Doubts and certainness in diagnosis of pulmonary embolism in the elderly

Masotti, Luca; Landini, Giancarlo; Cappelli, Roberto; Rottoli, Paola

doi:10.1016/j.ijcard.2005.07.067

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…Many doubts and little certainty still exist. Massotti et al [2] reported results from 7 studies involving PE in elderly patients and showed an important variability in clinical presentation among patients. Indeed, advanced age, for suspected PE.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary arteriography for pulmonary embolism diagnosis: “Old-fashioned”, but it is still a valuable diagnostic tool

Cardoso

Rodrigues

Cardoso

et al. 2008

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Pulmonary arteriography for pulmonary embolism diagnosis: “Old-fashioned”, but it is still a valuable diagnostic tool

Cardoso

Rodrigues

Cardoso

et al. 2008

International Journal of Cardiology

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“…Nel paziente anziano il processo diagnostico dell'EP presenta molti dubbi e poche certezze [19]. Nel paziente anziano la presentazione clinica dell'EP è infatti ancor meno specifica che nel giovane adulto e [19] spesso atipica, rendendo la diagnosi difficile e in molti casi tardiva o addirittura omessa ed effettuata, negli eventi fatali, al tavolo autoptico.…”

Section: Diagnosi DI Embolia Polmonare Nell'anziano E Applicabilità Cunclassified

“…Nel paziente anziano la presentazione clinica dell'EP è infatti ancor meno specifica che nel giovane adulto e [19] spesso atipica, rendendo la diagnosi difficile e in molti casi tardiva o addirittura omessa ed effettuata, negli eventi fatali, al tavolo autoptico. Pertanto il sospetto clinico di EP in un paziente anziano può non essere immediato e ciò può contribuire a ritardi o errori diagnostici.…”

Section: Diagnosi DI Embolia Polmonare Nell'anziano E Applicabilità Cunclassified

“…Questa frequente comorbidità influenza il punto chiave del processo decisionale diagnostico dell'EP, come detto rappresentato dalla stima della PTP e dal dosaggio conseguente del D-dimero. In Tabella VI vengono esposti i risultati principali di una recente revisione sulla presentazione clinica dell'EP nell'anziano [19]. Due recenti evidenze della letteratura hanno mostrato che la percentuale di pazienti con alta PTP aumenta con l'aumentare dell' età mentre la percentuale di pazienti con l'associazione non alta PTP/D-dimero negativo si riduce progressivamente nelle classi di età più avanzata, raggiungendo percentuali inferiori al 15% sopra i 75 anni [22,23].…”

Section: Diagnosi DI Embolia Polmonare Nell'anziano E Applicabilità Cunclassified

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Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

Masotti

Landini

Antonelli

et al. 2007

CMI

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L'applicabilità clinica del D-dimero nella diagnosi di embolia polmonare si riduce nei pazienti anziani CASO CLINICO 1Una donna di 77 anni venne ricoverata per riferita sincope preceduta da prodromi lipotimici associata a dolore lombosciatalgico sinistro non responsivo a nimesulide. In anamnesi si evidenziava un pregresso episodio di embolia polmonare acuta dopo intervento ortopedico al ginocchio sinistro 4 anni prima e safenectomia bilaterale circa 20 anni prima. La paziente era affetta da coxartrosi sinistra in trattamento con FANS, ipertensione arteriosa in trattamento con sartani e ipercolesterolemia in trattamento con statine. All'ingresso in reparto la donna era vigile, collaborante e non presentava deficit neurologici. L'esame obiettivo generale risultava nella norma per quanto riguarda gli apparati cardiovascolare, respiratorio e digerente. Non si evidenziavano segni clinici di trombosi venosa profonda (TVP) agli arti

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“…Moreover WBC and D-Dimer count were significantly higher in patients who died, while CRP and ESR were higher in survivors. nosis of PE in the elderly, many doubts exist (11). One of the most important doubts is the role of D-Dimer: few elderly patients in fact have D-Dimer below a cut-off of 500 ng/mL, value by which it should be safely possible to exclude PE in clinical low probability pre-test patients.…”

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confidence: 99%

C-Reactive Protein in Elderly Patients With Suspected and Confirmed Pulmonary Embolism

Masotti

Cappelli

2007

Clin Appl Thromb Hemost

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Recent scientific evidence has indicated that inflammation plays a fundamental role in all stages of atherosclerosis. Many reports contend that atherosclerosis could represent a chronic phlogistic disorder and its exacerbations could determine acute cardiovascular and cerebrovascular events. C-reactive protein (CRP) is the prototype of the acute phase of inflammation, so it is used as a biochemical marker in the studies demonstrating the relationship between inflammation and atherosclerosis in all its manifestations, both cardiovascular and cerebrovascular (1,3). Few data refer to the relation between the acute phase of inflammation, especially for CRP, and venous thromboembolic disease (VTD). In a prospective study, CRP, fibrinogen, and white blood cell (WBC) count were not associated with risk of venous thromboembolism in healthy subjects during a mean follow-up of about 8 years (4). Moreover, no association between CRP polymorphism/haplotypes and the risk of thromboembolism was observed (5). In another study, CRP did not provide additional information about the diagnosis of deep vein thrombosis and differential diagnosis with inflammatory diseases (6), while in another one it was demonstrated that CRP increases in the first day of admission for deep venous thrombosis (DVT) with a decline in the next days, demonstrating that inflammation could be the result of DVT rather than the cause (7). Steeghs and colleagues conclude that CRP could be used alone or combined with a model of pre-test clinical probability to safely exclude pulmonary embolism (PE) (8). In disagreement with these results, Aujesky and colleagues in a previous study had concluded that CRP cannot safely exclude PE when used alone

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Doubts and certainness in diagnosis of pulmonary embolism in the elderly

Cited by 6 publications

References 28 publications

Pulmonary arteriography for pulmonary embolism diagnosis: “Old-fashioned”, but it is still a valuable diagnostic tool

Pulmonary arteriography for pulmonary embolism diagnosis: “Old-fashioned”, but it is still a valuable diagnostic tool

Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

C-Reactive Protein in Elderly Patients With Suspected and Confirmed Pulmonary Embolism

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