2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Konstantinides, Stavros; Meyer, Guy; Becattini, Cecilia; Bueno, Héctor; Geersing, Geert‐Jan; Harjola, Veli‐Pekka; Huisman, Menno V.; Humbert, Marc; Jennings, Catriona; Jiménez, David; Kucher, Nils; Lang, Irene; Lankeit, Mareike; Lorusso, Roberto; Mazzolai, Lucia; Meneveau, Nicolas; Áinle, Fionnuala Ní; Prandoni, Paolo; Pruszczyk, Piotr; Righini, Marc; Torbicki, Adam; Belle, Éric Van; Zamorano, José Luís

doi:10.1183/13993003.01647-2019

Cited by 1,465 publications

(2,424 citation statements)

References 505 publications

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“…However, the best management of PE during pregnancy is still being debated (80). Non-contrast CMR using bright blood techniques such as balanced steady-state free precession sequences may be also considered as a viable alternative approach for ruling out PE in selected cases (81)(82)(83).…”

Section: Cardiac Imaging Modalities With Ionizing Radiationmentioning

confidence: 99%

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

Ricci

Innocentiis

Verrengia

et al. 2020

Front. Cardiovasc. Med.

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Ricci et al. Multimodality Imaging in Peripartum Cardiomyopathy KEY POINTS-Peripartum cardiomyopathy is a rare but potentially fatal disease requiring prompt identification and treatment. -Cardiac imaging plays a pivotal role for the diagnosis, risk stratification, and follow-up of peripartum cardiomyopathy and related complications. -Cardiovascular magnetic resonance is a high-throughput imaging modality providing relevant information for clinical decision-making and understanding of the pathophysiology underlying peripartum cardiomyopathy.

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Section: Cardiac Imaging Modalities With Ionizing Radiationmentioning

confidence: 99%

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

Ricci

Innocentiis

Verrengia

et al. 2020

Front. Cardiovasc. Med.

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“…Surgical pulmonary embolectomy is recommended for patients with high-risk PE in whom thrombolysis is contraindicated or has failed according to the ESC guidelines. [4] The patients with high-risk (17.8%) or intermediate-high-risk (82.2%) PE who underwent surgical embolectomy were evaluated retrospectively. [28] The mortality rate in the hospital was between 11.7% and 32.1% for the patients experiencing preoperative cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with PE, highrisk markers include increased troponin and brain natriuretic peptide (BNP), RV dysfunction (RVD), and hemodynamic instability. [4] The prognosis of high-risk PE patients is poor and mortality rates reach up to 65%. [4] These patients should be treated appropriately with thrombolytic therapy or emergency interventional therapies.…”

mentioning

confidence: 99%

“…[4] The prognosis of high-risk PE patients is poor and mortality rates reach up to 65%. [4] These patients should be treated appropriately with thrombolytic therapy or emergency interventional therapies. However, the treatment of intermediatehigh-risk PE patients still remains controversial.…”

mentioning

confidence: 99%

“…In this study, we aimed to evaluate the efficacy and the safety of the EKOS applications in patients hospitalized with intermediate-high-risk PE. [4] Only patients with intermediate-high-risk PE were included in the study. All patients included in the study had RVD on echocardiography and elevated cardiac biomarker levels (particularly a positive cardiac troponin test).…”

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confidence: 99%

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Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

Şaylan

Çalışkan

Canoğlu

et al. 2020

Turk Gogus Kalp Dama

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Bu çalışmada, orta-yüksek riskli pulmoner emboli tanısıyla hastaneye yatırılan hastalardaki EkoSonic™ endovasküler sistem uygulamalarının etkinliği ve güvenliliği değerlendirildi. Ça lış ma pla nı: Ocak 2018-Mart 2019 tarihleri arasında, pulmoner emboli nedeniyle EkoSonic™ endovasküler sistemi kullanılarak ultrasonografi ile hızlandırılmış tromboliz yapılan toplam 15 hasta (7 erkek, 8 kadın; ort. yaş 64.7±17.8 yıl; dağılım, 35-90 yıl) retrospektif olarak incelendi. Pulmoner emboli tanısı, pulmoner bilgisayarlı tomografi anjiyografi ile konuldu. Hastaların tümü sağ ventrikül disfonksiyonu açısından ekokardiyografi ile değerlendirildi ve serum troponin I ve beyin natriüretik peptid düzeyleri kaydedildi. Bul gu lar: Hastaların işlem öncesinde ve sonrasında ortalama arteriyel kan gazı oksijen satürasyon değerleri sırasıyla %86.3±3.5 ve %94.2±2.5 olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). İşlem öncesinde ve sonrasında ortalama parsiyel oksijen basıncı değerleri 73.3±7.7 mmHg ve 90.7±5.0 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). İşlem öncesinde ve sonrasında ortalama sağ ventrikül çapı açısından da istatistiksel olarak anlamlı bir fark vardı (p= 0.001). İşlem öncesinde ve sonrasında ortalama pulmoner arter basıncı sırasıyla 44±7.1 mmHg ve 36.3±4.5 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p= 0.001). Hastaların %93.7'sinde işlem sonrasında komplikasyon gözlenmedi. So nuç: EkoSonic™ endovasküler system orta-yüksek riskli pulmoner emboli hastalarında kanama riskinde bir artışa neden olmaksızın sağ ventrikül disfonksiyonunu iyileştirdi; pulmoner arter basıncını azalttı ve oksijenasyonu düzeltti. Anah tarsöz cük ler: EkoSonic™ endovasküler sistem, pulmoner emboli, ultrasonografi ile hızlandırılmış tromboliz.

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Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism

Freund

Chauvin

Jiménez

et al. 2021

JAMA

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IMPORTANCE Uncontrolled studies suggest that pulmonary embolism (PE) can be safely ruled out using the YEARS rule, a diagnostic strategy that uses varying D-dimer thresholds.OBJECTIVE To prospectively validate the safety of a strategy that combines the YEARS rule with the pulmonary embolism rule-out criteria (PERC) rule and an age-adjusted D-dimer threshold. DESIGN, SETTINGS, AND PARTICIPANTSA cluster-randomized, crossover, noninferiority trial in 18 emergency departments (EDs) in France and Spain. Patients (N = 1414) who had a low clinical risk of PE not excluded by the PERC rule or a subjective clinical intermediate risk of PE were included from October 2019 to June 2020, and followed up until October 2020.INTERVENTIONS Each center was randomized for the sequence of intervention periods. In the intervention period (726 patients), PE was excluded without chest imaging in patients with no YEARS criteria and a D-dimer level less than 1000 ng/mL and in patients with 1 or more YEARS criteria and a D-dimer level less than the age-adjusted threshold (500 ng/mL if age <50 years or age in years × 10 in patients Ն50 years). In the control period (688 patients), PE was excluded without chest imaging if the D-dimer level was less than the age-adjusted threshold. MAIN OUTCOMES AND MEASURESThe primary end point was venous thromboembolism (VTE) at 3 months. The noninferiority margin was set at 1.35%. There were 8 secondary end points, including chest imaging, ED length of stay, hospital admission, nonindicated anticoagulation treatment, all-cause death, and all-cause readmission at 3 months. RESULTSOf the 1414 included patients (mean age, 55 years; 58% female), 1217 (86%) were analyzed in the per-protocol analysis. PE was diagnosed in the ED in 100 patients (7.1%). At 3 months, VTE was diagnosed in 1 patient in the intervention group (0.15% [95% CI, 0.0% to 0.86%]) vs 5 patients in the control group (0.80% [95% CI, 0.26% to 1.86%]) (adjusted difference, −0.64% [1-sided 97.5% CI, −ϱ to 0.21%], within the noninferiority margin). Of the 6 analyzed secondary end points, only 2 showed a statistically significant difference in the intervention group compared with the control group: chest imaging (30.4% vs 40.0%; adjusted difference, −8.7% [95% CI, −13.8% to −3.5%]) and ED median length of stay (6 hours [IQR, 4 to 8 hours] vs 6 hours [IQR, 5 to 9 hours]; adjusted difference, −1.6 hours [95% CI, −2.3 to −0.9]).CONCLUSIONS AND RELEVANCE Among ED patients with suspected PE, the use of the YEARS rule combined with the age-adjusted D-dimer threshold in PERC-positive patients, compared with a conventional diagnostic strategy, did not result in an inferior rate of thromboembolic events.

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2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Abstract: Supplementary data with additional supplementary tables complementing the full text, as well as section 11 on non-thrombotic PE, are available from erj.ersjournals.com The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website

Cited by 1,465 publications

References 505 publications

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism

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