0000000000056081
AUTHOR
Jörn O. Balzer
D-dimer for risk stratification in haemodynamically stable patients with acute pulmonary embolism
Patients with submassive pulmonary embolism (PE) have a higher short-term mortality than those with low-risk PE. Rapid identification of submassive PE is important for adequate treatment of non-massive PE. We aimed to investigate the utility of D-dimer for the prediction of submassive PE stadium in normotensive PE patients.Normotensive PE patients were classified into submassive or low-risk PE groups. In addition to the comparison of the groups, area under the curve (AUC) and D-dimer cut-off for the prediction of submassive PE stadium, multi-variate logistic regression for association between D-dimer values above this cut-off and submassive PE stadium were also calculated.The data of 129 no…
Blood pressure for outcome prediction and risk stratification in acute pulmonary embolism.
Abstract Introduction Risk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. Blood pressure (BP) is rapidly available and a reliable parameter. We aimed to investigate BP for short-term outcome in acute PE. Materials and methods Data of 182 patients with acute PE were analyzed retrospectively. Logistic regression models were calculated to investigate associations between BP and in-hospital-death as well as myocardial necrosis. Moreover, receiver operating characteristic (ROC) curves and cutoff values for systolic and diastolic BPs predicting in-hospital death and myocardial necrosis were computed. Results A total of 182 pati…
Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism
Abstract Background Echocardiography for risk stratification in hemodynamically stable patients with pulmonary embolism (PE) is well-established. Right ventricular dysfunction (RVD) is associated with an elevated mortality and adverse outcome. The aim of our study was to compare RVD criteria and investigate the role of elevated systolic pulmonary artery pressure (sPAP) in the diagnosis of RVD. Methods We retrospectively analyzed the echocardiographic and laboratory data of all hemodynamically stable patients with confirmed PE (2006-2011). The data were compared with three different definitions of RVD: Definition 1: RV dilatation, abnormal motion of interventricular septum, RV hypokinesis or…
Right bundle branch block and SIQIII-type patterns for risk stratification in acute pulmonary embolism.
Abstract Introduction Risk stratification in acute pulmonary embolism (PE) is crucial for identification of patients with poor prognosis. We aimed to investigate the ECG alterations of right bundle branch block (RBBB) and S I Q III -type patterns for risk stratification in acute PE. Materials and methods Retrospective analysis of PE patients, treated in the Internal Medicine Department, was performed. Patients with RBBB and/or S I Q III -type were compared with those without both patterns. Logistic regression models for association between these ECG alterations and respectively right ventricular dysfunction (RVD), high-risk PE status and myocardial injury were computed. Results 175 patients…
The risk factor age in normotensive patients with pulmonary embolism: Effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients.
Abstract Introduction Right ventricular dysfunction (RVD), submassive pulmonary embolism (PE), elevated systolic pulmonary artery pressure (sPAP), elevated cardiac troponin I (cTnI) and old age are well-known risk factors for poor outcome in acute normotensive PE. The aim of this analysis was to calculate age cut-off values to predict submassive PE, cardiac injury, RVD and elevated sPAP in normotensive PE patients. Methods Retrospective analysis of clinical, laboratory, radiological and echocardiographic data of normotensive PE patients (2006–2011) was performed. Receiver operating characteristic (ROC) curves and Youden indexes were used to test the effectiveness of using patients' ages at …
Evaluation of Risk Stratification Markers and Models in Acute Pulmonary Embolism: Rationale and Design of the MARS-PE (Mainz Retrospective Study of Pulmonary Embolism) Study Programme
An acute pulmonary embolism (PE) is a crucial event in patients’ life and connected with serious morbidity and mortality. Regarding a high case-fatality rate, early and accurate risk-stratification is crucial. Risk for mortality and complications are closely related to hemodynamic stability and cardiac adaptations. The currently recommended risk-stratification approach is not overall simple to use and might delay the identification of those patients, who should be monitored more closely and may treated with more aggressive treatment strategies. Additionally, some risk-stratification criteria for the imaging procedures are still imprecise. Summarized, the search for the most effective risk-s…
D-Dimer and thrombus burden in acute pulmonary embolism.
Abstract Background Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients. Methods Overall, 161 PE patients were analyzed retrospectively, classified in 5 subgroups of thrombus burden according to clinical indications and compared regarding D-Dimer-levels. Linear regression models were computed to investigate the association between D-Dimer and the groups. In hemodynamically stable PE patients, a ROC curve was calc…
Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism
Background Deep vein thrombosis (DVT) and pulmonary embolism (PE) are connected with a poor outcome in cancer patients. We aimed to investigate the impact of cancer on the effectiveness of cardiac Troponin I (cTnI) to predict right ventricular dysfunction (RVD) in acute PE. Methods We retrospectively analyzed the data of 182 patients with confirmed PE. PE patients were subdivided into two groups: (i) with concomitant active cancer disease or history of cancer, and (ii) without known cancer. Receiver operating characteristic (ROC) curves with area under the curve (AUC) was calculated for cTnI predicting RVD and related cut-off levels for both groups. Results Thirty-seven PE patients (20.3%) …
Concomitant history of cancer in acute pulmonary embolism is connected with poorer outcome
Abstract Purpose: Cancer increases the risk of venous thromboembolism (VTE) substantially. VTE is connected with poorer outcome in cancer patients. The aim of our study was to investigate the impact of cancer on the severity and short-term outcome of pulmonary embolism (PE). Methods: We retrospectively analyzed the data of 182 patients with confirmed PE. PE patients were subdivided in the group with concomitant active cancer disease or history of cancer or in the group without cancer. Groups were compared with Wilcoxon–Mann–Whitney Test. Logistic regression models were calculated to investigate the association between cancer and several parameters such as age and PE severity status as well …
Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism
Abstract Background In addition to right ventricular dysfunction (RVD) and myocardial injury, impaired renal function is connected with poorer prognosis in pulmonary embolism (PE). We aimed to investigate renal function as a cofactor for risk stratification in PE. Methods Data from 182 patients with PE, treated between May 2006 and June 2011, were analysed retrospectively. PE patients with elevated creatinine were compared with those with normal values. Logistic regression models were calculated to investigate associations between creatinine and myocardial necrosis, RVD and in-hospital death. Prognostic performance of creatinine for prediction of myocardial necrosis and RVD were computed. R…
Syncope and collapse in acute pulmonary embolism.
Abstract Background Syncope and collapse (= presyncope) are 2 symptoms of pulmonary embolism (PE), which are suspected of being connected with poorer outcome, regardless of haemodynamic instability. However, pathomechanisms are not completely understood. We aimed to investigate these pathomechanisms in regard to blood pressure and heart rate of syncope/collapse in PE. Methods We performed a retrospective study of consecutive PE patients, who were treated in the Internal Medicine Department. Patients with and without syncope/collapse were compared. Regression models for associations between syncope/collapse and blood pressure, heart rate and shock index (SI) were computed. Moreover we calcul…
Elevated systolic pulmonary artery pressure for prediction of myocardial necrosis and right ventricular dysfunction in acute pulmonary embolism
Kontext: Echokardiografie je v soucasnosti hlavni metodou pro vysetřeni dysfunkce prave komory (right ventricular dysfunction, RVD) u akutni plicni embolie (PE). Dysfunkce prave komory je sice spojena s nepřiznivou prognozou, dosud vsak nebyla přijata žadna obecně uznavana definice. Systolický tlak v plicnici (systolic pulmonary artery pressure, sPAP) větsinou neni soucasti kriterii RVD. Cilem nasi studie bylo zhodnotit možnost použiti sPAP v predikci nekrozy myokardu a RVD u akutni PE.Metody: Retrospektivně byly analyzovany udaje 182 pacientů s akutni PE. Pacienti s PE a hodnotami sPAP ≤ 30 mm Hg byli srovnavani s pacienty s PE a hodnotami sPAP > 30 mm Hg. Vztahy mezi sPAP na jedne straně …