Factors determining clot resolution in patients with acute pulmonary embolism

Choi, Kang-Duk; Cha, Seung‐Ick; Shin, Kyung-Min; Lim, Jae‐Kwang; Yoo, Seung Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang‐Ho; Park, Jae Yong; Lee, Won-Kee

doi:10.1097/mbc.0000000000000425

Cited by 18 publications

(19 citation statements)

References 19 publications

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“…TGF beta is being activated by natural thrombolysis and is also present in the thrombus, promoting fibrosis of the vein wall. Therefore, early injury of the vein wall is associated with an active remodeling of the matrix which seems to promote fibrosis [30,34]. in pulmonary embolism activates MMP-2 and MMP-9.…”

Section: The Role Of Inflammatory Markers In Thrombus Resolutionmentioning

confidence: 99%

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Cocoi

Pop

Cocoi³

et al. 2017

Revista Romana De Medicina De Laborator

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Inflammation of the venous wall is involved in thrombogenesis, thrombus resolution, wall remodeling and the post-thrombotic syndrome. Different mechanisms are involved in both arterial and venous thrombosis and patients with atherothrombosis hold a higher risk of venous thrombosis. Although inflammation may represent the connection between arterial and venous thrombosis, it is not yet sure if it is the cause or consequence of venous thrombosis. Consequently, the relationships between inflammation markers as indicators of the inflammatory process and clinical venous thromboembolism need to be investigatd. For example, inflammation mediators such as the pro-inflammatory cytokines interleukin 8 (IL-8), IL-6, monocyte chemotactic protein 1 (MCP-1), C Reactive Protein (CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), matrix metalloproteinases and tumor necrosis factor alpha (TNF alpha)

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Section: The Role Of Inflammatory Markers In Thrombus Resolutionmentioning

confidence: 99%

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Cocoi

Pop

Cocoi³

et al. 2017

Revista Romana De Medicina De Laborator

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“…Of these, only Pesavento reported that the persistence of perfusion defects after 3 years of initial TED correlates with combined endpoint of CTEPH development + TED recurrence 5 . No remaining studies have shown any statistically significant correlation of persistent defects with higher incidence of recurrence of pulmonary embolism 9 or unfavourable patient outlook 10 . Similarly, our study, despite revealing a correlation of persisting perfusion defects with higher systolic pressure in the pulmonary artery, did not find any correlation of these defects with enlarged right heart compartments, with decreased right ventricular function or with functional abilities evaluated as NYHA class.…”

Section: Discussionmentioning

confidence: 99%

“…6,8,9 ). Only 3 published studies have examined the effect of persistent perfusion disorders in relation to clinical endpoints 5,9,10 . Of these, only Pesavento reported that the persistence of perfusion defects after 3 years of initial TED correlates with combined endpoint of CTEPH development + TED recurrence 5 .…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] ) or presence of central thrombi during initial CT scan 10 . Various studies highlight mostly the following clinical risk factors: Personal history of cardiovascular disease 9 or of thromboembolic disease (OR 2.06 -2.6) (ref.…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly reported risk factors of incomplete reperfusion traditionally include the severity of the initial PE expressed as the obstruction index [6][7][8][9] , presence of central emboli and right ventricular enlargement on the initial CT scan 10 . The aim of our multicentric study was prospective monitoring of the reperfusion of the pulmonary arteries after the first pulmonary embolism event and correlating the results of such monitoring to laboratory results taken at the time of the initial PE and to clinical risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Reperfusion after pulmonary embolism - long-term follow-up, risk factors, clinical impact

Mrózek¹,

Petrova²,

Vaclavkova³

et al. 2018

BIOMED PAP

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Background and Aim. Thromboembolic disease is the third most common cardiovascular disorder and deep vein thrombosis carries the risk of pulmonary embolism (PE). Questions related to reperfusion after PE remain, especially risk factors. Incomplete reperfusion after PE is closely related to the development of chronic thromboembolic pulmonary hypertension. The aim of this study was to determine the relation between reperfusion after PE in the long term over a period of 24 months, laboratory results and clinical risk factors found during the initial PE event.Patients and Methods. 85 consecutive patients with a first episode of acute PE, diagnosed at 4 cardiology clinics, were followed up using clinical evaluation, scintigraphy and echocardiography (6, 12 and 24 months after the PE. 35 patients were in the low risk category (41%), 42 (49%) in the intermediate risk group and 8 (9%) in the high risk category. Results. Perfusion defects persisted in 20 patients (26%) after 6 months, in 19 patients (25%) after 12 months and in 14 patients (19%) after 24 months. The incidence was more frequent in older patients, with more serious (higher risk) PE, increased right ventricular internal diameter during the initial episode, and more significant tricuspid insufficiency in the initial echocardiography. Notably, higher hemoglobin levels were also shown as a significant risk factor. The presence of perfusion defects after 24 months correlated with a concurrent higher pulmonary pressure but not with either patient function or adverse events (recurrence of PE, re-hospitalization or bleeding). In 3 cases (4% of patients), long-term echocardiographic evidence of pulmonary hypertension was detected. Conclusion. Even after 24 months from acute PE with adequate anticoagulation treatment, incomplete reperfusion was found in 19% of patients with a corresponding risk of chronic thromboembolic pulmonary disease and hypertension.

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Clinical Value of Noncontrast‐Enhanced Radial Quiescent‐Interval Slice‐Selective (QISS) Magnetic Resonance Angiography for the Diagnosis of Acute Pulmonary Embolism Compared to Contrast‐Enhanced Computed Tomography and Cartesian Balanced Steady‐State Free Precession

Ravesh

Tesch

Lebenatus

et al. 2020

Magnetic Resonance Imaging

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Background Free‐breathing noncontrast‐enhanced (non‐CE) magnetic resonance angiography (MRA) techniques are of considerable interest for the diagnosis of acute pulmonary embolism (APE), due to the possibility for repeated examinations, avoidance of side effects from iodine‐based contrast agents, and the absence of ionizing radiation exposure as compared to CE‐computed tomographic angiography (CTA). Purpose To analyze the clinical performance of free‐breathing and electrocardiogram (ECG)‐gated radial quiescent‐interval slice‐selective (QISS)‐MRA compared to CE‐CTA and to Cartesian balanced steady‐state free precession (bSSFP)‐MRA. Study Type Prospective. Subjects Thirty patients with confirmed APE and 30 healthy volunteers (HVs). Field Strength/Sequence Radial QISS‐ and bSSFP‐MRA at 1.5T. Assessment Signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio (CNR) were computed to compare the pulmonary imaging quality between MRA methods. The pulmonary arterial tree was divided into 25 branches and an ordinal scoring system was used to assess the image quality of each pulmonary branch. The clinical performance of the two MRA techniques in accurately assessing APE was evaluated with respect to CE‐CTA as the clinical reference standard. Statistical Tests Wilcoxon signed‐rank and Spearman's correlation tests were performed. Sensitivity and specificity of the MRA techniques were determined using CE‐CTA as the clinical reference standard. Results Thrombus‐mimicking artifacts appeared more frequently in lobar and peripheral arteries of patients with Cartesian bSSFP than with radial QISS‐MRA (pulmonary trunk: 12.2% vs. 14.0%, P = 0.64; lobar arteries: 35.6% vs. 22.0%, P = 0.005, peripheral arteries: 74.4% vs. 49.0%, P < 0.001). The relative increases in SNR and of CNR provided by radial QISS‐MRA with respect to Cartesian bSSFP‐MRA were 30–35% (P‐values of SNR/CNR, HVs: 0.09/0.09, patients: 0.03/0.02). The image quality of pulmonary arterial branches was considered good to excellent in 77.2% of patients with radial QISS‐MRA and in 43.2% with Cartesian bSSFP‐MRA (P < 0.0001). The clinical performance of radial QISS‐MRA was higher than Cartesian bSSFP‐MRA for grading embolism, with a total sensitivity of 86.0% vs. 80.6% and a specificity of 93.3% vs. 84.0%, respectively. Data Conclusion Radial QISS‐MRA is a reliable and safe non‐CE angiographic technique with promising clinical potential compared to Cartesian bSSFP‐MRA and as an alternative technique to CE‐CTA for the diagnosis of APE. Level of Evidence 1 Technical Efficacy Stage 3

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Factors determining clot resolution in patients with acute pulmonary embolism

Cited by 18 publications

References 19 publications

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Reperfusion after pulmonary embolism - long-term follow-up, risk factors, clinical impact

Clinical Value of Noncontrast‐Enhanced Radial Quiescent‐Interval Slice‐Selective (QISS) Magnetic Resonance Angiography for the Diagnosis of Acute Pulmonary Embolism Compared to Contrast‐Enhanced Computed Tomography and Cartesian Balanced Steady‐State Free Precession

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