Related Articles

Pulmonary Embolism Severity Index Accurately Predicts Long-Term Mortality Rate In Patients Hospitalized For Acute Pulmonary Embolism.

J Thromb Haemost. 2013 Oct 1;

Authors: Dentali F, Riva N, Turato S, Grazioli S, Squizzato A, Steidl L, Guasti L, Grandi AM, Ageno W

Abstract
BACKGROUND: The Pulmonary Embolism (PE) Severity Index (PESI) is a clinical prognostic rule that accurately classifies PE patients in five risk classes with increasing mortality. PESI score has been validated in studies with a relatively short-term follow-up and its accuracy in predicting long-term prognosis has never been established.
METHODS: Consecutive patients admitted to the tertiary care hospital of Varese (Italy) with an objectively diagnosed PE between January 2005 and December 2009 were retrospectively included. Information on clinical presentation, diagnostic work-up, risk factors, treatment, and mortality during a 1-year follow-up was collected.
RESULTS: 538 patients were enrolled in this study. Mean age was 70.6 (± SD 15.2), 44.4% of patients were males, and 27.9% had known cancer. One-year follow up was available for 96.1% of patients. Overall mortality rate was 23.2% at 3 months, 30.2% at 6 months and 37.1% at 12 months. The discriminatory power of the PESI score to predict long-term mortality, expressed as the area under the ROC curve, was 0.77 (95%CI 0.72-0.81) at 3 months, 0.77 (95%CI 0.73-0.81) at 6 months and 0.79 (95%CI 0.75-0.82) at 12 months. The PESI score confirmed its accurate prediction in patients without cancer. Simplified PESI had a similar overall accuracy compared to the original PESI at 3 and 6 months, but this was significantly lower at one year.
CONCLUSIONS: The results of this study suggest that PESI score may also be an accurate tool to define the 6-month and one-year mortality rates in PE patients. This article is protected by copyright. All rights reserved.

PMID: 24119089 [PubMed - as supplied by publisher]

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Predictors of pulmonary hypertension after intermediate-to-high risk pulmonary embolism.

Rev Port Cardiol. 2013 Oct 11;

Authors: Barros A, Baptista R, Nogueira A, Jorge E, Teixeira R, Castro G, Monteiro P, Providência LA

Abstract
BACKGROUND: Pulmonary embolism (PE) is a common cardiovascular emergency that, when combined with chronic thromboembolic pulmonary hypertension (PH), is associated with high mortality and morbidity. We aimed to determine the incidence of and predisposing factors for the development of PH after a PE episode.
METHODS: A retrospective study was conducted in 213 patients admitted to an intensive care unit with intermediate-to-high risk PE between 2000 and 2010. Clinical data at admission were collected and the incidence of PH as assessed by echocardiography (estimated pulmonary systolic artery pressure over 40 mmHg) was determined. Multivariate analysis was used to determine predictors of development of PH.
RESULTS: PH was detected in 12.4% of patients after a mean follow-up of three years. Only age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.02-1.20 per year; p=0.012) and body mass index (HR 1.19, 95% CI 1.04-1.36) per kg/m2, p=0.013) emerged as independent predictors of the development of this complication during follow-up.
CONCLUSIONS: PH after PE was a relatively common complication in our series. We identified advanced age and increased body mass index as predisposing factors.

PMID: 24125726 [PubMed - as supplied by publisher]

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Inferior vena cava filters: truth or dare?

Circ Cardiovasc Interv. 2013 Oct 1;6(5):498-500

Authors: Weinberg I, Jaff MR

PMID: 24129933 [PubMed - in process]

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Prognostic role of embolic burden assessed at computed-tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis.

J Thromb Haemost. 2013 Oct 17;

Authors: Vedovati MC, Germini F, Agnelli G, Becattini C

Abstract
BACKGROUND: In patients with acute pulmonary embolism (PE), risk stratification is indicated for tailoring both diagnostic strategies and acute treatment. Whether the embolic burden assessed at computed tomography (CT)-angiography has a role in risk stratification in these patients is debated.
OBJECTIVE: To systematically review and perform a meta-analysis to evaluate the role of CT-assessed burden associated with embolic obstruction and embolic localization in the prognostic stratification of patients with acute PE.
METHODS: We performed a systematic search in EMBASE and Medline up until June 30th 2013. Studies reporting on 30-day outcome of patients with confirmed PE and CT-assessed embolic burden were included. Study outcome was death.
RESULTS: Thirty studies reporting on the prognostic value of CT-assessed embolic burden met the inclusion criteria for this systematic review and of these, 19 were included in the meta-analysis. Five studies (2,215 patients) were included in the analysis of localization: an association between embolus localization in the central arteries and 30-day mortality was found after heterogeneity was resolved (OR 2.24, 95% CI 1.29-3.89; I-squared 0%). No correlation was observed between obstruction index (according to Qanadli scoring-system) and 30-day mortality after heterogeneity was reduced (16 studies, 3,884 patients, OR 1.22, 95% CI 0.99-1.51, I-squared 27%).
CONCLUSION: Localization of emboli assessed at CT-angiography can be used for risk stratification in patients with acute PE. Moreover, no correlation was observed between obstruction index and prognosis. This article is protected by copyright. All rights reserved.

PMID: 24134450 [PubMed - as supplied by publisher]