Intermediate-risk pulmonary embolism: echocardiography predictors of clinical deterioration

Weekes, Anthony J.; Fraga, Denise N.; Belyshev, Vitaliy; Bost, William; Gardner, Christopher A.; O’Connell, Nathaniel S.

doi:10.1186/s13054-022-04030-z

Cited by 8 publications

(3 citation statements)

References 47 publications

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“…In the process of cardiopulmonary resuscitation, this method is direct, simple, and does not delay rescue time, and sensitivity and specificity of diagnosing central PE can reach 80–90%; indirect signs include right ventricular and pulmonary artery dilatation, right ventricular wall motion weakened, abnormal ventricular septal motion, increased tricuspid regurgitation flow velocity, and other manifestations of increased right heart load. Some foreign authors believe that decreased right ventricular contractility caused by overload of right ventricle caused by other reasons generally does not affect apical segment of right ventricular free wall, and PE mostly has abnormal myocardial systolic function in this segment, and diagnosis is based on this sign [ 12 ]. The sensitivity of PE is 77% and specificity is 90%, so it is specific for diagnosis of PE.…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism

Yuan

Pan

et al. 2022

Stem Cells International

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Objective. The study aimed to evaluate the value of bedside echocardiography (TTE) and lower extremity blood vessels in diagnosis and prognosis of acute pulmonary embolism (APE). Methods. A retrospective study was performed on 53 patients with APE diagnosed by CT pulmonary angiography (CTPA) (systemic systolic blood pressure was >90 mmHg at time of consultation, and systemic systolic blood pressure decreased by <40 mmHg compared with basic value in those with hypertension). All patients underwent TTE examination before treatment. The high-risk factors, clinical manifestations, laboratory tests, and prognosis were retrospectively analyzed. Results. The rate of PE-related deterioration (cardiopulmonary resuscitation, tracheal intubation, cardiogenic shock, and death) within 14 days of hospitalization in RVD was 28%, and mortality rate (sudden death) was 20%, compared with non-RVD (both 0%). TTE examination showed that RVD as a predictor of pulmonary embolism-related death had a sensitivity of 100%, a specificity of 58%, a positive predictive value of 20%, and a negative predictive value of 100%. Conclusions. (1) TTE has increasingly shown obvious advantages in diagnosis of APE. It can detect direct or indirect signs of pulmonary embolism, confirm diagnosis or suspected diagnosis, and noninvasively and dynamically observe hemodynamic changes of heart in patients with acute PTE before and after treatment.. (2) The PE-related exacerbation rate (28%) or mortality (20%) of APE patients in normotensive with RVD was higher without RVD (0%). RVD is an independent predictor of poor prognosis in normotensive acute PTE. TTE tests allow people to identify people at risk of early death. The short-term prognosis of patients without RVD was better (14 days).

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Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism

Yuan

Pan

et al. 2022

Stem Cells International

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“…Hence, low-risk patients might be treated outside the hospital, and the appropriate therapies for intermediate-or high-risk patients should be evaluated [2]. Some additional parameters are well investigated and can be added to the PESI score or other prognostic models [17,18]. The addition of echocardiographic assessment findings to common clinical parameters can improve the outcome prediction in acute PEs [19].…”

Section: Risk Stratification Echocardiography and Biomarkers In Patie...mentioning

confidence: 99%

De Ritis Ratio to Predict Clinical Outcomes of Intermediate- and High-Risk Pulmonary Embolisms

Durak,

Nubbemeyer,

Zayat

et al. 2024

JCM

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Background: Abnormal liver function tests can identify severe cardiopulmonary failure. The aspartate transaminase/alanine transaminase (AST/ALT) ratio, or the De Ritis ratio, is commonly used to evaluate acute liver damage. However, its prognostic value in pulmonary embolism (PE) is unknown. Methods: Two cohorts, including patients with intermediate- and high-risk PEs, were established: one with an abnormal baseline AST/ALT ratio (>1) and another with a normal baseline AST/ALT ratio (<1). The primary outcome was a 60-day mortality. Secondary outcomes included peak N-terminal pro-brain-natriuretic-peptide (NT-proBNP) levels, complications, and the need for critical care treatment. To assess the effect of abnormal AST/ALT ratios, inverse probability weighted (IPW) analyses were performed. Results: In total, 230 patients were included in the analysis, and 52 (23%) had an abnormal AST/ALT ratio. After the IPW correction, patients with an abnormal AST/ALT ratio had a significantly higher mortality rate and peak NT-proBNP levels. The relative risks of 60-day mortality, shock development, use of inotropes/vasopressors, mechanical ventilation, and extracorporeal life support were 9.2 (95% confidence interval: 3.3–25.3), 10.1 (4.3–24), 2.7 (1.4–5.2), 2.3 (1.4–3.7), and 5.7 (1.4–23.1), respectively. Conclusions: The baseline AST/ALT ratio can be a predictor of shock, multiorgan failure, and mortality in patients with a pulmonary embolism.

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“…We studied patient characteristics and outcomes from the Clinical Outcomes in Pulmonary Embolism Research Registry (COPERR), which was approved by the Atrium Health Institutional Review Board. COPERR is an observational registry of adult patients treated by a multidisciplinary PERT in 11 emergency departments (EDs) within the Atrium Health system in North Carolina, USA [9]. PE care delivery at Atrium Health (inpatient and ED) is supported by an established PE management algorithm and PERT.…”

Section: Study Design and Settingmentioning

confidence: 99%

Comparison of Treatment Approaches and Subsequent Outcomes within a Pulmonary Embolism Response Team Registry

Weekes,

Trautmann,

Hambright

et al. 2024

Critical Care Research and Practice

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Objectives. To characterize the association between pulmonary embolism (PE) severity and bleeding risk with treatment approaches, outcomes, and complications. Methods. Secondary analysis of an 11-hospital registry of adult ED patients treated by a PE response team (August 2016–November 2022). Predictors were PE severity and bleeding risk. The primary outcome was treatment approach: anticoagulation monotherapy vs. advanced intervention (categorized as “immediate” or “delayed” based on whether the intervention was received within 12 hours of PE diagnosis or not). Secondary outcomes were death, clinical deterioration, and major bleeding. Results. Of the 1832 patients, 139 (7.6%), 977 (53.3%), and 9 (0.5%) were classified as high-risk, intermediate-high, intermediate-low, and low-risk severity, respectively. There were 94 deaths (5.1%) and 218 patients (11.9%) had one or more clinical deterioration events. Advanced interventions were administered to 86 (61.9%), 195 (27.6%), and 109 (11.2%) patients with high-risk, intermediate-high, and intermediate-low severity, respectively.Major bleeding occurred in 61/1440 (4.2%) on ACm versus 169/392 (7.6%) with advanced interventions (p <0.001): bleeding withcatheter-directed thrombolysiswas 19/145 (13.1%) versus 33/154(21.4%) with systemic thrombolysis,p= 0.07. High risk was twice as strong as intermediate-high risk for association with advanced intervention (OR: 5.3 (4.2 and 6.9) vs. 1.9 (1.6 and 2.2)). High risk (OR: 56.3 (32.0 and 99.2) and intermediate-high risk (OR: 2.6 (1.7 and 4.0)) were strong predictors of clinical deterioration. Major bleeding was significantly associated with advanced interventions (OR: 5.2 (3.5 and 7.8) for immediate, 3.3 (1.8 and 6.2)) for delayed, and high-risk PE severity (OR: 3.4 (1.9 and 5.8)). Conclusions. Advanced intervention use was associated with high-acuity patients experiencing death, clinical deterioration, and major bleeding with a trend towards less bleeding with catheter-directed interventions versus systemic thrombolysis.

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Intermediate-risk pulmonary embolism: echocardiography predictors of clinical deterioration

Cited by 8 publications

References 47 publications

The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism

The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism

De Ritis Ratio to Predict Clinical Outcomes of Intermediate- and High-Risk Pulmonary Embolisms

Comparison of Treatment Approaches and Subsequent Outcomes within a Pulmonary Embolism Response Team Registry

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