Diagnosis Of PE Research Articles

Pregnancy and Postpartum Experiences of Women Diagnosed with Preeclampsia: A Qualitative Study

Objective: The aim of this study is to determine the pregnancy and postpartum experiences of women diagnosed with preeclampsia. Methods: The study was conducted with a qualitative design. Data were collected through face-to-face or online interviews using a semi-structured form with 18 women who gave birth with a diagnosis of preeclampsia in the first six months following delivery at a university hospital in Istanbul. The findings were analyzed using content analysis. Results: The mean age of the participants was 30.1±4.1 years. 61.1% of the participants had preterm delivery, 88.8% stayed in the hospital for 2-6 days, and the mean duration after delivery was 90.3±44.6 days. Participants were diagnosed with preeclampsia at an average of 28.5±3.8 weeks. Five themes were identified as a result of qualitative interviews: “reaction to the diagnosis of pre-eclampsia”, ‘postpartum effects of pre-eclampsia’, ‘information gathering’, ‘social support’ and ‘lifestyle changes and pregnancy intention’. Conclusion: The diagnosis of PE affects women’s experiences during pregnancy and the postpartum period. The results indicate that women needed professional assistance with a multidisciplinary approach during this period.

Type of D-dimer assay determines the diagnostic yield of Computed Tomography in patients suspected for pulmonary embolism

ImportancePulmonary embolism (PE) is a life-threatening condition with high morbidity and mortality. The diagnosis of PE is challenging due to nonspecific symptoms, making reliable diagnostic tools essential. This study addresses the clinical impact of inter-assay variability in D-dimer measurements on the utilization and diagnostic yield of computed tomography pulmonary angiography (CTPA). ObjectiveTo investigate the effect of different D-dimer assays on the decision to perform CTPA and the subsequent diagnostic yield in patients with suspected PE. DesignThis retrospective cohort study analyzed data from three teaching hospitals in the Netherlands, covering the years 2018, 2019, 2022, and 2023. SettingMulticenter study involving three teaching hospitals in the south-west region of the Netherlands. ParticipantsThe study included data from 40,096 clinically requested D-dimer results and 11,372 CTPA records of patients with suspected PE. The D-dimer assays used were the Roche Tinaquant and Siemens Innovance. ResultsThe study found significant differences in CTPA utilization and diagnostic yield based on the D-dimer assay used. Hospitals using the Roche Tinaquant assay ordered 21% fewer CTPAs and had an 7% higher positivity rate compared to those using the Siemens Innovance assay. Conclusion and relevanceThe findings highlight the necessity for assay-specific cut-off values or, ideally, the standardization of the D-dimer assay to optimize the accuracy and efficiency of PE diagnosis. This study demonstrates that the choice of D-dimer assay significantly influences the clinical management of suspected PE, affecting both the number of CTPAs performed and the positivity rate of these scans. Implementing assay-specific cut-off values or standardization of the D-dimer assay could reduce unnecessary CTPA scans, minimize patient exposure to radiation, and lower healthcare costs. These results advocate for enhanced collaboration between clinicians and laboratory specialists to accurately interpret D-dimer results within the context of the specific assay used. Future research should validate these findings in prospective studies and explore standardized protocols that account for inter-assay variability.

Current practices in diagnosing acute pulmonary embolism: a comprehensive analysis of adherence to contemporary practice guidelines.

Acute pulmonary embolism (APE) poses significant diagnostic challenges, with potentially fatal outcomes if not promptly identified and treated. Despite the availability of clinical guidelines, adherence to diagnostic strategies varies globally, impacting patient outcomes. Our aim was to investigate current practices for PE diagnosis among Polish physicians and their adherence to the contemporary 2019 European Society of Cardiology (ESC) guidelines. This cross‑sectional study, utilizing a web‑based survey developed with the Delphi methodology, included hospital‑based physicians of various specialties from Poland. The survey focused on diagnostic practices, risk stratification, and adherence to the ESC 2019 guidelines for PE. The study showed a limited use of guideline‑recommended clinical prediction rules, with predominant reliance on D‑dimer assessment and computed tomography pulmonary angiography. Risk stratification practices varied, and were often based on individual experience rather than evidence‑based strategies. The vast majority of physicians (80.5%) had never contacted a PE response team, but 88% stated that they would if it were available. Cardiologists were more likely to employ guideline‑recommended methods than other specialists. There is a need for increased adherence to guideline‑recommended diagnostic and risk stratification strategies in APE among physicians in Poland. Enhancing the availability of PE response teams and promoting guideline‑directed practices could improve diagnostic accuracy and patient outcomes.

The role of pentraxin 3 and cathepsin B levels in pregnancies complicated by preeclampsia

Objective The objective of this study was to compare the levels of cathepsin B and pentraxin 3 in maternal serum of pregnant women with preeclampsia in the second trimester, to ascertain the impact of these levels on maternal and fetal outcomes, and to present a comprehensive analysis of the combined effects of cathepsin B and pentraxin 3 levels. Methods This prospective case-control study was conducted at Bursa Yuksek Ihtisas Training and Research Hospital between 1 January 2022 and 31 December 2022. The study included 78 pregnant women diagnosed with preeclampsia and 78 healthy pregnant women in the second trimester, between the ages of 18 and 45. Once a diagnosis of preeclampsia was established, maternal serum samples were obtained from the pregnant women prior to the initiation of any therapeutic intervention. Once all samples had been collected, the values for cathepsin B and pentraxin 3 were determined using the ELISA method. Results The results demonstrated a statistically significant elevation in the levels of pentraxin 3 (p = 0.008) and cathepsin B (p = 0.005) in pregnancies affected by preeclampsia when compared to those deemed healthy. Moreover, pentraxin-3 (p = 0.007) and cathepsin B (p = 0.002) were found to be significantly elevated in severe preeclampsia compared to mild preeclampsia. A comparison of the groups with and without HELLP syndrome revealed no statistically significant difference between the two groups. The ROC analysis revealed that the Cathepsin B 7.04 cut-off value was statistically significantly associated with the prediction of preeclampsia in all cases, with a sensitivity of 78.2% and a specificity of 47.4% (p = 0.005, AUC = 0.631). Conclusion The levels of CB and PTX3 may be employed as biomarkers to facilitate the early diagnosis of PE during the second trimester. Furthermore, these biomarkers may prove to be promising for the prediction of PE severity.

Explanation of the problem of pulmonary embolism in relation to the optimization of modern algorithms for the actions of the family doctor

The purpose of the work is to ensure the improvement of the quality of education and educational services at a level that meets the expectations and needs of the family doctor, contributes to the optimization of the educational process on the problem of pulmonary embolism. Determination of clinical probability is an important component of management of patients with suspected PE. In clinical practice, the Canadian (P.S. Wells) and Geneva scales are most often used for this. For a patient with a high clinical probability of PE, multispiral computer tomography (MSCT) is of primary importance. With suspected high-risk PE, evidenced by shock or hypotension, CT angiography or bedside transthoracic echocardiography should be performed for diagnostic purposes. Today, magnetic resonance imaging is not recommended for the diagnosis of PE. Outpatient treatment should be carried out with PESI class I-II. Inpatient treatment - with PESI III-V class. Anticoagulant therapy (ACT), which should be started as early as possible at the stage of diagnosis, is the basis of VE treatment. Thrombolytic therapy should be carried out in the clinic of shock or in the presence of hemodynamic instability. As a basis for planning the educational process, it is desirable to take the constructive alignment model, which consists of the following three logically interconnected components. First of all, these are learning outcomes that must be aligned with the goals of the curriculum. Secondly, educational activities should be related to expected learning outcomes. An important component is assessment and feedback. The professional training of a general practitioner - a family doctor is aimed at acquiring new knowledge, deepening professional competences and improving practical skills to maintain an appropriate level of training for today's urgent problem - pulmonary embolism, taking into account the realities of wartime and the threat of repeated outbreaks of covid infection (CI)

Epidemiology of pulmonary embolism diagnosis and management among United States emergency departments over an eight-year period

IntroductionPulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. However, as diagnostic imaging, risk stratification tools, and treatment have evolved over time, there is a critical need for current data on the incidence, testing, admission rates, and medical management of PE in the ED setting. MethodsThis was a cross-sectional study of ED patients with PE diagnoses from 1/1/2016 to 12/31/2023 using the Epic Cosmos national database. ED visits were identified using ICD-10 codes corresponding to acute PE. Chronic PEs were excluded. Outcomes included total ED visits, admission rates, anticoagulant treatment prescribed from the ED, and thrombolytic therapy. Anticoagulant prescriptions included warfarin, enoxaparin, dabigatran, apixaban, rivaroxaban, edoxaban, and betrixaban. Thrombolytic agents included alteplase, tenecteplase, and urokinase. We also assessed changes in the overall rate of CT pulmonary angiograms (CTPA) performed. ResultsOut of 186,138,130 total ED encounters, PE represented 531,968 (0.29 %). The overall rate of PE diagnosis rose slowly from 0.20 % in 2016 to a peak of 0.35 % in 2021. Among those with PE, 363,584 (68.3 %) were admitted. The rate of admission declined over time from 75.6 % to 66.1 %. Among those prescribed anticoagulation, the most common medication was apixaban (40.0 %), followed by rivaroxaban (17.3 %), enoxaparin (6.1 %), warfarin (2.6 %), and dabigatran (0.4 %). Thrombolytics were administered in 4.5 % of cases, with the rate of thrombolytics peaking at 5.3 % in 2018 before lowering to 3.5 % in 2023. The overall rate of CTPA increased from 2.4 % to 5.0 %, while the rate of proportion of PEs diagnosed declined from 8.7 % to 6.4 %. ConclusionThis study highlights significant shifts in the epidemiology and management of PE within the ED setting. Overall rates of PE rose, while a larger proportion were discharged. Direct oral anticoagulants have become the predominant therapy with the majority of patients receiving apixaban. Thrombolytic use occurs in a small subset and has been declining over time. CTPA rates have risen, while the overall diagnostic yield has declined.

Role of right ventricular–pulmonary arterial coupling assessed by echocardiography to predict adverse outcomes in patients with acute pulmonary embolism

BackgroundPulmonary embolism (PE) is a lethal type of venous thromboembolic disease. Right ventricular (RV) failure is not an uncommon complication of PE leading to higher adverse outcomes. The tricuspid annular peak systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio as a surrogate for RV–pulmonary artery coupling has proven to be among the predictor of clinical outcomes in multiple patient groups. We evaluated in this study the role of TAPSE/PASP ratio in predicting adverse clinical outcomes in patients with acute PE.ResultsAmong patients with established diagnosis of acute PE admitted to the coronary care unit, echocardiography was done within 12 h of admission and TAPSE/PASP ratio was calculated. The patients were followed during hospitalization and after discharge for 3 months for development of adverse outcomes including rehospitalization due to heart failure, recurrent PE and mortality. A total of fifty-five consecutive patients were recruited with mean age 58.3 ± 6.9 years and nearly equal male-to-female ratio. The mean ratio of TAPSE/PASP was 0.479 ± 0.206. In-hospital and 3-month follow-up showed that 10.9% needed rehospitalization with heart failure, 14.5% developed recurrent pulmonary embolism, and mortality was 9.1%. TAPSE/PASP ratio was significantly lower among the patients who developed adverse outcomes. TAPSE/PASP ratio was among the independent predictors of rehospitalization with heart failure, recurrent pulmonary embolism but not mortality at 3-month follow-up. TAPSE/PASP ratio predicted rehospitalization with heart failure at a cutoff point ≤ 0.325, with 100% sensitivity and 79.6% specificity, and predicted recurrent pulmonary embolism at a cutoff point ≤ 0.325, with 75% sensitivity and 78.7% specificity.ConclusionTAPSE/PASP ratio is a noninvasive tool that can predict the development of early adverse outcomes in patients with acute PE including rehospitalization with heart failure and recurrent pulmonary embolism.

Predictors of pulmonary embolism in chronic obstructive pulmonary diseases patients admitted for worsening respiratory symptoms: An individual participant data meta-analyses

BackgroundPulmonary embolism (PE) and acute exacerbation of chronic obstructive pulmonary disease (COPD) have similar clinical symptoms, making PE diagnosis challenging. Previous studies have shown that the prevalence of PE among COPD patients admitted with worsening respiratory symptoms was not negligible, but that systematic search for PE did not provide a clinical benefit. Predictive factors for PE remain unknown. Objectiveto identify predictive factors for PE among COPD patients with worsening respiratory symptoms. MethodsWe conducted an individual participant data meta-analysis which included the patients from the prospective PEP cohort and those randomized to the intervention arm in the SLICE trial which included a systematic search for PE in COPD patients admitted for worsening respiratory symptoms. Univariable and multivariable analysis were used to assess factors associated with the diagnosis of PE during the initial management. ResultsAmong 1110 COPD patients, PE was diagnosed in 61 (5.49 %; 95 %CI 4.15 %-6.84 %). In univariable analysis, BNP (Brain natriuretic peptide) (odds ratio [OR] 1.02 per 100 ng/L increase, 95 %CI 1.01–1.04), prothrombin time (OR 0.78, 95 %CI 0.65–0.94), fibrinogen (OR 0.80, 95 %CI 0.64–0.98), atrial fibrillation (OR 4.74, 95 %CI 1.84–10.80), respiratory rate ≥30 min (OR 2.34, 95 %CI 1.13–4.6) and recent medical immobilization (OR 1.79, 95 %CI 0.99–3.13]) were associated with the risk of PE diagnosed during the initial management. In multivariable analysis, respiratory rate ≥30 (OR 2.77, 95 %CI 1.08–6.71) was a predictive factor for PE, as well as BNP (OR 1.02, 95 %CI 1.00–1.05) with an area under the curve =0.64, negative predictive value =0.15 (95 %CI 0.09–0.23), sensitivity =0.78 (95 %CI 0.74–0.82) and specificity =0.46 (95 %CI 0.29–0.63). ConclusionAmong patients with COPD admitted for worsening respiratory symptoms, respiratory rate and BNP levels are predictor of PE, but with limited discriminatory power.

Role of chest ultrasound in the diagnosis of pulmonary embolism: a cohort study

BackgroundPulmonary embolism (PE) is a common and usually fatal condition that is commonly misdiagnosed and consequently ignored. Lung ultrasonography is quickly becoming a valuable tool in the ER and ICU for assisting in emergency decisions.MethodsOne hundred fourteen patients with moderate/high probability of PE in the Critical Care Department meeting the inclusion/exclusion criteria were enrolled in the study. A detailed medical history and a full physical examination involving vital signs, transthoracic ultrasound, CT pulmonary angiography (CTPA), and echocardiography were done for the eligible participants. The goal of this study was to evaluate the diagnostic role of transthoracic ultrasound (TUS) in PE and to compare its specificity and sensitivity with CT pulmonary angiography. Multivariate logistic regression analysis was performed.ResultsWithin the 75 patients with confirmed PE based on CTPA, 30 had LUS findings of confirmed PE (40%), and 45 had LUS findings not consistent with confirmed PE (60%). Within the 39 patients with no PE based on CTPA, all patients had LUS findings of non-confirmed PE (100%), and no patients had LUS findings of confirmed PE (0%). The diagnosis of pulmonary embolism based on confirmed LUS signs had sensitivity and specificity of 40% and 100% respectively with 100% positive predictive value and 46.4% negative predictive value.ConclusionPositive TUS findings with moderate/high suspicion for PE may prove a valuable tool in the diagnosis of PE at the bedside, especially in the emergency setting, but a negative TUS study cannot rule out PE with certainty.

Uterine Artery Doppler in the Second Trimester as a Predictor of Preeclampsia in High Risk Pregnancy

Abstract Background Preeclampsia is a multisystem disorder of pregnancy which is a major cause of maternal and fetal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive. Aim of the Work The aim of the work was to evaluate the role of uterine artery Doppler in the second trimester as a predictor of preeclampsia in high risk pregnancy. Patients and Methods We included 80 pregnant females in the second trimester at high risk pregnancy in our study, uterine artery Doppler ultrasound was done in the second trimester and the patients were followed up in the third trimester for blood pressure measurement and diagnosis of PE. Results Our results revealed correlation between high indices of uterine arteries and development of PE. Conclusion Our study revealed that we can use uterine artery Doppler as a reliable method to predict preeclampsia.

Predicting the Prognosis of Acute Pulmonary Embolism Using Computed Tomography Pulmonary Angiography Measurable Parameters in Comparison to Pulmonary Embolism Severity Index (PESI)

Abstract Background Pulmonary embolism is a leading cause of cardiovascular death and with CTPA being the gold standard in its diagnosis, it is feasible with radiologic parameters to stratify and early identify patients at risk of death. Aim of the Work To detect the prognostic value of radiologic parameters of CT pulmonary angiography (CTPA) in comparison to pulmonary embolism severity index (PESI). Patients and Methods This was a prospective study done at Ain Shams University Hospitals and included 84 patients diagnosed with acute pulmonary embolism and referred to the radio-diagnosis department for CT pulmonary angiography examination. Results 3.6% of patients died within 24 hours and 44% died within 30 days of diagnosis of PE. All patients who died within 30 days had abnormal CTPA findings especially RV/LV ratio, PT diameter, septal bowing and contrast reflux in the IVC which revealed significant relationship between them and 30-day-mortality. Meanwhile PESI showed contradictory results and was less reliable than the radiologic parameters. Conclusion The CTPA radiological parameters appeared valuable for the prediction of 30-day mortality in patients with acute PE, and was superior to the PESI.

Optimal initial duration of low molecular weight heparin lead-in before direct oral anticoagulants for short-term outcomes of hospitalized patients with non-high-risk acute pulmonary embolism.

There are currently three strategies for the duration of LMWH lead-in before DOACs in patients with acute PE: one is at least 5 days, the other is at least 3 days, and the last one is less than 3 days. Which one is the best is yet unknown. We divided non-high-risk PE patients into short-LMWH (LMWH <3 days), intermediate-LMWH (LMWH 3-5 days), and long-LMWH (LMWH >5 days) groups, in a 1:1:2 ratio by using propensity score matching. Primary outcomes were a composite of mortality including all-cause and PE-related mortality, VTE recurrence, and major bleeding, as well as each one of them, at 3-month after PE diagnosis. The short-LMWH group (N = 504) had higher 3-month composite primary outcome (129 [25.6%] vs 67 [13.3%], P < 0.001), all-cause mortality (112 [22.2%] vs 39 [7.7%], P < 0.001), and PE-related mortality (48 [9.5%] vs 17 [3.4%], P < 0.001), than the intermediate-LMWH group (N = 504). The short-LMWH group also had higher 3-month composite primary outcome (129 [25.6%] vs 151 [15.0%], P < 0.001), all-cause mortality (112 [22.2%] vs 90 [8.9%], P < 0.001), and PE-related mortality (48 [9.5%] vs 41 [4.1%], P < 0.001) than the long-LMWH group (N = 1008). The VTE recurrence and major bleeding rates were similar between the short-LMWH and intermediate-LMWH groups, and between the short-LMWH and long-LMWH groups. The intermediate-LMWH and long-LMWH groups had similar 3-month primary outcomes rates in whole or in part with each other. For patients with non-high-risk acute PE, the optimal duration of initial LMWH lead-in before switching to DOACs could be 3 to 5 days.

Pediatric pulmonary embolism: Unveiling clinical manifestations, diagnostic challenges, and outcomes in Southwest China

AbstractPulmonary embolism (PE) leads to obstruction of pulmonary circulation, resulting in increased pulmonary vascular resistance, elevated pulmonary arterial pressure, and increased right heart load. In severe cases, it can lead to cardiac decompensation and life‐threatening conditions. However, clinical studies on PE in children are limited, with many diagnostic and treatment guidelines derived from adult populations. We retrospectively analyzed the clinical manifestations, risk factors, co‐morbidity, and outcomes of PE patients admitted to a large children's hospital in southwest China. A total of 24 children with PE participated, 9 boys (37.5%), aged 0.1–14.6, (median: 8.15 years old). Except for two asymptomatic cases, the duration from symptom onset to the diagnosis of PE varied from 2 to 45 days (median: 12 days). Among these children, 13 (54.2%) patients experienced a delayed diagnosis exceeding 10 days. A total of 7 children died from underlying diseases, and no one met the outcome of recurrent PE or PE‐related death. Among the 17 survivors, complete resolution of PE was in 11 (64.7%) children, partial resolution who progressed to chronic PE was in 3 (17.7%) children, and no follow‐up computed tomography pulmonary angiography was performed in the remaining 3 (17.7%) children. This study revealed that the majority of pediatric PE cases presented with respiratory symptoms, with a considerable proportion initially misdiagnosed as pneumonia, and emphasized the importance of early recognition and appropriate management strategies in improving outcomes for the affected children. Further research is warranted to elucidate the pathophysiology, refine diagnostic algorithms, and establish standardized treatment protocols tailored to the pediatric population.

Mechanical circulatory support in high-risk PE for more than a decade

Abstract Funding Acknowledgements None. Background/Introduction Absence of solid evidence in clinical practice guidelines on the management of patients with a severe pulmonary thromboembolism (PTE) in a situation of cardiogenic shock requiring mechanical circulatory support (veno-arterial ECMO). A registry has been carried out in a tertiary hospital of patients admitted to the Cardiological Critical Care Unit (CCCU) with a diagnosis of high-risk PTE and V-A ECMO implantation. Purpose The objective is to describe the experience of our center due to the paucity of evidence from current guidelines in this area iin terms of morbimortality and expected outcomes. Methods Data were collected from all patients admitted with a diagnosis of high-risk PE in the CCCU from 05/01/2010 to 05/01/2023. Of these, only those in whom V-A ECMO was implemented during admission were analyzed and described below. Clinical, analytical and survival variables were explored. Results A total of 11 patients were included, 3 (27.27%) being women. The mean age was 53 years (SD 10.64). Every V-A ECMO cannulation was performed in a femoro-femoral configuration by a surgical approach. The mean length of stay in the Critical Care Unit, total hospital stay length and circulatory support time were respectively: 8 days (SD 5.5); 20.7 days (DS 16.5) and 3 days (DS 1.9). The indication for the implantation of V-A ECMO was in a situation of SCAI-E in 7 patients (in 2 of them, V-A ECMO was implanted during cardiac arrest, and a 100% of mortality was described in the first 24 hours). On the other hand, in the remaining 4 patients, the indication for support was a deteriorating evolution despite amines. Of these, in 2 of them, there was a formal contraindication for the administration of systemic fibrinolytic treatment (recent major surgery, in one of them oncology). It should be noted that VA ECMO without adjuvant fibrinolysis was used in 6 of the patients (54.5%), and in 1 of them (16%) of them died (anoxic encephalopathy). However, the remaining 5 patients received combined VA ECMO therapy and systemic fibrinolysis (45.5%), with 2 deaths reported in this subgroup (40%). Those deceases happened both due to adequacy of the therapeutic effort in the context of multiple organ failure. No major bleeding was reported, even in the combination therapy group. Conclusions Support with V-A ECMO has allowed survival &amp;gt;70% in patients diagnosed with high-risk pulmonary embolism, including in those cases with absolute contraindication for systemic fibrinolysis. High safety profile in terms of bleeding even in those patients with a combined approach.

Comparison of three diagnostic strategies for suspicion of pulmonary embolism: planar ventilation-perfusion scan (V/Q), CT pulmonary angiography (CTPA) and single photon emission CT ventilation-perfusion scan (SPECT V/Q): a protocol of a randomised controlled trial

IntroductionPulmonary embolism (PE) is a challenge to diagnose and when missed, exposes patients to potentially fatal recurrent events. Beyond CT pulmonary angiography (CTPA) and planar ventilation/perfusion (V/Q) scan, single photon...

Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients

BackgroundPulmonary embolism (PE) poses a significant challenge in diagnosis and treatment, particularly in high-risk patient populations such as those hospitalized for orthopedic reasons. This study explores the predictive and diagnostic potential of laboratory parameters in identifying PE among orthopedic patients. ObjectivesThe purpose of this study was to determine whether selected (inexpensive and readily available) laboratory parameters and their coefficients can be used to diagnose pulmonary embolism and whether they are applicable in predicting its occurrence. Material and methodsSelected laboratory parameters were determined twice in 276 hospitalized orthopedic patients with suspected PE: PLT, MPV, NEU, LYM, D-dimer, troponin I, age-adjusted D-dimer and their coefficients. Depending on the angio-CT results, patients were divided into groups. Selected popular laboratory coefficients were calculated and statistically analyzed. Optimal cutoff points were determined for the above laboratory tests and ROC curves were plotted. ResultsD-dimer/troponin I [p = 0.008], D-dimer [p = 0.001], age-adjusted D-dimer [p = 0.007], NLR/D-dimer [p = 0.005] and PLR [p = 0.021] are statistically significant predictors of PE. D-dimer/troponin I [p < 0.001], troponin I [p = 0.005] and age-adjusted D-dimer [p = 0.001] correlated with the diagnosis of PE after the onset of clinical symptoms. ConclusionsIn the context of orthopedic patients, cost-effective laboratory parameters, particularly the D-dimer/troponin I ratio and age-adjusted D-dimer, exhibit considerable potential in predicting and diagnosing PE. These findings suggest that combining readily available laboratory tests with clinical observation can offer a viable and cost-effective diagnostic alternative, especially in resource-constrained settings. Further studies with larger and diverse patient populations are recommended to validate these results.

Computational Decision Support for PE Diagnosis based on Ventilation Perfusion Ratio.

The aim of this study is to investigate whether computer-aided, semi-automated 3D lung lobe quantification can support decision-making on PE diagnosis based on the ventilation-perfusion ratio in clinical practice. A study cohort of 100 patients (39 male, 61 female, age 64.8±15.8 years) underwent ventilation/perfusion single photon emission computed tomography (V/Q-SPECT/CT) to exclude acute PE on SPECT/CT OPTIMA NM/CT 640 (GE Healthcare). Two 3D lung lobe quantification software tools (Q. Lung: Xeleris 4.0, GE Healthcare and LLQ: Hermes Hybrid 3D Lung Lobar Quantification, Hermes Medical Solutions) were used to evaluate the numerical lobar ventilation/perfusion ratio (VQR) and lobar volume/perfusion ratio (VPR). A test of linearity and equivalence of the two 3D software tools was performed using Pearson, Spearman, quadratic weighted kappa and the mean squared deviation for VPR/VQR. An algorithm was developed that identified PE candidates using ROC analysis. The agreement between the PE findings of an experienced nuclear medicine expert and the calculated PE candidates was represented by the magnitude of the YOUDEN index (J) and the size of the area under the receiver operating curve (AUC). Both 3D software tools showed good comparability. The YOUDEN index for QLUNG(VPR/VQR)/LLQ(VPR/VQR) was in the range from 0.2 to 0.5. The mean AUC averaged over all lung lobes for QLUNG(VPR) was 0.66, CI95%: ±14.0%, for QLUNG(VQR) 0.66, CI95%: ±13.3%, for LLQ(VPR) 0.64, CI95%: ±14.7% and for LLQ(VQR) 0.65, CI95%: ±13.1%. This study reveals that 3D software tools are feasible for numerical PE detection. The clinical decision can be supported by using a numerical algorithm based on ROC analysis.

Utility of original and simplified pulmonary embolism severity indices in risk stratification of patients with pulmonary embolism: a study from Saudi Arabia

Abstract Background We aimed to report our experience using both the pulmonary embolism severity index (PESI) and its simplified form (s-PESI) score in evaluating patients with PE admitted at a large Saudi Arabian Hospital. Patients and methods This was a retrospective analysis where the adult (≥14 years old) patients admitted to the hospital of the Armed Forces Hospital Southern Region with the diagnosis of acute PE through 1 year were enrolled. The accuracy of both PESI and s-PESI was evaluated for mortality. Results Two hundred and twelve patients were enrolled. We encountered a significant relation only with the 90, 180 days, 1 year, and overall in-hospital mortality for low versus high-risk classification by the s-PESI score. There was neither a significant correlation between any-period mortality and classes of PESI score nor between low versus high-risk s-PESI score and 30-day mortality. The sensitivity of PESI and s-PESI in predicting mortality were 66.7 and 97.0%, respectively. The area under the curve of PESI and s-PESI were 0.611 (P=0.043), and 0.629 (P=0.005), respectively. Conclusion Besides being an easier tool for stratifying the risk of patients with PE, our data show that the s-PESI score is utilizable in Saudi Arabian patients with PE admitted at a large tertiary hospital. s-PESI and PESI have good potential to predict the prognosis of PE in terms of in-hospital mortality, with higher sensitivity, negative predictive value, and area under the curve for s-PESI versus PESI. There was a significant correlation between the s-PESI and the 90, 180 days, 1 year, and the overall in-hospital mortality. Further prospective multicenter studies are needed.

Predictive accuracy of years score in diagnosis of pulmonary embolism

BackgroundPulmonary embolism (PE) is a sudden obstruction of pulmonary arteries usually associated with a high rate of mortality due to acute right ventricular failure. Early diagnosis is of much importance because most patients die within the first hours of presentation. Emergency management is usually highly valuable and right heart failure is potentially reversible. Multidetector computed tomography pulmonary angiography (CTPA) is the best diagnostic imaging modality to document acute pulmonary embolism. Overuse of CTPA increases the unrequired risk of radiation exposure, increasing the risk of malignancy, contrast-related anaphylaxis, and acute kidney injury. To abolish these issues, the simplified score for suspected acute pulmonary embolism using variable D dimer cut-off value in combination with clinical signs can exclude pulmonary embolism safely.Aim of the studyTo evaluate the predictive accuracy of YEARS score in the diagnosis of pulmonary embolism compared to CTPA that might lead to a decrease in the overuse of CTPA.MethodsThe study was held at the chest unit in Kasr ElAini hospitals. It included 50 patients, for which full history, examination, calculation of wells score, D-dimer, YEARS score, and CTPA were done.ResultsThe results showed that the YEARS score succeeded in predicting the presence or the absence of PE in 80% of the 50 enrolled patients in our study. YEARS score has a sensitivity of 90% and specificity of 65%.ConclusionPatients with zero YEARS score and D-dimer ≥ 1000 ng/ml as well as those with ≥ 1 YEARS score and D-dimer ≥ 500 ng/ml are rendered PE likely by the YEARS algorithm with a sensitivity of 90%. Using years score, we can exclude pulmonary embolism in patients with zero YEARS score and a D-dimer ˂ 1000 ng/ml as well as in patients with ≥ 1 YEARS score and D-dimer ˂ 500 ng/ml with 65% specificity, thus decreasing overuse of CTPA in the diagnosis of PE.

Acute venous thromboembolism plasma and red blood cell metabolomic profiling reveals potential new early diagnostic biomarkers: observational clinical study

BackgroundVenous thromboembolism (VTE) is a leading cause of cardiovascular mortality. The diagnosis of acute VTE is based on complex imaging exams due to the lack of biomarkers. Recent multi-omics based research has contributed to the development of novel biomarkers in cardiovascular diseases. Our aim was to determine whether patients with acute VTE have differences in the metabolomic profile compared to non-acute VTE.MethodsThis observational trial included 62 patients with clinical suspicion of acute deep vein thrombosis or pulmonary embolism, admitted to the emergency room. There were 50 patients diagnosed with acute VTE and 12 with non-acute VTE conditions and no significant differences were found between the two groups for clinical and demographic characteristics. Metabolomics assays identified and quantified a final number of 91 metabolites in plasma and 55 metabolites in red blood cells (RBCs). Plasma from acute VTE patients expressed tendency to a specific metabolomic signature, with univariate analyses revealing 23 significantly different molecules between acute VTE patients and controls (p < 0.05). The most relevant metabolic pathway with the strongest impact on the acute VTE phenotype was d-glutamine and d-glutamate (p = 0.001, false discovery rate = 0.06). RBCs revealed a specific metabolomic signature in patients with a confirmed diagnosis of DVT or PE that distinguished them from other acutely diseased patients, represented by 20 significantly higher metabolites and four lower metabolites. Three of those metabolites revealed high performant ROC curves, including adenosine 3′,5′-diphosphate (AUC 0.983), glutathione (AUC 0.923), and adenine (AUC 0.91). Overall, the metabolic pathway most impacting to the differences observed in the RBCs was the purine metabolism (p = 0.000354, false discovery rate = 0.68).ConclusionsOur findings show that metabolite differences exist between acute VTE and nonacute VTE patients admitted to the ER in the early phases. Three potential biomarkers obtained from RBCs showed high performance for acute VTE diagnosis. Further studies should investigate accessible laboratory methods for the future daily practice usefulness of these metabolites for the early diagnosis of acute VTE in the ER.