Differentiating electrocardiographic indications of massive and submassive pulmonary embolism: A cross‐sectional study in Southern Iran from 2015 to 2020
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ABSTRACT:
SUBMITTER: Bahreini Z
PROVIDER: S-EPMC10926280 | biostudies-literature | 2024 Mar
REPOSITORIES: biostudies-literature
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Project description:Little data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary embolism. Survivors of submassive or massive pulmonary embolism (n=20, age 57±13.3 years, 8/20 female) underwent clinical evaluation, transthoracic echocardiography, and cardiopulmonary exercise testing at 1 and 6 months following hospital discharge. At 1 month, 9/20 (45%) patients had New York Heart Association II or greater symptoms, 13/20 (65%) demonstrated either persistent RV dilation or systolic dysfunction, and 14/20 (70%) had objective exercise impairment as defined by a peak oxygen consumption (V˙O2) of <80% of age-sex predicted maximal values (16.25 [13.4-20.98] mL/kg per minute). At 6 months, no appreciable improvements in symptom severity, RV structure or function, and peak V˙O2 (17.45 [14.08-22.48] mL/kg per minute, P=NS) were observed. No patients demonstrated an exercise limitation attributable to either RV/pulmonary vascular coupling, as defined by a VE/VCO2 slope >33, or a pulmonary mechanical limit to exercise at either time point. Similarly, persistent RV dilation or dysfunction was not significantly related to symptom burden or peak V˙O2 at either time point. Persistent symptoms, abnormalities of RV structure and function, and objective exercise limitation are common among survivors of massive and submassive pulmonary embolism. Functional impairment appears to be attributable to general deconditioning rather than intrinsic cardiopulmonary limitation, suggesting an important role for prescribed exercise rehabilitation as a means toward improved patient outcomes and quality of life.
| S-EPMC5866315 | biostudies-literature
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| S-EPMC9358724 | biostudies-literature
Project description:Pulmonary embolism is associated with high rates of mortality and morbidity. It is important to understand direct comparisons of current interventions to differentiate favorable outcomes and complications. The objective of this study was to compare ultrasound-accelerated thrombolysis versus systemic thrombolysis versus anticoagulation alone and their effect on left ventricular outflow tract velocity time integral. This was a retrospective cohort study of subjects ≥18 years of age with a diagnosis of submassive or massive pulmonary embolism. The primary outcome was the percent change in left ventricular outflow tract velocity time integral between pre- and post-treatment echocardiograms. Ultrasound-accelerated thrombolysis compared to anticoagulation had a greater improvement in left ventricular outflow tract velocity time integral, measured by percent change. No significant change was noted between the ultrasound-accelerated thrombolysis and systemic thrombolysis nor systemic thrombolysis and anticoagulation groups. Pulmonary artery systolic pressure only showed a significant reduction in the ultrasound-accelerated thrombolysis versus anticoagulation group. The percent change of right ventricular to left ventricular ratios was improved when systemic thrombolysis was compared to both ultrasound-accelerated thrombolysis and anticoagulation. In this retrospective study of submassive or massive pulmonary embolisms, left ventricular outflow tract velocity time integral demonstrated greater improvement in patients treated with ultrasound-accelerated thrombolysis as compared to anticoagulation alone, a finding not seen with systemic thrombolysis. While this improvement in left ventricular outflow tract velocity time integral parallels the trend seen in mortality outcomes across the three groups, it only correlates with changes seen in pulmonary artery systolic pressure, not in other markers of echocardiographic right ventricular dysfunction (tricuspid annular plane systolic excursion and right ventricular to left ventricular ratios). Changes in left ventricular outflow tract velocity time integral, rather than echocardiographic markers of right ventricular dysfunction, may be considered a more useful prognostic marker of both dysfunction and improvement after reperfusion therapy.
| S-EPMC7534090 | biostudies-literature
Project description: Not available
| S-EPMC6058411 | biostudies-literature
Project description:BackgroundPopulation aging and more prevalent westernized lifestyle would be expected to result in a markedly rising burden of colorectal cancer (CRC) in the future years. The aim of this study is to estimate the limited-time prevalence of CRC in Iran between 2015 and 2020.Materials and methodsAggregated CRC incidence data were extracted from the Iranian national cancer registry (IR.NCR) reports for 2003-2009 and from GLOBOCAN-2012 database for 2012. Incidence trends were analyzed by age groups, genders, histopathologic, and topographic subtypes to estimate annual percentage changes. Incidence was projected for 2020. The prevalence was estimated applying an adopted version of a previously introduced equation to estimate limited-time prevalence based on the incidence and survival data. Monte Carlo sensitivity analyses were applied to estimate 95% uncertainty levels (ULs). In each scenario, incidence, survival, annual percentage changes, and completeness of case ascertainment at IR.NCR were replaced under pre-assumed distributions.ResultsNumber of estimated within 1, 2-3 and 4-5-year CRC patients in 2015 were 13676 (95% UL: 10051-18807), 20964 (15835-28268), and 14485 (11188-19293), respectively. Estimated 5-year prevalence for 2020 (99463; 75150-134744) was 2.03 times of that for 2015. Highest 5-year prevalence was estimated in ages 55-59 for females and 75 + for males. Adenocarcinoma (41376; 31227 55898) was the most prevalent histologic subtype. The most prevalent tumor location was colon (30822, 23262-41638).ConclusionA substantial growth in the prevalence of CRC survivors is highly expected for future years in Iran. Establishment of specialized institutes is highly recommended to provide medical and especially social supports for Iranian CRC survivors.
| S-EPMC5812060 | biostudies-literature
Project description:BackgroundThe efficacy of artificial intelligence (AI)-enhanced electrocardiography (ECG) for detecting hypertrophic cardiomyopathy (HCM) and its dilated phase (dHCM) has been developed, though specific ECG characteristics associated with these conditions remain insufficiently characterized.MethodsThis retrospective study included 19,170 patients, with 140 HCM or dHCM cases, from the Shinken Database (2010-2017). The 140 cases (HCM-total) were categorized into basal-only HCM (HCM-basal, n = 75), apical involvement (HCM-apical, n = 46), and dHCM (n = 19). We analyzed 438 ECG parameters across the P-wave (110), QRS complex (194), and ST-T segment (134). High parameter importance (HPI) was defined as 1/p > 104 in univariate logistic regression, while multivariate logistic regression was used to determine the area under the receiver operating characteristic curves (AUROC).ResultsIn HCM-basal and HCM-apical, HPI was predominantly observed in the ST-T segment (49% and 51%, respectively), followed by the QRS complex (29% and 27%). For dHCM, HPI was lower in the ST-T segment (16%) and QRS complex (22%). The P-wave had low HPI across all subtypes. AUROCs for models with total ECG parameters were 0.925 for HCM-basal, 0.981 for HCM-apical, and 0.969 for dHCM. While AUROCs for the top 10 HPI models were lower than the total ECG parameter model for HCM total, they were comparable across HCM subtypes.ConclusionsAs HCM progresses to dHCM, a shift in HPI from the ST-T segment to the QRS complex provides clinically relevant insights. For HCM subtypes, the top 10 ECG parameters yield predictive performance similar to the full parameter set, supporting efficient approaches for AI-based diagnostic models.
| S-EPMC11876995 | biostudies-literature
Project description:Pulmonary embolism (PE) is a common finding in patients with underlying malignancy and is the commonest cause of acute cor pulmonale. A 65-year-old woman with a background of non-small-cell lung cancer presented to the emergency department with nausea and vomiting after starting erlotinib; she was pyrexial and had raised C-reactive protein. Despite aggressive fluid resuscitation and antibiotics the patient remained tachycardic, hypotensive, profoundly hypoxic and had a persistent raised jugular venous pulse. Massive PE was therefore suspected. A bedside echocardiogram demonstrated a dilated right ventricle and evidence of pulmonary hypertension. A CT pulmonary angiogram excluded a PE but revealed progression of the right hilar tumour causing complete obstruction of the right upper and middle lobe pulmonary arteries. This case highlights an important differential diagnosis when assessing patients with an underlying intrathoracic tumour with findings suggestive of PE and the importance of obtaining further imaging before considering thrombolysis.
| S-EPMC4543115 | biostudies-other
Project description:Combining therapeutic doses of low-molecular-weight heparins and increasing doses of recombinant activated protein C - Drotrecogin alpha (activated), or DAA - is of theoretical interest with regard to the control of coagulation activation. The study by Dempfle and colleagues presents new data showing that endogenous activated protein C levels do not increase in nonseptic patients with pulmonary embolism. However, the results of the addition of these two treatments are puzzling, leaving unresolved the questionable clinical relevance of this combination and the possible increase in bleeding risk.
| S-EPMC3221987 | biostudies-other
Project description:BackgroundThe optimal therapy for submassive pulmonary embolism remains in question. The following meta-analysis compiles the current evidence comparing Catheter-Directed Thrombolysis (CDT) versus Systemic Anticoagulation (SA).MethodsAn electronic search through PubMed and Google scholar revealed studies comparing CDT versus SA in terms of mortality and major bleeding events. Thirty-day, 90-day, and one-year mortality results were analyzed.ResultsSix studies were included in the meta-analysis. Thirty-day and one-year mortality were less with CDT compared to SA (OR 0.27 [CI 0.11-0.67]; and OR 0.50 [CI 0.28-0.89]). Ninety-day mortality was similar between the two methods (OR 0.57 [CI 0.17-1.92]). Compilation of all studies reporting at least greater than 30-day mortality revealed less mortality with CDT (OR 0.51 [0.30-0.86]). Major bleeding was similar between the two treatments (OR 1.63 [CI 0.63-4.20]).ConclusionCDT has less 30-day and 1-year mortality with equivalent rates of major bleeding compared to SA for treatment of submassive pulmonary embolism.
| S-EPMC9241122 | biostudies-literature
Project description:BackgroundLittle data exist on the use of direct oral anticoagulant (DOAC) factor Xa inhibitors for submassive pulmonary embolism (PE) after catheter-directed thrombolysis (CDT). The objective of this evaluation was to determine whether the transition from parenteral anticoagulation to DOACs for submassive PE after CDT would decrease hospital length of stay (LOS) compared to warfarin.MethodsA retrospective review of patients diagnosed with submassive PE who underwent CDT was conducted from January 1, 2012, to February 28, 2017. Hospital LOS and major and minor bleeding events were recorded during hospitalization and at 90 days.ResultsSixty-two patients met the inclusion criteria, 36 in warfarin group and 26 in the DOAC group. Overall, patients receiving rivaroxaban or apixaban had a shorter median hospital LOS compared to warfarin (4.0 vs 6.1 days, P = .002). In the multivariate regression analysis, administration of DOAC was an independent predictor of decreased hospital LOS, β: -2.1, 95% confidence interval (-3.5 to -0.7).ConclusionAmong patients with submassive PE, initiation of a DOAC shortly after CDT may result in a decreased hospital LOS compared to parenterally bridged warfarin.
| S-EPMC6714714 | biostudies-literature