Residual pulmonary thromboemboli after acute pulmonary embolism

Alonso-Martínez, José Luis; Annicchérico-Sánchez, Francisco Javier; Urbieta-Echezarreta, Miren Aránzazu; Garcia-Sanchotena, Jose L.; Herrero, Helena Gómez

doi:10.1016/j.ejim.2011.08.018

Cited by 39 publications

(29 citation statements)

References 24 publications

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“…CTEPH develops from 0.1 to 8.8% of the patients (14) whilst residual perfusion defects are reported to range between >50% in older studies (15,16) and 26% in more recent observations (8). The reasons for this discrepancy are largely unknown.…”

Section: Discussionmentioning

confidence: 88%

“…M a n u s c r i p t 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 In a substantial number of acute PE patients persistent perfusion defects remain after anticoagulant treatment, even if applied according to standard guidelines and follow-up (8). The clinical significance of these perfusion defects is currently unclear.…”

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confidence: 94%

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Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment

Meysman

Everaert

Buls

et al. 2015

European Journal of Radiology

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 94%

Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment

Meysman

Everaert

Buls

et al. 2015

European Journal of Radiology

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“…Alonso-Martinez et al . [14] found overall in 26% of their patients residual thrombi using varying time points of evaluation and MDCT as imaging modality. In their cohort evaluated between 5 and 6 months after diagnosis, which accounted for only 15% of their total study population, residual thrombi were found in 16% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…[17] study (appearing in the mentioned review),[9] Q scintigraphy alone in the Wartski and Collignon[18] (from the same review)[9] or semi-quantified V/Q scanning[11] versus MDCT,[9121415] or a combination of both. [13] Furthermore, these studies often differ in time intervals at which patients were reassessed (varying between 1 month and 1 year) and in the type of patients included (provoked versus unprovoked PE; first versus recurrent episodes of PE) further explaining the differences in proportions of patients with residual Q-defects.…”

Section: Discussionmentioning

confidence: 99%

“…[11] and Cosmi et al . [13] found that patients with persistent Q-defects on scintigraphy were older than those with a normalized Q-scintigraphy while Alonso-Martínez et al .,[14] den Exter et al .,[15] and Cosmi et al .,[13] in their MDCT evaluated cohort, found no influence of age or gender on the persistence of thrombi. The patients with an abnormal Q-SPECT in our study tended to be older than those with normalized Q-SPECT.…”

Section: Discussionmentioning

confidence: 99%

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Factors determining altered perfusion after acute pulmonary embolism assessed by quantified single-photon emission computed tomography-perfusion scan

2017

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AIM OF THE STUDY:The aim of the study was to analyze the evolution of perfusion (Q)-defects in patients treated for acute pulmonary embolism (PE), correlation with baseline parameters and evaluation of recurrence risk.METHODS:This is a single-center prospective observational cohort study in symptomatic normotensive PE. Comparison of the ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT) acquired at baseline with a quantified SPECT (Q-SPECT) repeated at 1 week and 6 months. The Q-defect extent (percentage of total lung volume affected) was measured semiquantitatively. Data collected at baseline were age, gender, body mass index (BMI), history of previous venous thromboembolism (HVTE), Charlson's Comorbidity Score (CcS), plasma troponin-T and D-dimer levels, PE Severity Index, and tricuspid regurgitation jet (TRJ) velocity.RESULTS:Forty-six patients (22 men/24 women, mean age 61.7 years (± standard deviation 16.3)) completed the study. At 1 week, 13/46 (28.3 %) and at 6 months 22/46 (47.8%) patients had completely normalized Q-SPECT. Persistence of Q-defects was more frequent in female patients in univariate and multivariate analysis. We found no correlation between the persistence of Q-defects on Q-SPECT and HVTE, BMI, plasma troponin-T, and CcS. However, lower TRJ and younger age were statistically significantly linked to normalization of Q-scans after 6 months of treatment only in univariate analysis. There is no difference in the frequency of recurrent PE in relation to the persistence of Q-defects.CONCLUSION:Acute PE patients of female, older age, and higher TRJ in univariate analysis and patients of female in multivariate analysis seem to have a higher risk of persistent Q-defects after 6 months treatment. The presence of residual Q-abnormalities at 6 months was not associated with an increased risk for recurrent PE.

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Long‐term sequelae following acute pulmonary embolism: A nationwide follow‐up study regarding the incidence of CTEPH, dyspnea, echocardiographic and V/Q scan abnormalities

Andersson,

Nilsson,

Larsen

et al. 2023

Pulm. circ.

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We aimed to follow a nationwide cohort of patients with pulmonary embolism (PE) without any exclusions to generate information regarding long‐term symptoms, investigational findings and to determine the prevalence of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that this approach would yield generalizable estimates of CTEPH prevalence and incidence. All individuals diagnosed with acute PE in Sweden in 2005 were identified using the National Patient Register. In 2007, survivors were asked to complete a questionnaire regarding current symptoms. Those with dyspnea were referred for further examinations with laboratory tests, electrocardiogram (ECG), and a ventilation/perfusion scan (V/Q scan). If CTEPH was suspected, a referral to the nearest pulmonary arterial hypertension‐center was recommended. Of 5793 unique individuals with PE diagnosis in 2005, 3510 were alive at the beginning of 2007. Altogether 53% reported dyspnea at some degree whereof a large proportion had V/Q scans indicating mismatched defects. Further investigation revealed 6 cases of CTEPH and in parallel 18 cases were diagnosed outside this study. The overall prevalence of CTEPH was 0.4% (95% confidence interval [CI]: 0.2%–0.6%) and 0.7% (95% CI: 0.4%–1.0%) among the survivors. The cumulative incidence of CTEPH in the group of patients who underwent a V/Q scan was 1.1% (95% CI: 0.2%–2.0%). There was a high mortality following an acute PE, a high proportion of persistent dyspnea among survivors, whereof several had pathological findings on V/Q scans and echocardiography. Only a minority developed CTEPH, indicating that CTEPH is the tip of the iceberg of post‐PE disturbances.

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Residual pulmonary thromboemboli after acute pulmonary embolism

Cited by 39 publications

References 24 publications

Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment

Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment

Factors determining altered perfusion after acute pulmonary embolism assessed by quantified single-photon emission computed tomography-perfusion scan

Long‐term sequelae following acute pulmonary embolism: A nationwide follow‐up study regarding the incidence of CTEPH, dyspnea, echocardiographic and V/Q scan abnormalities

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