Impact Of Pulmonary Embolism Research Articles

Impact of pulmonary embolism on COVID-19 pneumonia hospitalizations: analysis of the national inpatient sample 2020

Abstract Background SARS-CoV-2 swept across the globe, overwhelming healthcare systems across the world regardless of borders and socioeconomic factors. While many were directly affected by COVID pneumonia (CP), others were impacted by complications from the illness. Pulmonary embolism (PE) is a well described complication in this population and results in worsening ventilation-perfusion mismatch further worsening their pulmonary reserve. We aimed to assess the impact of underlying PE on CP patients with a large sample size. Methods We utilized the National Inpatient Sample from 2020 to identify 1,058,815 hospitalized adults with CP. These hospitalizations were further stratified based on the presence of PE. A multivariate regression model was used to adjust for confounders and analyze the variables. Results Of those who were admitted for CP, 29,845 (2.8%) had PE. In-hospital mortality was higher in those with PE (16.5% vs 10.9%; p<0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, CP patients with PE had longer length of stay (LOS) by 2.4 days (p<0.001) and had additional hospital costs (HC) of $45,470 (p<0.001). Conclusion CP patients who had PE had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, arrhythmias, stroke, AKI, GI bleed, sepsis, cardiogenic shock, and being intubated. These patients poorly tolerate the ventilation-perfusion mismatch due to an already reduced pulmonary reserve.

OC 29.2 The Impact of Pulmonary Embolism on the Long-Term Health Outcomes of COVID-19

OC 29.2 The Impact of Pulmonary Embolism on the Long-Term Health Outcomes of COVID-19

STUDYING THE IMPACT OF PULMONARY EMBOLISM IN ADMITTED PATIENTS WITH DIABETIC KETOACIDOSIS: A 4-YEAR RETROSPECTIVE COHORT

STUDYING THE IMPACT OF PULMONARY EMBOLISM IN ADMITTED PATIENTS WITH DIABETIC KETOACIDOSIS: A 4-YEAR RETROSPECTIVE COHORT

Lead-related infective endocarditis with vegetations: Prevalence and impact of pulmonary embolism in patients undergoing transvenous lead extraction.

The prevalence and impact of pulmonary embolism (PE) in patients with lead-related infective endocarditis undergoing transvenous lead extraction (TLE) are unknown. Twenty-five consecutive patients with vegetations ≥10 mm at transoesophageal echocardiography were prospectively studied. Contrast-enhanced chest computed tomography (CT) was performed before (pre-TLE) and after (post-TLE) the lead extraction procedure. Pre-TLE CT identified 18 patients (72%) with subclinical PE. The size of vegetations in patients with PE did not differ significantly from those without (median 20.0 mm [interquartile range: 13.0-30.0] vs. 14.0 mm [6.0-18.0], p = 0.116). Complete TLE success was achieved in all patients with 3 (2-3) leads extracted per procedure. There were no postprocedure complications related to the presence of PE and no differences in terms of fluoroscopy time and need for advanced tools.In the group of positive pre-TLE CT, post-TLE scan confirmed the presence of silent PE in 14 patients (78%). There were no patients with new PE formation. Large vegetations (≥20 mm) tended to increase the risk of post-TLE subclinical PE (odds ratio 5.99 [95% confidence interval (CI): 0.93-38.6], p = 0.059).During a median 19.4 months follow-up, no re-infection of the implanted system was reported. Survival rates in patients with and without post-TLE PE were similar (hazard ratio: 1.11 [95% CI: 0.18-6.67], p = 0.909). Subclinical PE detected by CT was common in patients undergoing TLE with lead-related infective endocarditis and vegetations but was not associated with the complexity of the procedure or adverse outcomes. TLE procedure seems safe and feasible even in patients with large vegetations.

Impact of Pulmonary Embolism on Cardiac Bypass Surgery Outcomes

Impact of Pulmonary Embolism on Cardiac Bypass Surgery Outcomes

Impact of pulmonary embolism on perioperative outcomes of coronary artery bypass graft.

Impact of pulmonary embolism on perioperative outcomes of coronary artery bypass graft.

Impact of pulmonary embolism on in-hospital mortality of patients with ischemic stroke

BackgroundPulmonary embolism (PE) is a frequent complication in immobile stroke patients and an important cause of death in stroke patients. We aimed to investigate predictors of PE and the impact of PE on survival of ischemic stroke patients. MethodsPatients were selected by screening the German nationwide inpatient sample (2005–2017) for ischemic stroke (ICD-code I63) and stratified for occurrence of PE (ICD-code I26). Impact of PE on mortality and predictors for PE in ischemic stroke patients were analysed. ResultsOverall, 2,914,546 patients were hospitalized due to ischemic stroke (50.5% females; 69.3% aged ≥70 years) in Germany 2005–2017. Among these, 0.4% had PE and 7.2% died during hospitalization. In-hospital mortality rate of ischemic stroke patients with PE was substantially higher compared to those patients without PE (28.4% vs. 7.1%, P < 0.001). PE was strongly associated with in-hospital death (OR 5.786, 95%CI 5.515–6.070, P < 0.001). Important predictors of PE were cancer (OR 3.165, 95%CI 2.969–3.374, P < 0.001), coagulation abnormalities (OR 2.672, 95CI 2.481–2.878, P < 0.001), heart failure (OR 1.553, 95%CI 1.472–1.639, P < 0.001) and obesity (OR 1.559, 95%CI 1.453–1.672, P < 0.001).Systemic thrombolysis was not beneficial regarding survival in unselected ischemic stroke patients. In contrast, systemic thrombolysis was beneficial in ischemic stroke patients without PE, who had to undergo cardio-pulmonary resuscitation (OR 0.866, 95%CI 0.782–0.960, P = 0.006). ConclusionsPatients with ischemic stroke revealed still a high in-hospital mortality of 7.2% in Germany. While only a minority of 0.4% of the ischemic stroke patients suffered from occurrence of PE, PE was accompanied by a substantial increase regarding in-hospital mortality. Systemic thrombolysis was beneficial regarding short-term survival in ischemic stroke patients without PE, who had to undergo cardio-pulmonary resuscitation.

Impact of pulmonary embolism on morbidity and mortality in patients undergoing pancreatic surgery.

Postoperative pulmonary embolism (PE) after pancreatic surgery is a potentially life-threatening complication. However, the magnitude of morbidity and mortality of PE is still uncertain. The present study aims to assess the incidence of PE after pancreatic surgery and analyze its impact on the outcome. We conducted a retrospective study including all patients who underwent pancreatic resections between 2005 and 2017. The development of PE was analyzed for a 90-day period following surgery. Risk factors were evaluated using regression models. The study investigated 947 patients undergoing pancreatic surgery. Overall, 26 (2.7%) patients developed PE. The median body mass index (BMI) of patients with PE was significantly higher (28.1kg/m2 [24.7-31.8] vs. 24.8kg/m2 [22.4-27.8], p < 0.001). Patients with PE had a significantly increased duration of the operation and more often underwent multivisceral resections. The lowest incidence of PE was found after distal or total pancreatectomy (2%). In median, PE occurred on the fifth postoperative day (interquartile range: 3-9). Increased BMI, duration of operation, and postoperative deep venous thrombosis were found to be multivariate risk factors for the development of PE. Importantly, postoperative complications (53.8% vs. 15.1%, p < 0.001) and the 30-day mortality rate were significantly increased in the PE group (19.2% vs. 3.3%, p< 0.001). Patients with increased BMI, a history of deep venous thrombosis, and multivisceral resections are a high-risk group for PE after pancreatic surgery. While the absolute incidence and related mortality of PE after pancreatic surgery is low, it is associated with severe sequelae.

Evaluation of the Short, Medium and Long-term Prognosis of Pulmonary Embolism

Introduction: Pulmonary Embolism (PE) is the most severe form of venous thromboembolic disease. This is a serious condition not only because of its mortality but also its sequelae. Methodology: The aim of this study is to evaluate the prognosis of patients who had an episode of PE, hospitalized in the cardiology department of the Aristide Le Dantec University Hospital in Dakar. We performed a cohort study that included all patients admitted for pulmonary embolism during the period of May 1, 2011 to February 29, 2016. Subjects were contacted for a re-evaluation during the period of August 1st to September 1st 2016. We evaluated the status of patients (death or alive), to look for signs of chronic pulmonary heart based on the electrocardiogram (right atrial and ventricular hypertrophies, aspect S1S2S3, right bundle branch) and especially on the echocardiogram (right cavitary and parietal dimensions, measurement of the PASP). Results: A total of 77 pulmonary embolism cases were counted during the study period; 70 files were retained. It was a predominantly female population, with an average age of 51.2. Low risk forms (PESI I-II) accounted for 85.7% of the sample, versus 14.3% of PESI III-IV-V forms. At the re-evaluation, we counted 18 deaths (25.7%); twenty-two patients were lost to follow up. No recurrence was noted since hospitalization. Two patients had bilateral, noninflammatory edema. Dyspnea was found in 3 patients. No patient had any sign of right heart failure. Doppler echocardiography showed dilatation of the right ventricle along parasternal long axis in 6 cases and along apical section in 5 cases respectively. Right ventricular wall hypertrophy was noted in 6 patients. The systolic function of the right ventricle was normal in all cases. The right atrium was dilated in 5 cases. Pulmonary hypertension and increased pulmonary vascular resistance were noted in 7 cases, respectively. The overall mortality factors were acute circular insufficiency, right ventricular systolic dysfunction, PESI score of at least 1, tachycardia, PASP value greater than 50 mmHg, right heart failure and dilatation of the right atrium. Conclusion: Wall dilatation and hypertrophy of the right ventricle as well as pulmonary hypertension are frequent sequelae. The parameters of the hemodynamic impact of pulmonary embolism constitute the main prognostic factors.

Impact of Pulmonary Embolism on Acute Chronic Obstructive Pulmonary Disease Exacerbation

Purpose: This study aims to assess effect of pulmonary embolism (PE) on clinical and laboratory parameters of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Risk factors for PE development were also evaluated. Methods: In this retrospective study, patients who were hospitalized for AECOPD and underwentcomputed tomographic pulmonary angiography scan (CTPA) between 2009 and 2011 were included. Patients with PE were evaluated separately as those diagnosed at initial examination and those suspected during exacerbation therapy since they had inadequate response. Binary logistic regression analysis was used in order to determine risk factors on PE development. Results: The study consisted of 36 patients, 13 patients (36.1%) had PE. FEV 1 and FEV 1 /FVC values were higher in PE group (53.7% vs 41.4%; 62.3% vs 52% respectively; p<0.05). There was no difference between D-dimer levels of PE and non-PE patients. Risk of PE development did not differ with analyzed variables. Those diagnosed at initial examination had significantly less number of exacerbations in the last one year than those diagnosed during therapy (1.1 vs 3.2; p<0.05). Conclusion: PE should always be considered inAECOPDetiology, particularly in patients with frequent exacerbation history and D-dimer levels may bemisleading.

Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism.

The impact of pulmonary embolism on right ventricular (RV) performance can be evaluated by echocardiography, however, the relationship between pulmonary vascular involvement and RV burden is controversial. To assess the effect of clot burden on RV performance we studied 85 patients (aged 53 ± 17 years, 39 female) with confirmed PE by multislice computed tomography (CT) and echocardiography within 24 h of diagnosis. A CT score ranging from 1 to 20 points according to the pulmonary arteries involved was used. RV function was evaluated with fractional area change (FAC), with dysfunction present when FAC < 40%. Tissue Doppler RV systolic (s') velocities and myocardial performance index (MPI) were obtained, as well as pulmonary artery pressure (PAP). Mean CT score was 9.4 ± 6.7. Only 31 out of 85 patients (37%) presented with RV dysfunction, with FAC measuring 27.8 ± 7.2% in patients with dysfunction compared to 47.8 ± 4.4 for those with preserved RV function (p < 0.05). RV dysfunction was associated to older age, higher CT scores, increased pulmonary pressures and MPI and decreased s' (p < 0.001). An inverse correlation with CT clot burden was found for FAC (r = -0.57), whereas a direct correlation was seen for PAP (r = 0.51) and MPI (0.32). No correlation was observed for tissue Doppler velocities. In patients with acute PE, the effect of clot burden on RV performance is better expressed FAC than tissue Doppler indexes; the increase in pulmonary pressure is proportional to the magnitude of obstruction.

Ventilation / Perfusion SPECT for diagnostics of pulmonary embolism in clinical practice

The aim of this retrospective study is to illustrate clinical utility and impact of pulmonary embolism (PE) diagnostics of up to date Ventilation/Perfusion SPECT (V/P (SPECT)) applying holistic interpretation criteria. During a 2-year period 2328 consecutive patients referred to V/P(SPECT) for clinically suspected PE were examined. Final diagnosis was established by physicians clinically responsible for patient care. To establish the performance of V/P(SPECT) negative for PE, patients were followed up by medical records for 6 months. Ventilation/Perfusion SPECT was feasible in 99% of the patients. Data for follow-up were available in 1785 patients (77%). PE was reported in 607 patients (34%). Normal pattern was described in 420 patients (25%). Pathology other than PE such as a pneumonia, left heart failure, obstructive lung disease, tumour was described in 724 patients (41%). Report was nondiagnostic in 19 patients (1%). Six cases were classified as falsely negative because PE was diagnosed at follow-up and was fatal in one case. Six cases were classified as falsely positive because the clinician decided not to treat. In 608 patients with final PE diagnosis, 601 patients had positive V/P(SPECT) (99%). In 1177 patients without final PE diagnosis 1153 patients had negative V/P(SPECT) (98%). Holistic interpretation of V/P(SPECT,) yields high negative and positive predictive values and only 1% of nondiagnostic findings and was feasible in 99% of patients. It is a responsibility and a challenge of nuclear medicine to provide optimal care of patients with suspected PE by making V/P(SPECT) available.