Resolution Rate of Acute Pulmonary Embolism in Man

Dalen, James E.; Banas, John S.; Brooks, Harold L.; Evans, Gerald L.; Paraskos, John A; Dexter, Lewis

doi:10.1056/nejm196905292802202

Cited by 274 publications

(60 citation statements)

References 16 publications

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“…4,9 In addition, pulmonary angiographic studies revealed that in most cases of APE the resolution of thromboemboli occurred within 21 days. 5 However, it was reported that in some patients after APE, residual perfusion defects could be detected by control lung scintygraphy or spiral computer tomography even in spite of adequate long-term treatment. 10,11 Moreover, recent studies have shown that in some patients with APE symptomatic pulmonary hypertension might persist or develop despite treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] With antithrombotic treatment, resolution of echocardiographic signs of RV overload and normalization of the clinical status occur in the majority of patients with APE within several weeks. 4,5 However, organized residuals of thromboemboli may persist in pulmonary arteries even despite adequate longterm anticoagulation. Development of chronic thromboembolic pulmonary hypertension was reported in some patients after APE.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Ciurzyński

Kurzyna²,

Bochowicz

et al. 2004

Clinical Cardiology

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SummaryBackground and hypothesis: Hemodynamic and functional consequences of acute pulmonary embolism (APE) are believed to be reversible with antithrombotic treatment. To verify this hypothesis, we reassessed our patients at least 1 year after an episode of APE.Methods: We compared echo Doppler indices and 6-min walking test parameters (6-MWT) of 36 patients (13 men, 23 women, age 66 ± 11 years), studied on average 3.1 ± 2.2 years after an acute episode of pharmacologically treated massive or submassive APE, with data of 30 age-matched subjects (12 men, 18 women, age 67 ± 12 years).Results: At least 1 year after APE, right ventricular (RV) diameter remained increased in patients compared with controls (27 ± 2 vs. 23 ± 2 mm, p < 0.001). Also, acceleration time of pulmonary ejection (AcT) was markedly shorter (97 ± 19 vs. 123 ± 19 ms, p < 0.001) and the diameter of the pulmonary trunk was significantly larger in patients than in controls (21 ± 2.6 vs. 18 ± 2.2, p < 0.001). Although the mean value of the tricuspid valve peak systolic gradient (TVPG) in the APE group at follow-up was similar to that in controls, TVPG > 30 mmHg was recorded in three patients with APE (8.3%). There was no difference in the distance of 6-MWT between both groups; however, the mean desaturation after 6-MWT was higher in the APE group than in controls (3.04 ± 2.08 vs. 1.45 ± 0.69%, p = 0.0005).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Ciurzyński

Kurzyna²,

Bochowicz

et al. 2004

Clinical Cardiology

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“…In some, lung perfusion is rapidly restored, 34 although the resolution in the first week is typically incomplete. Recovery continues at a slower pace for the next 1 to 2 months, 35,36 during which clot remodeling may be occurring. Residual defects persist commonly beyond this period, suggesting that the clots have been remodeled into permanent vascular scars.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of dysfibrinogenemia among patients with chronic thromboembolic pulmonary hypertension

Morris

Marsh

Chiles

et al. 2009

Blood

157

114

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The mechanism by which chronic thromboembolic pulmonary hypertension (CTEPH) develops after acute pulmonary thromboembolism is unknown. We previously reported that fibrin from CTEPH patients is relatively resistant to fibrinolysis in vitro. In the present study, we performed proteomic, genomic, and functional studies on fibrin(ogen) to investigate whether abnormal fibrin(ogen) might contribute to the pathogenesis of CTEPH. Reduced and denatured fibrinogen from 33 CTEPH patients was subjected to liquid chromatography-mass spectrometry analysis. Fibrinogen from 21 healthy controls was used to distinguish atypical from commonly occurring mass peaks. Atypical peaks were further investigated by targeted genomic DNA sequencing. Five fibrinogen variants with corresponding heterozygous gene mutations (dysfibrinogenemias) were observed in 5 of 33 CTEPH patients: B␤ P235L/␥ R375W, B␤ P235L/␥ Y114H, B␤ P235L, A␣ L69H, and A␣ R554H (fibrinogens San Diego I-V ). B␤ P235L was found in 3 unrelated CTEPH patients. Functional analysis disclosed abnormalities in fibrin polymer structure and/or lysis with all CTEPH-associated mutations. These results suggest that, in some patients, differences in the molecular structure of fibrin may be implicated in the development of CTEPH after acute thromboembolism. (Blood. 2009;114: 1929-1936

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“…Serial pulmonary angiographic and lung scan studies, reported in the late 1960s, revealed that the great majority of acute pulmonary thromboemboli undergo in vivo fibrinolysis (either spontaneous or pharmacologically induced by heparin), mechanical dislodgment within 1 to 21 days of lodgment in the lung vasculature, or both. 11,12 These salutary processes are associated with a reduction in the degree of pulmonary vascular obstruction, a decrease in right ventricular afterload, and symptomatic improvement. Approximately 15% to 25% of patients, however, show only partial resolution of pulmonary vascular obstruction as revealed by persistent abnormal perfusion patterns on a follow-up lung scan performed 3 to 4 months after the primary embolic event.…”

Section: Specific Features Of Natural Historymentioning

confidence: 99%

Acute Pulmonary Thromboembolism

Peterson

1999

Circulation

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Resolution Rate of Acute Pulmonary Embolism in Man

Cited by 274 publications

References 16 publications

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

High prevalence of dysfibrinogenemia among patients with chronic thromboembolic pulmonary hypertension

Acute Pulmonary Thromboembolism

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