Pulmonary embolism最新文献_第7页

Incidental pulmonary embolism. Incidence, clinical-radiological features and survival 偶发性肺栓塞。发病率、临床放射学特征和生存率

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1462

F. García, G. Díaz, M. T. Río, Z. Vasquez, Elena Canal, E. Aguilar, Joaquin Costa, C. Matesanz, Jose Maria Serra Diaz, A. Abad

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Presentation and clinical evolution of Pulmonary Embolism in patients with Mental Disorders 精神障碍患者肺栓塞的表现和临床演变

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3648

Clara Martin Ontiyuelo, Oswaldo Antonio Caguana Vélez, A. Herranz blasco, A. Sancho Muñoz, L. Molina Ferragut, Raúl Millán Segovia, A. Vázquez Sanchez, O. Pallàs Villaronga, M. Mellado Joan, Fernando Fernández Alarza, C. Jiménez Martínez, J. R. Masclans Enviz, Cristina Estirado Vera, D. Rodriguez Chiaradia

{"title":"Presentation and clinical evolution of Pulmonary Embolism in patients with Mental Disorders","authors":"Clara Martin Ontiyuelo, Oswaldo Antonio Caguana Vélez, A. Herranz blasco, A. Sancho Muñoz, L. Molina Ferragut, Raúl Millán Segovia, A. Vázquez Sanchez, O. Pallàs Villaronga, M. Mellado Joan, Fernando Fernández Alarza, C. Jiménez Martínez, J. R. Masclans Enviz, Cristina Estirado Vera, D. Rodriguez Chiaradia","doi":"10.1183/13993003.congress-2019.pa3648","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3648","url":null,"abstract":"Introduction: In Patients with Mental Disorders (MD) the risk of venous thromboembolic disease has increased. There is little information regarding these patients during acute pulmonary embolism (PE). Objectives and Methods: This was a retrospective observational cohort study performed in a tertiary hospital in Spain. All patients with a primary diagnosis of PE between October 2015-September 2017 were included. The objective of the study was to compare the clinical presentation and the treatment of patients diagnosed of PE with and without MD. Results: One hundred fifty-three consecutive patients were included. Thirty-six (23.6%) had MD [depression 8(22%), anxiety 12(33%), schizophrenia 1(4%), bipolar 1(4%); more than one MD 14 (37%)]. Patients with MD were older compared to patients without MD (mean±SD, 75 ±9 vs 69 ±8 years, p=0.008) and mainly women (80% vs 56%, p=0.007). There were no significant differences in risk factors, comorbidities or clinical presentation. High levels of pro-BNP were showed in patients with MD (5499 ± 3120 vs 1764 ± 2692 pg/ml, p=0.01). Although the treatment was more conservative in patients with MD (97% of patients treated with low molecular weight heparin vs. 82% in the other group, p=0.040), hospital stay was longer in the MD group (11.9 ±6 vs 7.7 ±7 days, p=0.025). Among patients treated with psychotropic drugs, only patients in treatment with antipsychotics (n=9, 25%) were found to have a higher mortality at 90 days (p=0.044). Conclusions: Although conservative treatment of pulmonary embolism was predominant in the context of mental disorder, this was associated with a longer hospital stay. Patients on antipsychotic therapy may represent a potential higher risk population","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85227809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sincope is a risk marker in Pulmonary Embolism (PE) with a low risk clinical profile (sPESI:0) sinope是肺栓塞(PE)的危险标志，具有低风险临床概况(sPESI:0)。

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3644

Koral Fernandez De Roitegui Perez, J. Beristain, Igor Murga Arizabaleta, Cristina Bermudez Ampudia, A. Maestre, F. Bragado, R. Otero, M. Peris, Juan Jose Lopez Núlez, P. Verhamme, M. Monreal, Riete

{"title":"Sincope is a risk marker in Pulmonary Embolism (PE) with a low risk clinical profile (sPESI:0)","authors":"Koral Fernandez De Roitegui Perez, J. Beristain, Igor Murga Arizabaleta, Cristina Bermudez Ampudia, A. Maestre, F. Bragado, R. Otero, M. Peris, Juan Jose Lopez Núlez, P. Verhamme, M. Monreal, Riete","doi":"10.1183/13993003.congress-2019.pa3644","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3644","url":null,"abstract":"Introduction: Despite the fact that the Sincope is an alarming symptom that always forces us to suspect significant cardiac dysfunction, the most recommended Clinical Scales for the prognostic evaluation of the PE do not include it as a risk parameter, for the refusal on the part of the classic studies to observe an association with the clinical outcome. Among patients who, due to their clinical profile of Low Risk, would be candidates for extrahospital management, its prognostic significance is especially necessary to clarify. Objective: Considere if the presence of Sincope is associated with mortality in a large cohort of patients with PE and a low risk clinical profile according to the sPESI scale. Material and Methods: Patients included in the RIETE Registry until March 2017 and who presented a score of 0 on the sPESI scale. The Student and Mann-Whitney tests were used to compare the continuous variables, and the Chi-square test for qualitative ones. Univariate logistic regression analyzes were performed and a predictive model was constructed using multivariate logistic regression with the selected variables. Conclusion: In patients with a low risk clinical profile according to the sPESI scale, the presence of Sincope increases significantly the probability of short-term death. When making decisions about the initial outpatient management of PE its presence should be taken into account.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78299903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Refining risk in normotensive acute pulmonary embolism 正常血压急性肺栓塞的改善风险

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3646

K. Solverson, Christopher J. Humphreys, Zhiying Liang, P. Boiteau, Andre Freland, E. Herget, James Andruwchow, N. Fine, D. Helmersen, J. Weatherald

{"title":"Refining risk in normotensive acute pulmonary embolism","authors":"K. Solverson, Christopher J. Humphreys, Zhiying Liang, P. Boiteau, Andre Freland, E. Herget, James Andruwchow, N. Fine, D. Helmersen, J. Weatherald","doi":"10.1183/13993003.congress-2019.pa3646","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3646","url":null,"abstract":"Introduction: Normotensive acute pulmonary embolism (aPE) has a wide spectrum of outcomes. The best method to identify patients at higher-risk remains unclear. Aims and Objectives: 1) develop a unique prognostic model for adverse outcomes in normotensive aPE, 2) validate the Bova score in a North American population. Methods: This was a multi-centre retrospective cohort of all aPE admitted from emergency departments in Calgary, Canada between 2012-2017. Logistic regression models with bootstrapping for internal validation were used to predict the composite primary outcome of in-hospital death or hemodynamic decompensation. Results: 2067 patients with normotensive aPE were assessed. A primary outcome occurred in 32 patients (1.5%). Stratified by simplified pulmonary embolism severity index (sPESI), 21.2% were low-risk (0% event rate) and 78.8% were high-risk (2.0% event rate). The multivariable model in sPESI high-risk patients (n=1179) retained high-sensitivity troponin ≥50 pg/ml, CT right-left ventricular diameter ratio ≥1.5, systolic blood pressure Conclusions: Our novel risk score discriminated normotensive aPE patients at high risk of in-hospital adverse events better than the Bova score. Further validation of our score is warranted.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84442181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modification of the simplified PESI score to identify low risk patients with acute symptomatic pulmonary embolism 改进简化PESI评分以识别急性症状性肺栓塞低危患者

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3643

Diana Paulina Chiluiza Reyes, E. Barbero, A. Quezada, E. Mercedes, F. León, D. Jiménez

{"title":"Modification of the simplified PESI score to identify low risk patients with acute symptomatic pulmonary embolism","authors":"Diana Paulina Chiluiza Reyes, E. Barbero, A. Quezada, E. Mercedes, F. León, D. Jiménez","doi":"10.1183/13993003.congress-2019.pa3643","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3643","url":null,"abstract":"Introduction: The simplified Pulmonary Embolism Severity Index (PESI) score has been validated to identify low risk patients with acute symptomatic pulmonary embolism (PE). Aim: To evaluate if the modification in the cut-off value of the heart rate in the sPESI score increases its sensitivity without affecting its clinical utility. Material and Methods: We used the data set of the multicentric study PROTECT, which analysed a variety of prognostic tools in 848 normotensive patients with acute symptomatic PE from 12 different Spanish hospitals. The heart rate cut-off value was modified (positive if ≥100/bpm). The primary efficacy outcome was all-cause mortality during the first 30 days of treatment. The secondary efficacy outcome was a composite of complicated clinical course elements, defined as all-cause mortality, hemodynamic shock or non-fatal thromboembolism recurrence during the first 30 days of treatment. Results: The modified simplified PESI score identified 249 low risk patients (29%, confidence interval [CI] 95%, 26-33%) compared to 37% detected with the original sPESI score. The sensitivity of the modified sPESI for all-cause mortality, PE mortality and complicated clinical course was 100% (CI 95%, 89-100%), 100% (CI 95%, 68-99%) and 97%(CI 95%, 88-99%) respectively, compared to 97%(CI 95%, 85-100%), 91% (CI 95%, 57-100%) and 92% (CI 95%, 82-97%) of the original score. Conclusions: The modification in the cut-off value of the heart rate in the sPESI score diminished its clinical utility but at the same time it increased its sensitivity to identify normotensive patients with PE and low mortality and short-term complications risk.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84445120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Streamlining diagnostic work-up of pulmonary embolism: Comparing YEARS algorithm with original and simplified Well’s scores 简化肺栓塞的诊断检查:将YEARS算法与原始和简化的Well评分进行比较

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3640

A. Zahid, A. Azam, Q. Abdullah, I. Hamigi, A. Kodamanchile, S. Ekhelikar, M. Ganaie

引用次数: 0

Can implementation of the pulmonary embolism rule-out criteria (PERC) safely reduce D-dimer and CTPA requests in a two-tier Wells model? 在两层Wells模型中，肺栓塞排除标准(PERC)的实施能否安全地减少d -二聚体和CTPA的要求?

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3641

H. L. Ang, Hann Hsiang Tan, A. Ionescu

{"title":"Can implementation of the pulmonary embolism rule-out criteria (PERC) safely reduce D-dimer and CTPA requests in a two-tier Wells model?","authors":"H. L. Ang, Hann Hsiang Tan, A. Ionescu","doi":"10.1183/13993003.congress-2019.pa3641","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3641","url":null,"abstract":"Introduction: An elevated D-dimer results in an extensive pulmonary embolism (PE) workup, subjecting patients to radiation, potentially harmful side effects from IV contrast and anticoagulation treatment. The PERC rule1 was developed to risk stratify low-risk patients (Wells score ≤2). If PERC score is 0, the pre-test probability would be so low that the risks involved in a PE workup outweigh the benefits1. This is yet to be tested in a two-tier Wells model (Wells score ≤4). Purpose: To assess the role of the PERC rule in safely reducing D-dimer and CTPA requests in a two-tier Wells model. Methods: We performed a retrospective analysis by applying the PERC rule in Wells score ≤4 patients who had a D-dimer test upon presentation to the Emergency Department of Royal Gwent Hospital, from July 2018 to December 2018. Results: 430 patients were included in this study. 141 patients had PERC=0. 27 of the PERC=0 patients had a CTPA scan and amongst those, 2 patients had confirmed PE. Our pre-test probability of PE in PERC=0 patients is 1.4%. By implementing the PERC rule, we could reduce the number of D-dimers ordered by 32.3% and CTPAs by 21.0%. Conclusion: Our pre-test probability of PE in patients with PERC=0 is 1.4%, below the recommended threshold of 1.8% (p=0.367)1. The use of the PERC rule could improve the use of CTPA in the diagnosis of PE. Reference: 1. Kline J, Mitchell A, Kabrhel C, Richman P, Courtney D. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2004;2(8):1247-1255.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"118 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77242847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Should thrombolysis and sildenafil be given in the acute management of patients with large pulmonary embolism? An assessment of the short and long-term outcomes 在大肺栓塞患者的急性治疗中是否应该给予溶栓和西地那非?对短期和长期结果的评估

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3653

N. Hill, N. Bascon, N. Barnes, B. Madden

{"title":"Should thrombolysis and sildenafil be given in the acute management of patients with large pulmonary embolism? An assessment of the short and long-term outcomes","authors":"N. Hill, N. Bascon, N. Barnes, B. Madden","doi":"10.1183/13993003.congress-2019.pa3653","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3653","url":null,"abstract":"Introduction: The role of thrombolysis in the management of patients with haemodynamic compromise in the presence of pulmonary embolism (PE) is recognised although it is unclear whether there is an indication for concomitant use of advanced pulmonary vasodilator therapy. Aims: To assess the potential benefit of sildenafil on outcome when administered acutely with, or without thrombolysis, to patients with large PE. Method: We performed a retrospective review of the outcome of 20 consecutive patients (9 male, 11 female) who presented with acute right heart strain on echocardiographic assessment, computed tomography or biochemical markers (beta natriuretic peptide), in association with large PE, between January 2015–June 2017, who received sildenafil (25mg TDS) at the time of presentation, with or without thrombolysis. Results: Sildenafil was tolerated without complication in 19 patients. There were 2 deaths due to malignancy at 10, and 18 months, and no deaths directly attributable to thromboembolic disease. Of those with calculable pulmonary arterial systolic pressures (PASP) (n=12), the average reduction in PASP at 3-6 months and 12-24 months was -22.04mmHg, and -17.25mmHg respectively. Those receiving sildenafil alone had a greater average reduction in PASP at short and long term follow up (-24.13mmHg, and -25.44mmHg respectively) compared with those also receiving thrombolysis due to haemodynamic compromise (-17.88mmHg, and -1.67mmHg respectively). Our experience suggests that sildenafil can be used safely in this patient group with good haemodynamic outcome, although larger randomised trials are necessary to support this.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72642177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incorporating age adjusted d-dimer limit in place of differential cut-off in YEARS algorithm. Does it help to reduce CTPA burden? 采用年龄调整的d-二聚体限制来代替YEARS算法中的差分截止。是否有助于减轻CTPA的负担?

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3639

A. Zahid, A. Azam, Q. Abdullah, I. Hamigi, A. Kodamanchile, S. Ekhelikar, M. Ganaie

引用次数: 0

Thromboprophylaxis (TP) in Pulmonology department in Galdakao-Usansolo Hospital Galdakao-Usansolo医院肺病科血栓预防(TP)

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1465

Leyre Chasco Eguilaz, Aitor Ballaz Quincoces, A. U. Echeverría, Amaia Aramburu Ojembarrena, Txomin Zabala Hernandez, Amaia Artaraz Ereño, Olaia Bronte Moreno, Patrizia García Hontoria, Ana Jodar Samper

引用次数: 0