Chest最新文献

{"title":"Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes Following Cardiac Surgery: A Nationwide Cohort Study.","authors":"Jae-Woo Ju,Jaeyeon Chung,Gang Heo,Youn Joung Cho,Yunseok Jeon,Karam Nam","doi":"10.1016/j.chest.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.008","url":null,"abstract":"BACKGROUNDEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce.RESEARCH QUESTIONDoes perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery?STUDY DESIGN AND METHODSThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume.RESULTSA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65-0.76).INTERPRETATIONPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of albumin versus no albumin on renal replacement therapy and mortality in patients with septic shock and renal impairment.","authors":"Asad E Patanwala,Alexander H Flannery,Hemalkumar B Mehta,Thomas E Hills,Colin J McArthur,Brian L Erstad","doi":"10.1016/j.chest.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.012","url":null,"abstract":"BACKGROUNDAlbumin infusions may be renally protective or harmful in patients with septic shock who have kidney impairment. This can affect the need for renal replacement therapy (RRT) and in-hospital mortality.RESEARCH QUESTIONDoes the early use of albumin mitigate the need for RRT or in-hospital mortality in patients with septic shock and kidney impairment on hospital admission.STUDY DESIGN AND METHODSThis was a retrospective, multicenter, inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the U.S. Adult patients were included if they had septic shock and kidney impairment on hospital admission. Patients were categorized as those who received albumin (within 24h of admission) or no albumin during hospitalization. Proportion of patients with RRT or in-hospital mortality were compared between groups.RESULTSOf the 9988 patients included in the final cohort, 7929 did not receive albumin and 2059 received albumin. Patients had a mean (SD) age of 67.8 years (14.8), 46.3% were female, and mean (SD) eGFR was 32 (12) ml/min/1.73m2 on the day of admission. In the weighted cohort, the composite outcome of RRT or in-hospital mortality occurred in 33.8% without albumin and 39.7% with albumin (OR 1.29, 95% CI 1.14 - 1.47, p<0.001). There was no significant difference with 5% albumin (OR 1.07, 95% CI 0.84 - 1.37), but there was a significantly increased risk with 25% albumin (OR 1.43, 95% CI 1.16 - 1.76).INTERPRETATIONIn patients with septic shock and kidney impairment on hospital admission, early albumin use may be associated with an increased composite outcome of RRT or in-hospital mortality. This increased risk is most associated with hyperoncotic rather than iso-oncotic albumin.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflicts of Interest in Bronchoscopy Research - Is Self-Reporting Sufficient?","authors":"Kaele M Leonard,Timothy A Khalil,Jacob Welch,Greta Dahlberg,Ankush Ratwani,Jennifer D Duke,Rafael Paez,Elisa J Gordon,Samira Shojaee,Robert J Lentz,Fabien Maldonado","doi":"10.1016/j.chest.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.006","url":null,"abstract":"BACKGROUNDRobotic assisted bronchoscopy has been enthusiastically adopted in the U.S. and transformed the management of patients with indeterminate pulmonary nodules. Unprecedented industry investments in research, development, and marketing have profoundly affected the bronchoscopy landscape, leading to concerns that conflicts of interest could influence the validity of bronchoscopy studies. Disclosures of conflicts of interest in research are predicated on open and transparent self-reporting.RESEARCH QUESTIONAre self-reported relevant conflicts of interest in articles pertaining to robotic assisted bronchoscopy accurate when compared to publicly available payments on the Centers of Medicare & Medicaid Services' Open Payments Database?STUDY DESIGN AND METHODSAll articles pertaining to robotic assisted bronchoscopy indexed on PubMed between 2016 and 2022 were screened for relevance. Articles appearing in the five journals with the most relevant publications were selected. General, research, and associated research payments reported in the Open Payments Database were recorded for each US physician-author with available data. \"Relevant payments\" refer to transactions made to authors by bronchoscopy-related companies. Documentation of all payments involving these companies during the three years prior to an article's submission date was obtained. These payments were compared to the self-reported conflicts of interest for each author, per article, and the number and value of payments were categorized and totaled.RESULTSTwenty-seven articles were included, accounting for 75 U.S. physicians with data reported in the Open Payments Database. Of the $17 million in relevant payments reported, $9.9 million were not disclosed (57%). Sixty-eight of 75 (91%) of authors had incomplete physician disclosures. Excluding food and beverage payments, sixty authors had incomplete disclosures (80%).INTERPRETATIONRelevant conflicts of interest appear to be inconsistently disclosed in publications on robotic assisted bronchoscopy, suggesting self-reporting may be an insufficient strategy. A centralized disclosure process that is automated or easier to use should be considered.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolation of genetically distinct strains within the same species during treatment of MAC pulmonary disease.","authors":"Jiwon Lee,Su-Jin Park,Sangmi Kim,Han Na Lee,Heungsup Sung,Tae Sun Shim,Kyung-Wook Jo","doi":"10.1016/j.chest.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.010","url":null,"abstract":"BACKGROUNDResearch on isolating genetically different strains within the same species in patients undergoing treatment for Mycobacterium avium complex (MAC) pulmonary disease (PD) is limited. We investigated the frequency of genetically distinct strains identified within the same species among on-treatment isolates compared with pre-treatment isolates throughout the course of MAC-PD treatment.RESEARCH QUESTIONWhat is the frequency of genetically distinct strains identified within the same species among pre- and on-treatment isolates in patients with MAC-PD?STUDY DESIGN AND METHODSWe serially collected pre- and on-treatment clinical isolates from patients with MAC-PD treated for over one month from November 2019 to October 2022 at a tertiary hospital in South Korea. We utilized multilocus sequence typing (MLST) genotypic analysis to determine whether the on-treatment isolate was a genetically different strain compared with the pre-treatment isolate.RESULTSAmong 327 enrolled patients, we identified the on-treatment isolates of 198 patients as the same species as the pre-treatment isolates. The median treatment duration for the 198 patients was 14.4 months (interquartile range, 12.1-16.9 months). Of these patients, MLST analysis revealed the presence of a genetically different strain among the on-treatment isolates at least once in 24.7% (49/198) of patients (95% confidence interval, 18.9-31.4) compared to the pre-treatment isolate. There were variations in the timing, frequency, and number of distinct strains in these 49 patients.INTERPRETATIONWe identified a genetically distinct strain within the same species at least once in approximately 25% of patients in whom the same species was isolated after the initiation of anti-MAC-PD therapy. These findings may affect the determination of treatment outcomes and corresponding MAC-PD treatment strategies.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editing approaches to treat Alpha-1 Antitrypsin Deficiency (AATD).","authors":"Derek M Erion,Liu Leah Y,Christopher R Brown,Stephen Rennard,Humam Farah","doi":"10.1016/j.chest.2024.09.038","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.038","url":null,"abstract":"TOPIC IMPORTANCEAlpha-1 antitrypsin (AAT) deficiency (AATD) is a genetic disorder most commonly due to a single G to A point mutation, leading to debilitating lung and/or liver disorders and is associated with increased mortality. The E342K point mutation causes a conformational change of the AAT protein resulting in its retention in liver hepatocytes. This reduces AAT secretion into the serum resulting in higher protease activities due to the lack of inhibition from AAT, causing damage to healthy lung tissue. The current standard of care for lung manifestations involves weekly intravenous augmentation therapy and is considered sub-optimal for these patients. Furthermore, there is currently no approved treatment for liver manifestations. The unmet medical need for AATD patients remains high and new treatment options are needed to treat the underlying disease etiology.REVIEW FINDINGSAdvances in genomic medicines may enable treatment by editing the DNA or RNA sequence to produce wild-type AAT instead of the mutated AAT caused by the E342K mutation. One approach can be achieved by directing endogenous Adenosine Deaminases that act on RNA (ADARs) to the E342K RNA site, where they catalyze adenosine to inosine conversion through a process known as RNA editing. The A-I RNA change will be read as a G during protein translation, resulting in an altered amino acid and restoration of wild-type AAT secretion and function.SUMMARYIn this review, we will discuss the pathophysiology of AATD and emerging treatment options with particular focus on RNA editing as a disnd have stock options in ease-modifying treatment for both liver and lung disease.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial Lung Abnormality: Narrative Review of the Approach to Diagnosis and Management.","authors":"Zein Kattih, Brett Bade, Hiroto Hatabu, Kevin Brown, Joseph Parambil, Akinori Hata, Peter J Mazzone, Stephen Machnicki, Dominick Guerrero, Muhammad Qasim Chaudhry, Liz Kellermeyer, Kaitlin Johnson, Stuart Cohen, Ramona Ramdeo, Jason Naidich, Alain Borczuck, Suhail Raoof","doi":"10.1016/j.chest.2024.09.033","DOIUrl":"10.1016/j.chest.2024.09.033","url":null,"abstract":"<p><strong>Topic importance: </strong>As interstitial lung abnormalities (ILAs) are increasingly recognized on imaging and in clinical practice, identification and appropriate management are critical. We propose an algorithmic approach to the identification and management of patients with ILAs.</p><p><strong>Review findings: </strong>The radiologist initially identifies chest CT scan findings suggestive of an ILA pattern and excludes findings that are not consistent with ILAs. The next step is to confirm that these findings occupy > 5% of a nondependent lung zone. At this point, the radiologic pattern of ILA is identified. These findings are classified as non-subpleural, subpleural nonfibrotic, and subpleural fibrotic. It is then incumbent on the clinician to ascertain if the patient has symptoms and/or abnormal pulmonary physiology that may be attributable to these radiologic changes. Based on the patient's symptoms, physiological assessment, and risk factors for interstitial lung disease (ILD), we recommend classifying patients as having ILA, at high risk for developing ILD, probable ILD, or ILD. In patients identified as having ILA, a multidisciplinary discussion should evaluate features that indicate an increased risk of progression. If these features are present, serial monitoring is recommended to be proactive. If the patient does not have imaging or clinical features that indicate an increased risk of progression, then monitoring is recommended to be reactive. If ILD is subsequently diagnosed, the management is disease specific.</p><p><strong>Summary: </strong>We anticipate this algorithmic approach will aid clinicians in interpreting the radiologic pattern described as ILA within the clinical context of their patients.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study.","authors":"Sarah Pankovitch, Michael Frohlich, Bader AlOthman, Jeffrey Marciniuk, Joanie Bernier, Dorcas Paul-Emile, Jean Bourbeau, Bryan A Ross","doi":"10.1016/j.chest.2024.09.031","DOIUrl":"10.1016/j.chest.2024.09.031","url":null,"abstract":"<p><strong>Background: </strong>COPD inhaler regimens should be appropriate for the patient's peak inspiratory flow (PIF) and should ideally consist of single or similar device(s).</p><p><strong>Research questions: </strong>In a subspecialized COPD clinic: (1) What is the prevalence of patients with suboptimal PIF and with inappropriate device(s) for measured PIF? (2) Are there patient-related risk factors associated with suboptimal PIF? (3) What is the prevalence of patients with non-single inhaler therapy (SIT)/nonsimilar devices? (4) Does point-of-care PIF affect clinical decision-making?</p><p><strong>Study design and methods: </strong>In this single-center real-world observational study, PIF was measured systematically at every outpatient visit in a subspecialized COPD clinic, and point-of-care results were provided to the clinician. Coprimary outcomes were the prevalence of outpatients with suboptimal PIF and with inappropriate devices for measured PIF. Secondary outcomes were patient-related risk factors associated with suboptimal PIF, the prevalence of non-SIT/nonsimilar devices, the prevalence of regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices, and the effect of point-of-care PIF on clinical decision-making.</p><p><strong>Results: </strong>Suboptimal PIF was identified in 45 of 161 participants (28%), and inappropriate device(s) for measured PIF were identified in 18 participants (11.2%). Significant associations were observed between suboptimal PIF and age (1.09; 95% CI, 1.04-1.15), female sex (10.30; 95% CI, 4.45-27.10), height (0.92; 95% CI, 0.88-0.96), BMI (0.90; 95% CI, 0.84-0.96), and FEV₁ (0.09; 95% CI, 0.03-0.26). After adjustment for age and sex, the association between suboptimal PIF and BMI, but not height, remained significant. Non-SIT and/or nonsimilar devices were identified in 50 participants (31.1%). Regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices were observed in 59 participants (36.6%). Inhaler prescription changes were observed in this latter group (3.39; 95% CI, 1.76-6.64), as well as in patients with suboptimal PIF who already had SIT/similar regimens (2.93; 95% CI, 1.07-7.92).</p><p><strong>Interpretation: </strong>Suboptimal PIF and inappropriate devices for measured PIF are highly prevalent among outpatients from a subspecialized COPD clinic. Female sex, reduced FEV₁, and low BMI are important, readily identifiable risk factors for suboptimal PIF, and point-of-care PIF can inform clinical decision-making.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Differences in Outcomes of Ambulatory and Hospitalized Patients With Obesity Hypoventilation Syndrome.","authors":"Nathan C Nowalk, Babak Mokhlesi, Julie M Neborak, Juan Fernando Masa Jimenez, Ivan Benitez, Francisco J Gomez de Terreros, Auxiliadora Romero, Candela Caballero-Eraso, Maria F Troncoso, Mónica González, Soledad López-Martín, José M Marin, Sergi Martí, Trinidad Díaz-Cambriles, Eusebi Chiner, Carlos Egea, Isabel Utrabo, Ferran Barbe, Maria Ángeles Sánchez-Quiroga","doi":"10.1016/j.chest.2024.10.002","DOIUrl":"10.1016/j.chest.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>Obesity hypoventilation syndrome (OHS) is associated with high morbidity and mortality. There are few data on whether there are gender differences in outcomes.</p><p><strong>Research question: </strong>Is female gender associated with worse outcomes in ambulatory and hospitalized patients with OHS?</p><p><strong>Study design and methods: </strong>Post hoc analyses were performed on 2 separate OHS cohorts: (1) stable ambulatory patients from the 2 Pickwick randomized controlled trials; and (2) hospitalized patients with acute-on-chronic hypercapnic respiratory failure from a retrospective international cohort. We first conducted bivariate analyses of baseline characteristics and therapeutics between genders. Variables of interest from these analyses were then grouped into linear mixed effects models, Cox proportional hazards models, or logistic regression models to assess the association of gender on various clinical outcomes.</p><p><strong>Results: </strong>The ambulatory prospective cohort included 300 patients (64% female), and the hospitalized retrospective cohort included 1,162 patients (58% female). For both cohorts, women were significantly older and more obese than men. Compared with men, baseline Paco₂ was similar in ambulatory patients but higher in hospitalized women. In the ambulatory cohort, in unadjusted analysis, women had increased risk of emergency department visits. However, gender was not associated with the composite outcome of emergency department visit, hospitalization, or all-cause mortality in the fully adjusted model. In the hospitalized cohort, prescription of positive airway pressure was less prevalent in women at discharge. In unadjusted analysis, hospitalized women had a higher mortality at 3, 6, and 12 months following hospital discharge compared with men. However, after adjusting for age, gender was not associated with mortality.</p><p><strong>Interpretation: </strong>Although the diagnosis of OHS is established at a more advanced age in women, gender is not independently associated with worse clinical outcomes after adjusting for age. Future studies are needed to examine gender-related health disparities in diagnosis and treatment of OHS.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Growth of Screening-Detected Pure Ground-Glass Nodules Following 10 Years of Stability.","authors":"Bo-Guen Kim, Hyunseung Nam, Inwoo Hwang, Yoon-La Choi, Jung Hye Hwang, Ho Yun Lee, Kyung-Mi Park, Sun Hye Shin, Byeong-Ho Jeong, Kyungjong Lee, Hojoong Kim, Hong Kwan Kim, Sang-Won Um","doi":"10.1016/j.chest.2024.09.037","DOIUrl":"10.1016/j.chest.2024.09.037","url":null,"abstract":"<p><strong>Background: </strong>It remains uncertain how long pure ground-glass nodules (pGGNs) detected on low-dose CT (LDCT) imaging should be followed up. Further studies with longer follow-up periods are needed to determine the optimal follow-up duration for pGGNs.</p><p><strong>Research question: </strong>What is the percentage of enlarging nodules among pGGNs that have remained stable for 10 years?</p><p><strong>Study design and methods: </strong>This was a retrospective cohort study originating from participants with pGGNs detected on LDCT scans between 1997 and 2006 whose natural courses were reported in 2013. We re-analyzed all the follow-up data until July 2022. The study participants were followed up per our institutional guidelines until they were no longer a candidate for definitive treatment. The growth of the pGGNs was defined as an increase in the diameter of the entire nodule by ≥ 2 mm or the appearance of new solid portions within the nodules.</p><p><strong>Results: </strong>A total of 89 patients with 135 pGGNs were followed up for a median of 193 months. Of 135 pGGNs, 23 (17.0%) increased in size, and the median time to the first detection of a size change was 71 months. Of the 23 growing pGGNs, 122 were detected on the first LDCT scan and 13 were newly detected on the follow-up CT scan. An increase in size was observed within 5 years in 8 nodules (34.8%), between 5 and 10 years in 12 nodules (52.2%), and following 10 years in 3 nodules (13.0%). Fifteen nodules were histologically confirmed as adenocarcinoma by surgery. Among the 76 pGGNs stable for 10 years, 3 (3.9%) increased in size.</p><p><strong>Interpretation: </strong>Among pGGNs that remained stable for 10 years, 3.9% eventually grew, indicating that some pGGNs can grow even following a long period of stability. We suggest that pGGNs may need to be followed up for > 10 years to confirm growth.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graded Transthoracic Contrast Echocardiography After Pulmonary Arteriovenous Malformation Embolization: Can Chest CT Be Avoided in Patients With a Low-Grade Shunt?","authors":"J Hessels, S Klompmaker, D A F van den Heuvel, S Boerman, J J Mager, M C Post","doi":"10.1016/j.chest.2024.09.029","DOIUrl":"10.1016/j.chest.2024.09.029","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arteriovenous malformations (PAVMs) are direct connections between the pulmonary artery and vein, creating a right-to-left shunt (RLS). Embolization is indicated to prevent complications. Guidelines recommend follow-up chest CT scans to confirm persistent occlusion and embolization of all treatable PAVMs. Graded transthoracic contrast echocardiography (TTCE) after PAVM embolization may offer a reliable alternative in a subgroup of patients while preventing radiation exposure.</p><p><strong>Research question: </strong>Can TTCE predict the need for additional embolotherapy in the postembolization population as accurately as it does in the treatment-naive population?.</p><p><strong>Study design and methods: </strong>Since 2018, follow-up after PAVM embolization at our study institution includes both TTCE and chest CT scan after 6 to 12 months and every 3 to 5 years thereafter. Patients who underwent at least 1 follow-up TTCE and chest CT scan were included. The indication for additional embolotherapy was discussed in a multidisciplinary team meeting. The primary outcome was the indication for additional embolotherapy in each RLS grade. Additionally, the association between the RLS grade and indication for additional embolotherapy was investigated.</p><p><strong>Results: </strong>A total of 339 patients with 412 embolization procedures were included; median time to follow-up TTCE was 7.5 months. An RLS was present in 399 postembolization TTCEs (97%): RLS grade 1 in 93 patients (23%), grade 2 in 149 patients (36%) and grade 3 in 157 patients (38%). In patients with RLS grades 0 and 1, no treatable PAVMs were found on CT scan. In patients with RLS grades 2 and 3, 22 (15%) and 72 (46%) underwent additional embolization.</p><p><strong>Interpretation: </strong>This study shows chest CT scan might be forgone in patients with RLS grades 0 and 1 after PAVM embolization.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}