Follow-up Of Pulmonary Embolism Research Articles

Pulmonary Embolism (PE) to Chronic Thromboembolic Pulmonary Disease (CTEPD): Findings from a Survey of UK Physicians.

Chronic thromboembolic pulmonary disease (CTEPD) is a complication of pulmonary embolism (PE). We conducted an online survey of UK PE-treating physicians to understand practices in the follow-up of PE and awareness of CTEPD. The physicians surveyed (N = 175) included 50 each from cardiology, respiratory and internal medicine, plus 25 haematologists. Most (89%) participants had local guidelines for PE management, and 65% reported a PE follow-up clinic, of which 69% were joint clinics. Almost half (47%) had a protocol for the investigation of CTEPD. According to participants, 129 (74%) routinely consider a diagnosis of CTEPD and 97 (55%) routinely investigate for CTEPD, with 76% of those 97 participants investigating in patients who are symptomatic at 3 months and 22% investigating in all patients. This survey demonstrated variability in the follow-up of PE and the awareness of CTEPD and its investigation. The findings support the conduct of a national audit to understand the barriers to the timely detection of CTEPD.

No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study

No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study

Ancillary findings assessed by ventilation/perfusion tomography. Impact and clinical outcome in patients with suspected pulmonary embolism.

Ventilation/perfusion tomography (V/P SPECT) is a recommended method for diagnosing and follow-up of pulmonary embolism (PE). Moreover, it is possible to recognize other pathologies in addition to PE, such as pneumonia, COPD and left heart failure (LHF). The objective of this prospective study was to identify frequency of ancillary findings among patients with suspected PE. Patients, material, method: 331 consecutive patients with suspected PE were examined and classified with V/P SPECT. Patients were followed up clinically and by means of other laboratory tests. 80 patients had a normal V/P SPECT and no clinical consequences in the follow-up. PE had 104 patients: 23 of them had also additional findings. Among the remaining 147 patients, pneumonias were shown in 82, acute in 75 patients and 7 had chronic post inflammatory state. COPD was present in 42 patients, in 3 combined with pneumonia. Sign of LHF was observed in 10: in 7 the acute LHF diagnosis was established, 3 were classified as having a chronic cardiopulmonary disease. Furthermore, in 16 patients, the V/P pattern was suggestive of a tumour. The clinical outcomes were 6 lung tumours, 3 empyema, one sarcoidosis, 2 were unclarified and 4 were lost in the follow-up. V/P SPECT identifies a high prevalence of other cardiopulmonary diseases among patients with a clinical suspicion of PE. Ancillary findings with V/P SPECT clarified patients' symptoms and had an impact on the treatment. These findings were verified by a clinical outcome by the follow-up over three months.

S118 Incidence And Severity Of Chronic Thromboembolic Pulmonary Hypertension Following The Introduction Of A One-stop Clinic For Acute Pulmonary Embolism

Introduction The management and follow-up of pulmonary embolism (PE) is delivered by various specialities resulting in both under and over investigation for suspected chronic thromboembolic pulmonary hypertension (CTEPH). To standardise our approach to long-term PE management a “one-stop” clinic was established in Sheffield in March 2010 to review all patients approximately 3 months after their presentation with acute PE. The aim of this study was to evaluate the incidence and severity of CTEPH identified from a one-stop clinic using an investigative strategy based on careful clinical assessment Methods Consecutive patients attending the one-stop PE clinic following hospital admission with acute PE were identified. During the one-stop consultation a haematologist and respiratory physician reviewed the patient jointly. The need for further investigation was based on clinical assessment. CTEPH was defined as mean pulmonary artery pressure (mPAP) at right heart catheterisation ≥25 mmHg and required multimodality imaging (isotope perfusion scanning, CT pulmonary angiography and MR imaging including MRA and MR perfusion mapping) demonstrating classical features of CTEPH. Results Over a 3-year period between March 2010 and March 2013, 616 patients (mean age 67.7 years, 50% male) attended the one-stop PE clinic approximately 3 months following their acute presentation. 16 patients were diagnosed with CTEPH. An overall diagnostic rate of CTEPH of 2.6% for patients seen at the clinic and an annual incidence of 8.9/million/year was observed based on a referral population of 600,000. This compares to an annual incidence of CTEPH of 4.8/million/year in patients referred to the SPVDU over the same time period, based on a referral population of 15 million. The 16 patients with CTEPH had mPAP 37 ± 11 mmHg, pulmonary vascular resistance (PVR) 362 ± 240 dynes, significantly lower than patients with CTEPH diagnosed at the SPVDU until 2010 (n = 242) mPAP 48 ± 11 mmHg and PVR 735 ± 389 dynes (Hurdman et al Eur Respir J 2012:39(4):945–955). Conclusion Introduction of a one-stop PE clinic for routine follow-up of patients with acute pulmonary embolism identifies patients with higher rates of CTEPH with less severe pulmonary haemodynamic changes.

V/P scan in diagnosis and follow-up of pulmonary embolism in 15-25-year-old females in relation to hormonal contraception use

An analysis of medical records of young females who were examined in our department during a five-year period (2005-2009) on suspicion of pulmonary embolism (PE) in relation to hormonal contraception (HC). The patient sample included 86 young females aged 15-25 (mean 21) years who underwent a ventilation/ perfusion scintigraphy (V/P scan). Seventeen of them were examined repeatedly. Altogether, 114 scintigraphic examinations were performed. Lung perfusion scintigraphy was performed using a planar gamma camera (Mediso MB 9200) in 4 projections following 100 MBq 99mTc--MAA i.v. application with 81 mKr ventilation scintigraphy concurrently. 1. Among 57/86 (66%) patients on HC, 24 (42%) had scintigraphic signs of PE. 2. 11/57 (19%) of them had clinical signs of deep venous system thrombosis of the lower limbs that were confirmed by sonography. 3. Leiden mutation was found in 9/24 (37%) patients with PE. 4. Among 29/86 (34%) females not taking HC, PE was detected in only 3 patients (10%). 5. 10/17 (59%) repeatedly examined females had permanent post-embolic residual changes of lung perfusion. In our group of patients who underwent a P/V scan, 42% of those on HC were diagnosed with PE on scintigraphy, compared to 10% of those not taking HC. Among the patients with PE, there were 10/24 (42%) young females with persistent post-embolic changes. Our study indicates that the well-known risk of venous thromboembolism related to the use of HC needs to be considered as a cause of PE even among very young females. In our experience, prevention of these life-threatening conditions in patients with a family history of venous thromboembolism consists of timely examination of their thrombotic profile and selection of appropriate contraception.

Tomographic ventilation/perfusion lung scintigraphy in the monitoring of the effect of treatment in pulmonary embolism

Pulmonary embolism (PE) is a severe condition with nonspecific symptoms. Diagnosis relies on medical imaging but follow-up is currently based on clinical symptoms and general risk factors. The duration of anticoagulant treatment after an acute episode of PE is still subject to debate and the best method of identifying the risk of recurrence in individual patients is undefined. Tomographic lung scintigraphy [ventilation/perfusion single photon emission computed tomography (V/P SPECT)] has improved the diagnostic accuracy with regard to PE but has not been evaluated for PE follow-up. The aim of this prospective study was to quantitatively follow the natural history of treated PE using V/P SPECT, which could prove helpful in defining an anticoagulant treatment regime for individual patients. Of 83 consecutive patients with clinically suspected PE examined with V/P SPECT, 23 patients with confirmed PE were followed by serial V/P SPECT examinations over a 6-month period. All patients were also followed clinically. The mean relative decrease in PE extent compared with the time of diagnosis was 54±26% at 2 weeks, 79±30% at 3 months, and 82±30% at 6 months. Significant resolution of mismatched perfusion defects occurred between V/P SPECT controls within the first 3 months of anticoagulation (P<0.001) but not thereafter. V/P SPECT identified four patients with chronic PE, even though all patients were free from symptoms at 3-month follow-up. Follow-up of PE with V/P SPECT is feasible to evaluate treatment effectiveness in individual patients and to identify patients that develop chronic PE. This study also confirms that resolution of perfusion defects after PE occurs within the first 3 months of treatment. It is therefore recommended that V/P SPECT follow-up should be considered at 3 months after diagnosis.

The feasibility and accuracy of enhanced MR pulmonary perfusion imaging in evaluating therapeutic effect of pulmonary embolism

Objective To investigate the feasibility and accuracy of enhanced magnetic resonance pulmonary perfusion imaging(MRPP) in the diagnosis and follow-up of pulmonary embolism(PE). Methods Sixty patients suspected of PE underwent MRPP. Twenty-seven patients also underwent radionuclide perfusion imaging. 22 patients repeated MRPP examination after 3 day to 1 month anticoagulation or thrombolytic therapy. The feasibility and accuracy of MRPP in the diagnosis and follow-up of PE were evaluated according to the transformation rate of signal (TROS), time-signal curve and some parameters of main pulmonary artery(such as peak value of flow,mean flow velocity and flow rate). The t test and rank sum test were used for the statistics. Results MRPP showed a high agreement with radionuclide perfusion imaging. TROS was (2. 86 ± 2. 48 ) vs ( 6. 72 ± 2. 54) ( t = 3. 370, P ＜ 0. 01 ), the peak time was ( 13.98 ±5.60) vs ( 12. 33 ± 3.63 ) s ( t = 3. 930, P ＜ 0. 01 ), the peak value of main pulmonary blood flow was (60.39 ± 15. 17) vs (69.93±13.22) cm/s(t=2.930, P＜0. 01) and mean flow velocity (11.68±5.46) vs ( 13.54 ± 4. 18 ) cm/s ( t = 2. 380, P ＜ 0. 05 ) before and after anticoagulation or thrombolytic therapy. The flow rate per unit was (80. 57 ± 24. 87) vs ( 85.48 ± 11.81 ) ml/s ( t = 0. 86,P ＞ 0. 05 ) . Conclusion MRPP shows a high agreement with radionuclide perfusion imaging and is a useful method for the diagnosis and follow-up of PE. Key words: Pulmonary embolism; Magnetic resonance angiography; Radionuclide imaging

Early and Late Follow-Up of Pulmonary Embolism

This study includes 61 patients referred with pulmonary embolism (PE) during 1 year. At admission, blood gas analysis, chest radiography and pulmonary lung scan were obtained in each patient; in a subset of patients pulmonary angiography was also performed to make the definitive diagnosis. Patients were treated with heparin and, later, with oral anticoagulants. Blood gas analysis, chest radiograph and perfusion lung scan were repeated 7, 30, 180 and 365 days after the diagnosis to evaluate the usefulness of these techniques in the follow-up of PE. Arterial hypoxemia and perfusion impairment recovered in parallel, both in the acute phase after embolism (7 days) and later up to 1 year. The great majority of recovery occurred within the first month after embolization. Radiographic signs compatible with PE tended to decrease early and disappeared almost completely after 30 days. Arterial blood gas analysis and perfusion scintigraphy detected 8 recurrences of PE that would be missed by chest radiograph. Arterial hypoxemia and the enlargement of descending pulmonary artery were positively correlated with the number of unperfused lung segments and, thus, may help predicting the severity of perfusion impairment in the acute stage. In conclusion, blood gas analysis and chest radiograph may be employed with or without perfusion lung scan to follow patients with PE up to 1 month after embolization; after that, only blood gas analysis and perfusion lung scan may give useful information about recovery from or recurrence of PE.

Comparison of lung scanning and pulmonary angiography in the detection and follow-up of pulmonary embolism: The urokinase-pulmonary embolism trial experience

N PREVIOUS REPORTS, 1'2 brief comments were made on the comparison of pulmonary angiography and lung scan in the assessment of thrombolytic therapy in patients with pulmonary embolism. Much information concerning the sensitivity and specificity of these two methods in the detection and follow-up study of pulmonary embolism w~s left out because of the length of these reports and consideration of priority. In this communication, we shall deal with a detailed comparison of pulmonary angiography and lung scan. We believe the information derived from this trial is valuable in the critical examination of the two methods and is not readily available elsewhere for the following reasons: (1) both pulmonary angiography and lung scan were performed in the same patients under standardized techniques usually within 6 hr of each other, (2) these data were from multiple institutions, (3) interpretations were performed by independent panelists consisting of vascular radiologists for the pulmonary angiograms and specialists in nuclear medicine for