Related Articles

The yield of CT pulmonary angiograms to exclude acute pulmonary embolism.

Emerg Radiol. 2013 Nov 2;

Authors: Costa AF, Basseri H, Sheikh A, Stiell I, Dennie C

Abstract
There is accumulating evidence regarding the overuse of computed tomography pulmonary angiography (CTPA) to exclude pulmonary embolism (PE). We evaluated the yield of CTPA studies performed at our tertiary care hospital between April 2008 and March 2010 for emergency patients (ED), inpatients (INPT), and intensive care unit inpatients (ICU). For each patient group, we also compared CTPA positivity rates among the following: daytime and on-call studies, 1 year before and after institution of an Emergency Radiology division, interpreting thoracic and non-thoracic radiologists, and individual emergency physicians. Patients with a history of PE and indeterminate studies were excluded. The diagnosis of PE was based on the radiology report. D-dimer values obtained within 24 h prior to CTPA were recorded. A total of 3,571/4,757 CTPA studies satisfied the inclusion criteria. The fraction of positive studies was 252/1,677 (15.0 %) ED, 255/1,548 (16.5 %) INPT, and 62/346 (17.9 %) ICU. There was no difference in yield between patient groups, daytime vs. on-call studies, before vs. after instituting an emergency radiology division, and thoracic vs. non-thoracic radiologists (p > 0.05). For individual emergency physicians, the mean CTPA positivity rate was 15.4 % but varied considerably (σ = 8.5 %, range, 0-38.5 %). In comparison to other recent studies, our yield of ED CTPA is relatively high but varied widely among individual emergency physicians. While the reasons for such differences require further investigation, our results reinforce the importance of a strong clinical assessment in the work-up of suspected PE.

PMID: 24185370 [PubMed - as supplied by publisher]

Related Articles

Massive pulmonary embolism.

Cardiol Clin. 2013 Nov;31(4):503-18

Authors: Moorjani N, Price S

Abstract
Massive pulmonary embolism (PE) is a potentially lethal condition, with death usually caused by right ventricular (RV) failure and cardiogenic shock. Systemic thrombolysis (unless contraindicated) is recommended as the first-line treatment of massive PE to decrease the thromboembolic burden on the RV and increase pulmonary perfusion. Surgical pulmonary embolectomy or catheter-directed thrombectomy should be considered in patients with contraindications to fibrinolysis, or those with persistent hemodynamic compromise or RV dysfunction despite fibrinolytic therapy. Critical care management predominantly involves supporting the RV, by optimizing preload, RV contractility, and coronary perfusion pressure and minimizing afterload. Despite these interventions, mortality remains high.

PMID: 24188217 [PubMed - in process]

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Statin treatment and risk of recurrent venous thromboembolism: a nationwide cohort study.

BMJ Open. 2013;3(11):e003135

Authors: Nguyen CD, Andersson C, Jensen TB, Gjesing A, Schjerning Olsen AM, Malta Hansen C, Büller H, Torp-Pedersen C, Gislason GH

Abstract
OBJECTIVES: Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin therapy and risk of recurrent VTE.
DESIGN: A prospective cohort study.
SETTING: All hospitals in Denmark.
PARTICIPANTS: All patients with a hospital diagnosis of VTE in Denmark during 1997-2009 associated with a warfarin or heparin prescription were identified.
MAIN OUTCOME MEASURES: Adjusted HR of recurrent hospitalised VTE (ie, fatal or non-fatal DVT or PE) associated with use of statins.
RESULTS: 44 330 patients with VTE were included in the study. Of these 3914 were receiving statin therapy at baseline. Patients receiving statins were older (68±11 compared to 62±18 years), had more comorbidity and used more medications. The incidence rate for recurrent VTE was 24.4 (95% CI 22.8 to 26.2) per 1000 person-years among statin users and 48.5 (95% CI 47.4 to 49.7) per 1000 person-years among non-statin users. Statin use was associated with a significantly lower risk of a recurrent VTE, adjusted HR 0.74 (95% CI 0.68 to 0.80), compared with no statin use. The association between statin use and risk of recurrent VTE was significantly affected by age. Among younger individuals (≤80 years), statin use was associated with lower risk of recurrent VTE, HR 0.70 (95% CI 0.65 to 0.76) whereas in older individuals (>80 years) statin use was significantly associated with higher risk of recurrent VTE, HR 1.28 (95% CI 1.02 to 1.60), p for interaction=<0.0001.
CONCLUSIONS: Statin use was associated with a decreased risk of recurrent VTE.

PMID: 24202053 [PubMed]

Correlation Between ST-Segment Elevation and Negative T Waves in the Precordial Leads in Acute Pulmonary Embolism: Insights into Serial Electrocardiogram Changes.

Ann Noninvasive Electrocardiol. 2013 Nov 8;

Authors: Zhong-Qun Z, Bo Y, Nikus KC, Pérez-Riera AR, Chong-Quan W, Xian-Ming W

Abstract
BACKGROUND: Acute pulmonary embolism (APE) is often misdiagnosed as acute coronary syndrome because of the similarity of the presenting symptoms and of the electrocardiogram (ECG) manifestations. In APE, ST-segment elevation (STE) in leads V1 to V3 /V4 , mimicking anteroseptal myocardial infarction, is not a rare phenomenon. Negative T waves (NTW) in the precordial leads mimicking the "Wellens' syndrome" is an important ECG manifestation of APE. The evolution of these ECG changes-STE and NTW-in APE has not been thoroughly studied.
METHODS: We present two patient cases with APE and their evolving serial ECGs to analyze the correlation between STE and NTW.
RESULTS: NTW developed later than STE in these two patient cases.
CONCLUSIONS: NTW might represent a "postischemic" ECG pattern indicating a previous stage with transmural myocardial ischemia.

PMID: 24206526 [PubMed - as supplied by publisher]