Prognostic implications of computed tomographic right ventricular dilation 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:10.1016/j.thromres.2013.11.020

Cited by 45 publications

(36 citation statements)

References 32 publications

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“…Post = post-embolization procedure, MPAP = mean pulmonary artery pressure, PAWP = pulmonary artery wedge pressure, CVP = central venous pressure, CO = cardiac output, PVR = pulmonary vascular resistance, HR = heart rate, MAP = mean arterial pressure. Numerous studies have demonstrated that RV dilation on CT is a sign of RVD and a useful predictor for clinical outcomes in patients with acute PE, including the mortality in-hospital and 30 days and 3 months following discharge [3,4,[26][27][28][29][30][31][32]. In our study, significant RV dilation was observed after embolization, with the RVESV increasing from 11.11 ml to 24.71 ml and the RVEDV from 20.73 ml to 34.63 ml.…”

Section: Discussionsupporting

confidence: 53%

Establishment of a canine model of acute pulmonary embolism with definite right ventricular dysfunction through introduced autologous blood clots

Zhao

Jia

et al. 2015

Thrombosis Research

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Section: Discussionsupporting

confidence: 53%

Establishment of a canine model of acute pulmonary embolism with definite right ventricular dysfunction through introduced autologous blood clots

Zhao

Jia

et al. 2015

Thrombosis Research

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“…An adverse outcome comprised PE-related inhospital death and serious clinical conditions due to PE, including requirement for inotropic support, impending respiratory failure or mechanical ventilation, cardiopulmonary resuscitation, and secondary thrombolysis (18). A PE-related in-hospital death was defined if an in-hospital death was directly caused by PE, or if it could not be attributed to other causes and PE could not be excluded (18). Blood laboratory data, including serum N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and plasma troponin I, were also assessed.…”

Section: Data Collectionmentioning

confidence: 99%

“…The diameters of the RV and left ventricular (LV) were measured at their widest points between the inner surface of the free wall and the surface of the interventricular septum (21), and the RV/LV diameter ratios were calculated. An RV/LV diameter ratio of ≥1 was designated as RV dilation (18). Pulmonary infarction was defined as a peripheral consolidation in the region of pulmonary emboli, based on the modified criteria of a previous study (22).…”

Section: Radiological Evaluationmentioning

confidence: 99%

Pulmonary embolism concurrent with lung cancer and central emboli predict mortality in patients with lung cancer and pulmonary embolism

Cha¹,

Shin²,

Lim³

et al. 2018

J. Thorac. Dis.

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Background: Patients with lung cancer commonly experience pulmonary embolism (PE). The aim of the present study was to examine the clinical features of patients with lung cancer and PE and to investigate prognostic factors in these patients. Methods: This retrospective study divided patients with lung cancer and PE into a group of patients with PE diagnosed concomitantly with lung cancer (concurrent group) and a group with PE detected after lung cancer (sequential group), compared the clinical characteristics of patients in the two groups, and investigated prognostic factors in these patients. =2.64, 95% confidence interval (CI): 1.57-4.43, P<0.001] and central PE (HR =1.46, 95% CI: 1.02-2.10, P=0.04) were independent predictors of mortality in patients with lung cancer and PE. Conclusions: PE concurrent with lung cancer is characterized by more severe PE and infrequent small cell carcinoma. PE concurrent with lung cancer and central emboli may be independent prognostic factors in patients with lung cancer and PE. cancers (4). Lung cancer is the most commonly identified malignancy in patients with VTE (5), with an incidence of 3-13.9% in patients with VTE and that of up to 3.8% in patients with pulmonary embolism (PE) (6-9).The mechanisms of VTE in cancer patients, although not completely established, appear to be multifactorial (6,7). The occurrence of VTE in lung cancer has a prognostic implication, in that the survival of lung cancer patients with PE was shorter than that of those without PE (10). However, most deaths in patients with lung cancer and PE or VTE have been attributed to lung cancer rather than thromboembolism (11). These findings suggest that VTE may be a marker of an advanced stage cancer or of a more biologically aggressive tumor (12). A previous study including small numbers of patients demonstrated that patients with lung cancer with concurrently diagnosed PE had poorer survival than those without PE (10). In another study, no difference in survival was found between patients with PE diagnosed at less than 3 months after the diagnosis of lung cancer and those with PE diagnosed at 3 months or more following lung cancer diagnosis (13). Therefore, it is unclear whether the timing of the presentation of PE in patients with lung cancer may influence patient prognosis.Several factors that may determine short-term prognosis in patients with PE, including pulmonary embolism severity index (PESI) score, cardiac biomarkers, right ventricular (RV) dilation, and central emboli, have been proposed (14). However, information regarding these PE-related prognostic factors in patients with lung cancer and PE is lacking. The aim of the present study was to examine the clinical features of patients with lung cancer patients and PE, to compare clinical characteristics of PE found concurrently at lung cancer diagnosis and PE developed sequentially after the diagnosis of lung cancer, and to investigate the PE-related predictors of mortality in patients with lung cancer patients and PE. Methods Study designThe pre...

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“…Outcome parameters, including in-hospital mortality (PE-related or PE-unrelated), adverse outcomes, and recurrence of venous thromboembolism were reviewed. As in a previous study, an adverse outcome was defined as a PE-related in-hospital death or PE resulting in a serious clinical condition requiring intensive care treatment, such as inotropic support and mechanical ventilation, impending respiratory failure or refractory hypoxia, cardiopulmonary resuscitation, or secondary thrombolysis [15] . A PE-related in-hospital death was defined as an inhospital death that met one of the following criteria: (1) objective evidence of death directly caused by PE, and (2) death that could not be attributed to other causes and in which PE could not be excluded [15] .…”

Section: Data Collectionmentioning

confidence: 99%

“…Subsequently, the RV/LV diameter ratios were calculated. An RV was considered dilated if the RV/LV diameter ratio measured on a CT scan equaled or exceeded 1 [15] . The extent of pleural effusion was assessed as follows: small, <3 cm at maximal depth; moderate, 3-5 cm; and large, >5 cm [18] .…”

Section: Radiological Evaluationmentioning

confidence: 99%

Clinical Relevance of Pleural Effusion in Patients with Pulmonary Embolism

Choi¹,

Cha²,

Shin³

et al. 2017

Respiration

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Background: Data regarding pleural effusion due to pulmonary embolism (PE) are limited. Objectives: The aim of this study was to investigate the clinical characteristics of PE patients with pleural effusion caused by PE. Methods: Patients with PE were retrospectively analyzed and divided into 2 groups based on computed tomography: a group with pleural effusion due to PE (effusion group) and a group without pleural effusion (control group). Clinical characteristics were compared between the 2 groups. Results: The study population consisted of the effusion group (n = 127) and the control group (n = 651). Serum C-reactive protein (CRP) level was significantly higher in the effusion group than in the control group. The percentages of high-risk Simplified PE Severity Index (57 vs. 47%, p = 0.008), central PE (84 vs. 73%, p = 0.013), right ventricular dilation (45 vs. 36%, p = 0.053), and pulmonary infarction (40 vs. 8%, p < 0.001) were higher in the effusion group than in the control group. Multivariate analysis demonstrated that pulmonary infarction (odds ratio [OR] 6.20, 95% confidence interval [CI] 3.49-10.91, p < 0.001) and CRP level (OR 1.05, 95% CI 1.101-1.09, p = 0.023) were independent predictors of pleural effusion due to PE. The presence of pleural effusion was not a predictor of short-term outcomes or length of hospital stay. Conclusions: Patients with more severe PE are likely to have pleural effusion caused by PE. However, pleural effusion was not a proven predictor of short-term outcome or length of hospital stay. Pulmonary infarction and CRP levels were independent risk factors for the development of pleural effusion.

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Prognostic implications of computed tomographic right ventricular dilation in patients with acute pulmonary embolism

Cited by 45 publications

References 32 publications

Establishment of a canine model of acute pulmonary embolism with definite right ventricular dysfunction through introduced autologous blood clots

Establishment of a canine model of acute pulmonary embolism with definite right ventricular dysfunction through introduced autologous blood clots

Pulmonary embolism concurrent with lung cancer and central emboli predict mortality in patients with lung cancer and pulmonary embolism

Clinical Relevance of Pleural Effusion in Patients with Pulmonary Embolism

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