Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope

Verma, Amol A.; Masoom, Hassan; Rawal, Shail; Guo, Yishan; Razak, Fahad

doi:10.1001/jamainternmed.2017.1246

Cited by 24 publications

(29 citation statements)

References 7 publications

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“…We demonstrated a low diagnostic rate of PE at both index ED visit and over a 180‐day follow‐up. This result was in line with previous studies, which found the rate of PE to be <1.5% . Despite the low prevalence, 15.7% of all patients underwent D‐dimer testing, and 7.2% had CTPA performed.…”

Section: Discussionsupporting

confidence: 93%

“…were Caucasian (reflecting demographics in the geographic area) ( The rate of PE in patients with syncope in our study is in agreement with several other studies [10][11][12][13]15 and is much lower than the rate found in the PESIT trial. However, the rates of testing for PE were not reported in these studies, suggesting the possibility of underascertainment.…”

Section: Methodssupporting

confidence: 92%

“…The American College of Cardiology/American Heart Association/Heart Rhythm Society 2017 guidelines define syncope as “a symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone, with rapid and spontaneous recovery.” The etiologies of syncope range from benign to potentially life‐threatening pathologies . Pulmonary embolism (PE) is often considered as an etiology for syncope, but the likelihood of finding PE in patients presenting with syncope has varied substantially across studies . The Pulmonary Embolism in Syncope Italian Trial (PESIT) evaluated patients admitted to the hospital after their first syncopal episode and reported an overall prevalence of PE of 17.3% .…”

Section: Introductionmentioning

confidence: 99%

“…5,7,8 Pulmonary embolism (PE) is often considered as an etiology for syncope, but the likelihood of finding PE in patients presenting with syncope has varied substantially across studies. 5,[9][10][11][12][13] The Pulmonary Embolism in Syncope Italian Trial (PESIT) evaluated patients admitted to the hospital after their first syncopal episode and reported an overall prevalence of PE of 17.3%. 9 This reported prevalence rate was significantly higher than previous studies.…”

Section: Introductionmentioning

confidence: 99%

“…Costantino et al conducted a multinational retrospective, observational study and found an overall rate of PE in patients presenting with syncope to range from 0.06% to 0.55% (a subgroup analysis of patients with similar characteristics to those enrolled in the PESIT trial revealed a rate of only 0.15%-2.10%). 10 An additional study published by Verma et al 13 found rates of 1.4% for venous thromboembolism (VTE), which included diagnosed PE or isolated deep venous thrombosis. A prospective single-center cohort study by Frizell et al, 12 found an overall rate of PE diagnosis at 30 days of 1.4% in ED patients presenting with syncope.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic yield of pulmonary embolism testing in patients presenting to the emergency department with syncope

Kelly

Bledsoe

Woller

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Syncope occurs in 1 in 4 people during their lifetime and accounts for 1% to 1.5% of emergency department (ED) visits. Most causes of syncope are benign, but syncope may be caused by life‐threatening conditions including pulmonary embolism (PE) in up to 2% of cases. A recent publication reported the prevalence of PE in patients with syncope to be over 17%. Aims We sought to determine the frequency and diagnostic yield of testing for PE in patients presenting to the ED with syncope in our large, integrated health care system. Methods We performed a retrospective, longitudinal cohort study of patients who presented with syncope to EDs within a 21‐hospital integrated health care system from 2010 to 2015 to find the frequency and diagnostic yield of testing for PE in patients with syncope at index ED visit and within 180 days afterward. Results We screened 2 749 371 ED encounters to find 32 440 (1.2%) with syncope. Median age was 52 (interquartile range, 31‐71), 57.5% were female, and 90% were Caucasian. PE was diagnosed on the index ED visit in 259 (0.8%; 95% confidence interval [CI], 0.7%‐0.9%) cases. Assessment for suspected PE with D‐dimer occurred in 5089 (15.7%) patients, and 2338 (7.2%) underwent computed tomography pulmonary angiography (CTPA). The yield of CTPA was 7.9%. PE was detected in 2.2% in whom a D‐dimer was performed. From index visit to 180 days, 467 (1.4%; 95% CI, 1.3%‐1.6%) patients were diagnosed with a PE, and 1051 (3.2%, 95% CI, 3.0%‐3.4%) patients died. Conclusion Diagnostic testing for PE is frequent in patients with syncope presenting to the EDs of a large, integrated health care system. The yield of diagnostic testing is low.

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Section: Discussionsupporting

confidence: 93%

Section: Methodssupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic yield of pulmonary embolism testing in patients presenting to the emergency department with syncope

Kelly

Bledsoe

Woller

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Prevalence of Pulmonary Embolism in Patients With Syncope

et al. 2018

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IMPORTANCE Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope.OBJECTIVE To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged Ն18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016. MAIN OUTCOMES AND MEASURESThe prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed.RESULTS A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients.CONCLUSIONS AND RELEVANCE Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.

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Expression and diagnostic value of circulating miRNA‐190 and miRNA‐197 in patients with pulmonary thromboembolism

Zhou

Hao

et al. 2020

Clinical Laboratory Analysis

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Background Diagnosing pulmonary thromboembolism (PTE) remains challenging due to the lack of specific clinical symptoms and biomarkers. Circulating microRNAs (miRNAs) have proved to be potential biomarkers for numerous cardiovascular diseases. The aims of this study were to quantitatively analyze the expression of plasma miRNA‐190 and miRNA‐197 in patients with PTE and to evaluate the diagnostic value for PTE. Methods Thirty patients diagnosed with PTE by computed tomographic pulmonary angiography at the emergency department were enrolled in this study, and plasma was collected immediately. For comparison, myocardial infarction (MI, n = 45) and healthy participants (NC, n = 45) were recruited as the control groups. Quantitative reverse transcription PCR (qRT‐PCR) was conducted to reveal the relative expression levels of miRNA‐190 and miRNA‐197 in each group. The plasma concentrations of D‐dimer were measured by immunoturbidimetric assay. The diagnostic value was evaluated by analyzing the area under the receiver operating characteristic curve (AUC). Results The relative expression levels of miRNA‐190 and miRNA‐197 in the PTE group were both significantly higher than in the MI group (t = 3.602 t = 4.791, P < .05, respectively) and the healthy control group (t = 5.814, t = 5.886, P < .05, respectively). As diagnostic indicator, the sensitivity and specificity of miRNA‐190 were 75.56% and 80%, respectively, with an AUC of 0.7844 (95%CI: 0.6858‐0.8831, P < .001). The sensitivity and specificity of miRNA‐197 were 73.33% and 86.67%, respectively, with an AUC value of 0.7931 (95%CI: 0.6870‐0.8991, P < .001). Combining miRNA‐190 and miRNA‐197 with D‐dimer levels significantly increased the diagnostic power, improving the AUC to 0.9536 (95% CI: 0.9083‐0.9989, P < .001). Conclusions The relative expression levels of miRNA‐190 and miRNA‐197 in PTE patients were significantly higher than in the MI and healthy control groups, indicating that (a) both may be involved in the pathophysiological process of PTE and (b) both may serve as potential noninvasive diagnostic markers for PTE. The combination of miRNA‐190, miRNA‐197, and D‐dimer levels showed better sensitivity and specificity, which is more conducive to the diagnosis of PTE.

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Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope

Abstract: Drs Verma and Masoom had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Verma and Masoom are co-first authors.

Cited by 24 publications

References 7 publications

Diagnostic yield of pulmonary embolism testing in patients presenting to the emergency department with syncope

Diagnostic yield of pulmonary embolism testing in patients presenting to the emergency department with syncope

Prevalence of Pulmonary Embolism in Patients With Syncope

Expression and diagnostic value of circulating miRNA‐190 and miRNA‐197 in patients with pulmonary thromboembolism

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