A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism

Bova, Carlo; Vanni, Simone; Prandoni, Paolo; Dentali, Francesco; Bernardi, Enrico; Mumoli, Nicola; Picariello, Claudio; Pesavento, Raffaele; Bottino, Fabrizio; Jiménez, David; Nazerian, Peiman; Viviani, Gabriele; Crocco, Francesco; Morelli, Gaetano; Barrios, Deisy; Quezada, Andrés; Morello, Fulvio; Arche, A. Dall'; Brescianini, Sonia; Sardo, Liborio; Stea, Francesco; Bucherini, Eugenio; Vastola, Marie E.; Barbar, Sofia; Roncon, Loris; Giatti, Sara; Enea, Iolanda; Puato, Massimo; Spinazzè, Alice; Poggioni, Claudio

doi:10.1016/j.thromres.2018.04.002

Cited by 41 publications

(20 citation statements)

References 16 publications

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“…Besides the modified FAST score, the Bova score was developed to identify patients at higher risk for adverse early events. Patients classified in class III (> 4 points, intermediate-high risk) had a rate of an adverse outcome of 29.2% in the derivation and of 42.0% and 7.5% in validation studies, respectively [ 7 – 9 ]. However, in the present study, the Bova score was not able to discriminate between patients at intermediate-low (4.7% in-hospital adverse outcome rate) and intermediate-high risk (4.4% in-hospital adverse outcome rate) and was associated with a lower sensitivity (29%) and a lower positive predictive value (4%) compared to the 2019 ESC algorithm (52% and 7%, respectively) and the modified FAST score (59% and 5%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…The algorithm for risk stratification proposed by the 2019 ESC guideline is characterized by complexity caused by the calculation of a clinical score (preferably the simplified Pulmonary Embolism Severity Index [sPESI]), laboratory testing and imaging procedures. Combination models such as the FAST [ 5 , 6 ] and the Bova score [ 7 – 9 ] were developed and validated to identify normotensive patients at highest risk of early PE-related complications (Table 1 ). Since the FAST score requires measurement of heart-type fatty acid-binding protein (H-FABP), a biomarker of myocardial injury, which is not routinely available in the majority of hospitals, we demonstrated that replacement of H-FABP by high-sensitivity troponin T (hsTnT) for calculation of the modified FAST score provides equivalent prognostic information in normotensive PE patients [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism

et al. 2020

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Background Recent studies demonstrate an improved prognostic performance of the 2014 European Society of Cardiology (ESC) algorithm for risk stratification of patients with pulmonary embolism (PE) compared to the 2008 ESC algorithm. The modified FAST and Bova scores appear especially helpful to identify PE patients at intermediate-high risk. Methods We validated the prognostic performance of the modified FAST score compared to other scores for risk stratification in a post-hoc analysis of 868 normotensive PE patients included in the prospective Italian Pulmonary Embolism Registry. In-hospital adverse outcome was defined as PE-related death, mechanical ventilation, cardiopulmonary resuscitation or administration of catecholamines. Results Overall, 27 patients (3.1%) had an adverse outcome and 32 patients (3.7%) died. The rate of an adverse outcome was highest in the intermediate-high risk classes of the 2019 ESC algorithm (7.5%) and the modified FAST score (5.3%) while the Bova score failed to discriminate between intermediate-low and intermediate-high-risk patients. Patients classified as intermediate-high risk by the 2019 ESC algorithm (Odds Ratio [OR], 4.2 [95% CI, 1.9-9.0]) and modified FAST score (OR, 2.8 [1.3-6.2]) had a higher risk of an adverse outcome compared to patients classified by the Bova score (OR, 1.6 [0.7-3.7]). The c-index was higher for the 2019 ESC algorithm and the modified FAST score (AUC, 0.69 [0.58-0.79] and 0.67 [0.59-0.76]) compared to the Bova score (AUC, 0.64 [0.55-0.73]). Conclusions The 2019 ESC algorithm provided the best prognostic performance, but also the modified FAST score accurately stratified normotensive PE patients in different risk classes while the Bova score failed to identify patients at highest risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism

et al. 2020

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“…Fortunately, our patient's hemodynamics including blood pressure stayed stable. He was carefully monitored in the intensive care unit with plans for further management including thrombolysis or thrombectomy in case he developed signs of hemodynamic instability [10,11]. With therapeutic heparin along with ventilator support for COVID-19, the patient gradually improved and his inflammatory markers trended down and was ultimately extubated.…”

Section: Discussionmentioning

confidence: 99%

Rare Presentation of Pulmonary Embolism Amidst Coronavirus Disease 2019 Era: Utility of Multiorgan Ultrasonography

Ahmed¹,

Ahmed²,

Kumar

et al. 2020

Cureus

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Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) is the underlying cause of a global crisis that the entire world is facing. It is a highly contagious viral infection, which is why social distancing seems to be effective. Its ability to survive on various surfaces and aerosolize necessitates very meticulous precautions, including airborne isolation for severely ill patients requiring mechanical ventilation. However, these patients may need routine diagnostic investigations including chest computed tomography and chest tomography angiogram scans (CT and CTA) to rule out other potential differential diagnoses and guide management. In this case, we focus on the utility of multiorgan ultrasonography (MOU) at the bedside to diagnose and manage pulmonary embolism (PE) in COVID-19 patients.

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“…recently validated in a prospective study: Patients classified in stage III (>4 points, intermediate-high-risk) had a 6.5-fold increased risk for an adverse outcome (95% CI 3.1-13.5; p<0.001) as compared to patients stratified to stages I or II [29]. In the present study, patients classified to stage III by the Bova score had a 2.6-fold increased risk for an in-hospital adverse outcome.…”

Section: Discussionmentioning

confidence: 99%

Definition of tachycardia for risk stratification of pulmonary embolism

Hobohm

Becattini

Ebner

et al. 2020

European Journal of Internal Medicine

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Background: Tachycardia is a reliable predictor of adverse outcomes in normotensive patients with acute pulmonary embolism (PE). However, different prognostic relevant heart rate thresholds have been proposed. The aim of the study was to investigate the prognostic performance of different thresholds used for defining tachycardia in normotensive PE patients. Methods: We performed a post-hoc analysis of normotensive patients with confirmed PE consecutively included in a single-centre and a multi-centre registry. An adverse outcome was defined as PE-related death, need for mechanical ventilation, cardiopulmonary resuscitation or administration of catecholamines. Results: Of 1567 patients (median age: 72 [IQR, 59-79] years; females: 46.1%) included in the analysis, 78 patients (5.0%) had an in-hospital adverse outcome. The rate of an adverse outcome was higher in patients with a heart rate ≥100 bpm (7.6%) and ≥110 bpm (8.3%) compared to patients with a heart rate <100 bpm (3.0%). A heart rate ≥100 bpm and ≥110 bpm was associated with a 2.7 (95% CI 1.7-4.3) and 2.4-fold (95% CI 1.5-3.7) increased risk for an adverse outcome, respectively. Receiver operating characteristics analysis revealed a similar area under the curve with regard to an adverse outcome for all scores and algorithm (ESC 2019 algorithm, modified FAST and Bova score) if calculated with a heart rate threshold of ≥100 bpm or of ≥110 bpm. Conclusions: Defining tachycardia by a heart rate ≥100 bpm is sufficient for risk stratification of normotensive patients with acute PE. The use of different heart rate thresholds for calculation of scores and algorithm does not appear necessary.

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A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism

Cited by 41 publications

References 16 publications

Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism

Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism

Rare Presentation of Pulmonary Embolism Amidst Coronavirus Disease 2019 Era: Utility of Multiorgan Ultrasonography

Definition of tachycardia for risk stratification of pulmonary embolism

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