachycardia or active neoplasia (p-value 0.006, OR 21.3, 95% CI 2.4–187.3). Conclusions This study revealed that lactate has a better discriminatory power when compared to NT-proBNP and troponin in predicting prognosis in acute PE patients. Its routinely addition to current stratification tools could be of interest.

Introduction Left ventricular thrombi may develop as a complication of myocardial infarction. Transthoracic echocardiography (TTE) has a low sensitivity for thrombus detection and other imaging methods are usually required. Case report A 32-years-old man with a past medical history of smoking habits, obesity and a ST-segment elevation myocardial infarction (STEMI) diagnosed on December 2017. Primary angioplasty was performed with stent implantation in the anterior descending coronary artery. TTE revealed severe systolic dysfunction (SD) and an apical aneurysm with thrombus formation. Six months after anticoagulation with warfarin, a cardiac magnetic resonance revealed thrombus resolution and it was decided to stop warfarin. On September 2021, the patient presented to the Emergency Department referring sudden chest pain. The electrocardiogram showed an anterior STEMI and in the Cath Lab a late stent thrombosis was evident. TTE revealed a severe SD and akinesia of apical segments (poor acoustic window). On the 3rd day of hospital stay, the patient developed backache and Murphy´s punch sign. Imaging workup was suggestive of right renal infarction. At this time, the suspicion of embolic source arises, and the patient underwent contrast echocardiography demonstrating a filling defect suggestive of an apical thrombus. Therapy with warfin was reinitiated concomitantly with dual antiplatelet therapy. Conclusion This is a particular case of an apical thrombus formation occurring twice in a young patient. There is a lack of evidence about the adequate screening methods and therapeutic approach. More cases need to be reported to understand the best approach in each case to minimize complications.