Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Hariharan, Praveen; Giordano, N.; Muzikansky, Alona; Kabrhel, Christopher

doi:10.1016/j.ijcard.2021.01.057

Cited by 5 publications

(5 citation statements)

References 48 publications

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“…This was consistent with the study of D Jiménez et al which included 23,858 patients with acute PE enrolled in the RIETE registry between 2001 and 2013 [25]. Additionally, the IPER registry and P Hariharan et al reported a significant association between recent major surgery and massive PE [26,27].…”

Section: Discussionsupporting

confidence: 88%

Association between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients with Acute Pulmonary Embolism

Sroor

Shaban²,

Elmasry³

et al. 2022

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Background: Acute right ventricular dysfunction (RVD) is a leading cause of death in the setting of acute pulmonary embolism (PE). Therefore, several studies investigated the predisposing factors of RVD. However, at present, little is known about the clinical predictors of RVD in the patients presented with acute PE. Objective: To assess the association of CHA2DS2-VASc Score with the PE severity, RVD and the in-hospital mortality in patients presented with acute PE. Methods: This study was conducted on 50 patients admitted with acute PE at Tanta University Hospitals. We studied the association of different variables including demographic data, common risk factors, clinical presentation, management and the in-hospital mortality with the PE clinical subgroups (massive, sub-massive and non-massive) based on the severity of clinical presentation and also the association of these variables with the thromboembolic risk (high, moderate and low) based on the CHA2DS2-VASc scores. The independent predictors of the RVD were then investigated by the univariate and multivariate regression analyses. Results: The massive PE presentation was associated with higher CHA2DS2-VASc scores (P value = 0.02). Also, the incidence of RVD was higher among the high risk group of patients (CHA2DS2-VASc scores ≥3) with P value = 0.009. TAPSE, MPI, FAC, and E`/A` ratio were found to be more significant in the high risk group (P value = 0.032, 0.002, 0.007 and 0.001), respectively. The independent predictors of RVD were demonstrated to be tachycardia, lower systolic blood pressure and CHA2DS2-VASc score (P value = 0.022, 0.007, 0.021), respectively. The CHA2DS2-VASc score predicted the presence of RVD with 66.7 % sensitivity and 78.6% specificity as demonstrated by the receiver operating characteristic (ROC) analysis, with area under the curve (AUC) of 0.776 (CI 0.636-0.882, P value < 0.001). This study demonstrated no statistically significant difference between the different risk groups regarding the in-hospital mortality. Conclusion: Being independent of other factors, the CHA2DS2-VASc score can be used as a new, simple, and reliable tool to predict the development of RVD in patients with acute PE.

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Section: Discussionsupporting

confidence: 88%

Association between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients with Acute Pulmonary Embolism

Sroor

Shaban²,

Elmasry³

et al. 2022

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“…Second, prognostic classification, which is related to severity, is more important in the clinic. 16 However, the limited numbers of patients with massive PE in our center limited the subgroup assignments in our study. Third, 50 patients who were confirmed to undergo both PE and LEDVT were not included because of missing and incomplete data.…”

Section: Discussionmentioning

confidence: 96%

Association Between Inferior Vena Cava-Involved Thrombosis, Severe Iliac Vein Stenosis, and Proximal Pulmonary Embolism in Patients With Deep Vein Thrombosis

Gong

Shi

Kong

et al. 2023

Clin Appl Thromb Hemost

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To investigate the possible risk factors for proximal pulmonary embolism (PE) in patients with lower extremity deep vein thrombosis (LEDVT). A single-center, retrospective cohort study was conducted. Consecutive patients diagnosed with unilateral LEDVT and confirmed PE by computed tomography (CT) pulmonary angiography and indirect CT venography between September 2015 and January 2022 were included. Patient demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed to determine the univariable and multivariable associations. The associations between thrombus location, stenosis, and proximal PE were assessed using a stratified analysis. A total of 115 eligible patients (60.08 ± 15.18 years, 59.1% male) were included. Of these patients, 40 (34.8%) were in the proximal PE group (proximal thrombus involved main or lobar pulmonary artery), and 75 (65.2%) were in the distal PE group (without main and labor pulmonary artery involvement). The univariable analysis showed that onset time of LEDVT symptoms ≤ 7 days ( P = .041), inferior vena cava (IVC) involvement ( P = .035), and severe iliac vein stenosis (IVS) (stenosis ratio > 61.3%) ( P = .010) were associated with the occurrence of proximal PE. Further multivariant analysis showed that IVC involvement was associated with an increased odds of proximal PE (OR: 4.45, 95% CI: 1.083 − 18.248, P = .038), whereas severe IVS (stenosis ratio > 61.3%) was associated with a decreased odds of proximal PE (OR: 0.294, 95% CI: 0.110-0.783, P = .014). Among patients with unilateral LEDVT, IVC involvement increased the risk of proximal PE; patients with severe IVS (stenosis ratio > 61.3%) had a lower risk of developing proximal PE compared with distal PE; and severe IVS seemed to be a protective factor for proximal PE.

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“…[18] The embolism theory is limited by the transient nature of certain BCIS transients, thereby reducing its explanatory power. [14] Similarly, the anaphylactic reaction theory is hindered by the inability of histamine antagonists to prevent BCIS development [15] and the absence of mast cell activation during autopsy, [20] questioning its validity. Furthermore, the concentration of bone cement monoliths in the bloodstream is insufficient to induce cardiovascular symptoms, further limiting the plausibility of this theory.…”

Section: The Pmma Toxicity Hypothesismentioning

confidence: 99%

“…Most BCIS occurs within 3 minutes (mucous filament phase), which is significantly different from the time of occurrence of pulmonary embolism. [ 2 , 14 ] The embolization theory is difficult to convince all researchers, but right ventricular failure secondary to elevated pulmonary arterial pressure is thought to be the primary cause of systemic hypotension and cardiac arrest. [ 15 ]…”

Section: The Pathogenesis Of Bcismentioning

confidence: 99%

Study of the cement implantation syndrome: A review

Yang,

Meng,

Huang

2024

Medicine

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Bone cement implantation syndrome (BCIS) is a critical and potentially life-threatening condition that manifests during implantation. Characterized by a constellation of symptoms, including hypoxemia, hypotension, cardiac arrhythmias, elevated pulmonary vascular resistance, and occasionally cardiac arrest, BCIS typically ensues shortly after cement introduction, albeit with rare instances of delayed onset. Primarily attributed to the exothermic reaction of bone cement implantation, this syndrome is caused by local tissue damage, histamine and prostaglandin release, and microemboli formation, ultimately triggering a systemic immune response that culminates in respiratory and circulatory failure. The current hypotheses regarding BCIS include embolism, allergic reactions, and cement autotoxicity. BCIS management emphasizes preventative strategies, encompassing meticulous patient risk assessment, comprehensive preoperative and intraoperative evaluations, and precise cement application techniques. Treatment primarily involves symptomatic therapy and life-support measures to address the systemic effects of the syndrome.

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Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Cited by 5 publications

References 48 publications

Association between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients with Acute Pulmonary Embolism

Association between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients with Acute Pulmonary Embolism

Association Between Inferior Vena Cava-Involved Thrombosis, Severe Iliac Vein Stenosis, and Proximal Pulmonary Embolism in Patients With Deep Vein Thrombosis

Study of the cement implantation syndrome: A review

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