Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism

Rodrigues, Ana Clara T.; Guimarães, Laise; Guimarães, Juliana Frota; Monaco, Claudia; Cordovil, Adriana; Lira, Edgar; Vieira, Marcelo Carvalho; Fischer, Cláudio Henrique; Nomura, César Higa; Morhy, Samira Saady

doi:10.1007/s10554-014-0576-8

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…In addition, PAB is measured in increased quantity. In APE, the right ventricular dysfunction is associated with poor prognosis, and plays a decisive role in clinical treatment (11). Our patient underwent bedside Transthoracic ECO.…”

Section: Casementioning

confidence: 88%

Acil Serviste Trombolitik Tedavi Uygulanan Gebe Hastada Massif Akut Pulmoner Emboli

Bayrak

Özer

Yeniocak

2021

Phoenix Medical Journal

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Acute pulmonary embolism is one of the most important preventable mortality causes during pregnancy. In this case report, a 24-week pregnant patient who were diagnosed with Acute pulmonary embolism and who underwent thrombolytic treatment was discussed in the light of a literature review. The 27-year-old female patient, who was pregnant, applied to the emergency service with sudden shortness of breath and chest pain. Since the hemodynamic condition of the patient was unstable, no imaging could be carried out in the radiology unit. As a result of the right ventricular load symptoms detected in bedside Transthoracic Echocardiography, massive Acute pulmonary embolism was diagnosed, and thrombolytic treatment was initiated. Acute pulmonary embolism should be considered in patients who are admitted to emergency services with sudden shortness of breath and chest pain complaints. Patients who are excessively unstable for imaging in the radiology unit should be evaluated quickly with bedside transthoracic Echocardiography, in terms of massive embolism. ÖZET Akut pulmoner emboli (APE), gebelik döneminde en önemli önlenebilir ölüm nedenlerinden birisidir. Bu yazıda APE tanısı alan ve trombolitik tedavi uygulanan 24 haftalık gebe bir hastayı litaratür eşliğinde tartışılmıştır. Gebe olan 27 yaşındaki bayan hasta, ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise müracaat etti. Hastanın hemodinamik durumu unstabil olduğundan radyoloji ünitesinde herhangi bir görüntüleme yapılamadı. Yatakbaşı transtorasik ekokardiyografi (EKO)'de sağ ventrikül yüklenme bulguları görülmesi sonucu massif APE tanısı konularak trombolitik tedavi uygulandı. APE, hemodinamik olarak unstabil olan hastalarda kardiyovasküler acil durumların en yaygın nedenlerinden birisi olup, çok mortal seyreder. Ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise başvuran hastalarda, mutlaka APE düşünülmelidir. Radyoloji ünitesinde görüntüleme yapılamayacak kadar unstabil olan hastalar, hızlıca yatakbaşı transtorasik EKO ile massif emboli açısından değerlendirilmelidir.

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Section: Casementioning

confidence: 88%

Acil Serviste Trombolitik Tedavi Uygulanan Gebe Hastada Massif Akut Pulmoner Emboli

Bayrak

Özer

Yeniocak

2021

Phoenix Medical Journal

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“…Abdelwahab et al (23) found a significant correlation between clot volume and parameters of RV dysfunction assessed by CTPA, but there was no significant correlation between the two using echocardiography. Rodrigues et al (24) also found that most usual echocardiographic parameters evaluating RV fail to demonstrate a good correlation with clot burden, but Bach et al (25) found there was no association of global obstruction and prognosis. Ghuysen et al (26) also found that the pulmonary obstruction index could not predict patient outcome.…”

Section: A B Cmentioning

confidence: 99%

Clot burden of acute pulmonary thromboembolism: comparison of two deep learning algorithms, Qanadli score, and Mastora score

Zhang¹,

Cheng²,

Cheng³

et al. 2022

Quant Imaging Med Surg

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Background: The deep learning convolution neural network (DL-CNN) benefits evaluating clot burden of acute pulmonary thromboembolism (APE). Our objective was to compare the performance of the deep learning convolution neural network trained by the fine-tuning [DL-CNN (ft)] and the deep learning convolution neural network trained from the scratch [DL-CNN (fs)] in the quantitative assessment of APE. Methods: We included the data of 680 cases for training DL-CNN by DL-CNN (ft) and DL-CNN (fs), then retrospectively included 410 patients (137 patients with APE, 203 males, mean age 60.3±11.4 years) for testing the models. The distribution and volume of clots were respectively assessed by DL-CNN(ft) and DL-CNN(fs), and sensitivity, specificity, and area under the curve (AUC) were used to evaluate their performances in detecting clots on a per-patient and clot level. Radiologists evaluated the distribution of clots, Qanadli score, and Mastora score and right ventricular metrics, and the correlation of clot volumes with right ventricular metrics were analyzed with Spearman correlation analysis. Results: On a per-patient level, the two DL-CNN models had high sensitivities and moderate specificities (DL-CNN (ft): 100% and 77.29%; DL-CNN (fs): 100% and 75.82%), and their AUCs were comparable (Z=0.30, P=0.38). On a clot level, DL-CNN (ft) and DL-CNN (fs) sensitivities and specificities in detecting central clots were 99.06% and 72.61%, and 100% and 70.63%, respectively. DL-CNN (ft) sensitivities and specificities in detecting peripheral clots were mostly higher than those of DL-CNN (fs), and their AUCs were comparable. Clot volumes measured with the two models were similar (U=85094.500, P=0.741), and significantly correlated with Qanadli scores [DL-CNN(ft) r=0.825, P<0.001, DL-CNN(fs) r=0.827, P<0.001] and Mastora scores [DL-CNN(ft) r=0.859, P<0.001, DL-CNN(fs) r=0.864, P<0.001]. Clot volumes were also correlated with right ventricular metrics. Clot burdens were increased in the low-risk, moderate-risk, and high-risk patients. Binary logistic regression revealed that only the ratio of right ventricular area/left ventricular area (RVa/LVa) was an independent predictor of in-hospital death (odds ratio 6.73; 95% CI, 2.7-18.12, P<0.001). Conclusions: Both DL-CNN (ft) and DL-CNN (fs) have high sensitivities and moderate specificities in detecting clots associated with APE, and their performances are comparable. While clot burdens quantitatively calculated by the two DL-CNN models are correlated with right ventricular function and risk stratification, RVa/LVa is an independent prognostic factor of in-hospital death in patients with APE.

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“…Albeit not specific, it has been proven to occur in the presence of RV pressure overload, generally indicates a higher clot burden, and is usually associated with other advanced signs of RV systolic dysfunction [ 10 , 11 ]. Like RV dilatation, other functional parameters have been correlated to clot burden, as shown in the study conducted by Rodrigues et al that found an inverse correlation of Right ventricular fractional area change (RVFAC) with the severity of the pulmonary vascular bed occlusion [ 12 ].…”

Section: Acute Cor Pulmonalementioning

confidence: 99%

Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings

et al. 2020

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Cor pulmonale is the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process. Depending on the speed of onset of the pathological condition and subsequent effects on the right ventricle, it is possible to distinguish the acute cor pulmonale from the chronic type of disease. Echocardiography plays a central role in the diagnostic and therapeutic work-up of these patients, because of its non-invasive nature and wide accessibility, providing its greatest usefulness in the acute setting. It also represents a valuable tool for tracking right ventricular function in patients with cor pulmonale, assessing its stability, deterioration, or improvement during follow-up. In fact, not only it provides parameters with prognostic value, but also it can be used to assess the efficacy of treatment. This review attempts to provide the current standards of an echocardiographic evaluation in both acute and chronic cor pulmonale, focusing also on the findings present in the most common pathologies causing this condition.

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Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism

Cited by 11 publications

References 23 publications

Acil Serviste Trombolitik Tedavi Uygulanan Gebe Hastada Massif Akut Pulmoner Emboli

Acil Serviste Trombolitik Tedavi Uygulanan Gebe Hastada Massif Akut Pulmoner Emboli

Clot burden of acute pulmonary thromboembolism: comparison of two deep learning algorithms, Qanadli score, and Mastora score

Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings

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